AB1087,3,22 49.45 (3n) Supplemental payments to hospitals. (a) In this subsection:
AB1087,3,33 1. “High-acuity patient” means any of the following:
AB1087,3,74 a. A hospital patient with bariatric care needs, identified by a minimum data
5set assessment indicating a body mass index equal to or greater than 40 and a need
6for total or extensive assistance with activities of daily living, who is non- or
7semi-ambulatory, and needs at least a two-person assist with a lift.
AB1087,3,108 b. A hospital patient who has a disability, has a need for extensive wound care,
9has a mental illness, has high behavior needs, has a substance use disorder, is
10receiving intravenous fluid or intravenous medication, or requires dialysis.
AB1087,3,1411 2. “Qualifying avoidable patient day” means any day following the 7th
12consecutive day on which a high-acuity patient was eligible for discharge from a
13hospital, as reasonably identified by the hospital, and the hospital was not able to
14identify a setting to which the patient could be safely discharged.
AB1087,3,1815 (b) 1. At the beginning of each quarter starting with the quarter that begins on
16July 1, 2024, and ending with the quarter that begins on April 1, 2025, the
17department shall pay to hospitals that have qualifying avoidable patient days a
18payment as calculated under this paragraph.
AB1087,3,2119 2. Each quarter during the period described under subd. 1., the department
20shall distribute $5,000,000 plus any matching federal funds to the hospitals
21described under subd. 1.
AB1087,4,4
13. Subject to subd. 4., the department shall pay to each hospital described
2under subd. 1. a percentage of the distribution under subd. 2. that equals the
3hospital's percentage of the total number of qualifying avoidable patient days
4reported by all hospitals for the applicable quarterly reporting period.
AB1087,4,75 4. The department shall limit the maximum amount of funding to any hospital
6under this paragraph in accordance with any federal rules concerning
7hospital-specific funding limits.
AB1087,4,128 (c) 1. To receive a portion of the quarterly supplemental funding the
9department distributes on July 1, 2024, a hospital seeking a payment under this
10subsection shall submit to the department by May 1, 2024, the total number of
11qualifying avoidable patient days at the hospital between January 1, 2024, and
12March 31, 2024.
AB1087,4,1613 2. To receive a portion of the quarterly supplemental funding the department
14distributes on October 1, 2024, a hospital seeking a payment under this subsection
15shall submit to the department by August 1, 2024, the total number of qualifying
16avoidable patient days at the hospital between April 1, 2024, and June 30, 2024.
AB1087,4,2017 3. To receive a portion of the quarterly supplemental funding the department
18distributes on January 1, 2025, a hospital seeking a payment under this subsection
19shall submit to the department by November 1, 2024, the total number of qualifying
20avoidable patient days at the hospital between July 1, 2024, and September 30, 2024.
AB1087,4,2521 4. To receive a portion of the quarterly supplemental funding the department
22distributes on April 1, 2025, a hospital seeking a payment under this subsection shall
23submit to the department by February 1, 2025, the total number of qualifying
24avoidable patient days at the hospital between October 1, 2024, and December 31,
252024.
AB1087,5,7
1(d) The department shall submit any necessary request to the federal
2department of health and human services for a state plan amendment or waiver of
3federal Medicaid law to receive federal matching funds for the supplemental
4payments to hospitals under this subsection. The department shall implement this
5subsection regardless of whether the federal approval of any necessary state plan
6amendment or waiver of federal Medicaid law, as specified in this paragraph, is
7received.
AB1087,2 8Section 2 . 49.45 (6r) of the statutes is created to read:
AB1087,5,169 49.45 (6r) Nursing home rates for bariatric and extensive wound care needs.
10(a) During the 2023-25 fiscal biennium, the department shall develop an enhanced
11rate for reimbursement under the Medical Assistance program under this
12subchapter for bariatric and extensive wound care needs for nursing home residents
13who are admitted on or after July 1, 2024. The calculated cost of the enhanced rate
14developed by the department under this subsection may not exceed $10,000,000.
15Once the department has developed a rate under this subsection, the department
16shall implement the enhanced rate.
AB1087,5,2117 (b) In seeking reimbursement under the enhanced rate implemented under
18this subsection, a nursing home may claim only one enhanced rate type for a resident
19and may not claim both an enhanced bariatric care reimbursement rate and an
20enhanced extensive wound care reimbursement rate for the same resident at the
21same time.
AB1087,5,2322 (c) With respect to a bariatric care needs enhanced rate developed under this
23subsection, the department shall apply all of the following standards:
AB1087,6,3
11. A nursing home shall identify bariatric care needs by a minimum data set
2assessment at admission indicating a body mass index equal to or greater than 40
3and total or extensive assistance with activities of daily living.
AB1087,6,54 2. A bariatric care needs rate applicable for a resident under this subsection
5shall be available for the duration of the resident's stay at the nursing home.
AB1087,6,86 3. An enhanced rate for bariatric care needs may be used to provide
7reimbursement for specialized mattresses, diets, medical supplies, extra staff for
8transfers, as well as more expensive or specialized transportation services.
AB1087,6,109 4. The enhanced rate for bariatric care needs shall only be applicable if all of
10the following apply:
AB1087,6,1111 a. The resident is admitted to the nursing home directly from a hospital.
AB1087,6,1212 b. The resident is non- or semi-ambulatory.
AB1087,6,1313 c. The resident needs at least a two-person assist with a lift.
AB1087,6,1514 (d) With respect to an extensive wound care needs enhanced rate developed
15under this subsection, the department shall apply all of the following standards:
AB1087,6,2016 1. A nursing home shall identify extensive wound care needs by a prior
17authorization process that includes consideration of the number and stage of
18wounds, the cost and frequency of necessary interventions and supplies, including
19including vacuum-assisted closure of wounds, nutritional supplements, specialized
20mattresses, and wheelchair cushions.
AB1087,6,2221 2. The enhanced rate for extensive wound care needs may only be applicable
22if all of the following are true:
AB1087,6,2323 a. The resident is admitted to the nursing home directly from a hospital.
AB1087,7,2
1b. The resident did not acquire the wound or wounds while a resident of the
2nursing home.
AB1087,7,33 (End)
Loading...
Loading...