AB 148

Medical Assistance payment for hospitals for nursing facility care

This bill requires the Department of Health Services to provide reimbursement

or a supplemental payment to hospitals under the Medical Assistance program for

providing nursing-facility-level custodial care. To receive reimbursement or a

supplemental payment, the hospital must notify DHS that it is participating as a

swing bed hospital under the Medical Assistance program and providing custodial

care for which federal financial participation is approved to an individual who is

eligible for discharge after receiving inpatient care in the hospital, who needs

nursing-facility-level care, and for whom the hospital is unable to locate a nursing

facility that accepts the individual for admission. If providing reimbursement

instead of a supplemental payment, DHS must pay the hospital the statewide

average per-diem rate paid to nursing facilities. DHS must use the same standards

and eligibility criteria as the federal Medicare program uses to determine

reimbursement for swing beds or, for hospitals that are not critical access hospitals,

the terms of a federal waiver issued during the federally declared national

emergency related to the 2019 novel coronavirus. This requirement to reimburse

hospitals for providing nursing facility care applies until January 1, 2022, or until

the termination of any public health emergency declared by the secretary of the

federal Department of Health and Human Services related to the 2019 novel

coronavirus, whichever is earlier.

Payment for outpatient services provided by hospitals

The bill requires DHS to provide reimbursement or a supplemental payment

through the Medical Assistance program to a hospital for services provided on an

outpatient basis that are usually reimbursed when provided at the hospital's

inpatient facility but are provided at the hospital's outpatient facility due to the 2019

novel coronavirus pandemic. To receive reimbursement or supplemental payment

under the bill, the outpatient services must be approved for federal financial

participation and must be provided in a facility that is operated by the hospital and

is certified for outpatient services under the federal Medicare program, including

under the terms of a federal waiver issued during the federally declared national

emergency related to the 2019 novel coronavirus. DHS must seek any federal

approval necessary to provide the reimbursement or supplemental payment. The

payment requirement applies until the conclusion of a public health emergency

declared by the secretary of the federal Department of Health and Human Services

in response to the 2019 novel coronavirus or until January 1, 2022, whichever is

earlier.

Utilization data in the Medical Assistance program

The bill requires DHS to provide, semiannually, to any health care data

aggregator all fee-for-service and managed care encounter claims data and data

specifications for the Medical Assistance program. A health care data aggregator is