2020 Session

Budget Amendments - HB30 (Conference Report)

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Medicaid Hospital Readmissions Policy

Item 313 #29c

Item 313 #29c

First Year - FY2021 Second Year - FY2022
Health and Human Resources
Department of Medical Assistance Services FY2021 ($5,680,341) FY2022 ($5,792,214) GF
FY2021 ($9,106,611) FY2022 ($9,275,260) NGF

Page 294, line 18, strike "$15,939,731,997" and insert "$15,924,945,045".
Page 294, line 18, strike "$17,038,007,934" and insert "$17,022,940,460".

Page 321, after line 18, insert:

"GGGG. The Department of Medical Assistance Services shall amend the State Plan for Medical Assistance Services under Title XIX to modify the definition of readmissions to include cases when patients are readmitted to a hospital for the same or a similar diagnosis within 30 days of discharge, excluding planned readmissions, obstetrical readmissions, admissions to critical access hospitals, or in any case where the patient was originally discharged against medical advice. If the patient is readmitted to the same hospital for a potentially preventable readmission then the payment for such cases shall be paid at 50 percent of the normal rate, except that a readmission within five days of discharge shall be considered a continuation of the same stay and shall not be treated as a new case.  Similar diagnoses shall be defined as ICD diagnosis codes possessing the same first three digits.  The department shall have the authority to implement this reimbursement change effective July 1, 2020, and prior to the completion of any regulatory process undertaken in order to effect such change.  The department shall report quarterly on the number of hospital readmissions, the cost, and the primary diagnosis of such readmissions to the Joint Subcommittee for Health and Human Resources Oversight."


(This amendment adds language to modify the definition of hospital readmissions to change it to 30 days making the readmission criteria for both Medicaid managed care organizations (MCOs) and providers more aligned with Medicare policy. Hospital readmissions after five days but within 30 days shall be paid at 50 percent of the normal rate.)