Relating to reimbursement of hospitals for days awaiting placement through private insurance and the Medicaid program

This bill relates to reimbursement for services provided by a hospital during a days awaiting placement period. The bill provides that under private insurance and fee-for-service and managed care administration of Medicaid, a hospital shall not be denied reimbursement for the continuation of all higher-level services, including but not limited to inpatient care, provided to a covered individual or Medicaid-eligible member, respectively, during a days awaiting placement period. Reimbursement shall be provided to a hospital for each day a covered individual or Medicaid-eligible member remains in the care of the hospital while awaiting placement in a lower-level facility. The bill defines ”days awaiting placement” as the days during which a covered individual or Medicaid-eligible member no longer meets acute care criteria for stay in a hospital, has been verified to require placement in a lower-level facility which may not be immediately located, and is awaiting placement at the lower-level facility. “Lower-level facility” is defined as a facility that is able to provide adequate, available, and accessible services and supports, including but not limited to mental health services and supports, to meet a covered individual’s or Medicaid-eligible member’s needs as specified in the covered individual’s or Medicaid-eligible member’s discharge plan. The bill provides the criteria that must be met by a hospital to receive reimbursement and requires the department of human services and the commissioner or insurance, respectively, to adopt administrative rules to administer the bill.