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2022 Session

Budget Amendments - HB30 (Member Request)

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Chief Patron: Adams D.
Reimbursement Plan Nursing Home Residents with Behavioral Health Needs (language only)

Item 304 #54h

Item 304 #54h

Health and Human Resources
Department of Medical Assistance Services

Language

Page 340, after line 10, insert:

"PPPP. The Department of Medical Assistance Services shall develop a plan for increased reimbursement to nursing homes serving members with significant behavioral health needs. The rate increase will apply to members in the Medicaid fee-for-service and CCC plus programs. In developing the plan, the department shall consider input from the Department of Behavioral Health and Developmental Services. The plan shall include specific inclusion criteria for a member to be eligible for increased reimbursement, the amount of the increased reimbursement depending on the member's diagnoses, an implementation timeline, and the potential fiscal impact for increased reimbursement. The department shall submit the plan by November 1, 2022 to the Joint Commission on Health Care, as well as the Chairs of the House Appropriations and Senate Finance and Appropriations Committees."



Explanation

(This amendment directs the Department of Medical Assistance Services to develop a plan for increased reimbursement to nursing homes serving members with significant behavioral health needs. Research indicates that nursing homes are caring for a steady increase in residents with behavioral health needs. Residents with behavioral health needs require more attention and staff time but nursing homes are not always properly equipped to meet those needs. Behavioral health needs are captured as part of the Minimum Data Set which is used to assess resident acuity, but the behavioral health needs are not fully accounted for in the current Medicaid reimbursement methodology. Developing a supplemental nursing home reimbursement rate for residents with specific behavioral health needs could help nursing homes increase capacity and improve staffing and quality of care for these residents. This is a recommendation from the Joint Commission on Health Care.)