2020 Session

Budget Amendments - SB30 (Member Request)

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Chief Patron: Petersen
Medicaid Definition of Hospital Readmissions (language only)

Item 313 #27s

Item 313 #27s

Health and Human Resources
Department of Medical Assistance Services


Page 321, after line 18, insert:

"GGGG. The Department of Medical Assistance Services shall amend the State Plan for Medical Assistance Services to change the definition of "readmissions" to mean "when patients are readmitted within the same hospital systems for the same or a similar diagnosis within 30 days of discharge. Such cases shall be considered a continuation of the same stay and shall not be treated as new cases. Similar diagnoses shall be defined as ICD diagnosis codes possessing the same first three digits." This change in definition aligns with the Medicaid Managed Care Organizations clinical efficiency requirements related to readmissions. 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."


(This amendment adds language to change the definition of hospital readmissions to change it to 30 days making the readmission criteria for both Medicaid managed care organizations (MCOs) and providers consistent, and in alignment with similar Medicare rules. The Medicaid MCOs are unable to achieve these Medicaid clinical efficiencies without this policy change to bring uniformity in readmission criteria.)