AB 1087

This bill requires the Department of Health Services, at the beginning of each

quarter starting with the quarter that begins on July 1, 2024, and ending with the

quarter that begins on April 1, 2025, to provide a supplemental payment under the

Medical Assistance program to hospitals that have qualifying avoidable patient

days. Under the bill, a qualifying avoidable patient day means any day following the

seventh consecutive day on which a high-acuity patient was eligible for discharge

from a hospital, as reasonably identified by the hospital, and the hospital was not

able to identify a setting to which the patient could be safely discharged. The Medical

Assistance program is a joint federal and state program that provides health services

to individuals who have limited financial resources.

Under the bill, in each quarter during the period described in the bill, DHS

must distribute a total of $5,000,000 plus any matching federal funds to hospitals

that have qualifying avoidable patient days. The bill provides that DHS must pay

to each of these hospitals a percentage of the total distribution that equals the

hospital's percentage of the total number of qualifying avoidable patient days

reported by all hospitals for the applicable quarterly reporting period. The bill

requires that DHS limit the maximum amount of funding to any hospital under the

bill in accordance with any federal rules concerning hospital-specific funding limits.

The bill provides that in order to receive a portion of the quarterly supplemental

funding that DHS distributes each quarter, a hospital must submit, by a specific

deadline, the total number of qualifying avoidable patient days at the hospital for the

relevant period.

The bill requires DHS to submit any necessary request to the federal

Department of Health and Human Services for a state plan amendment or waiver

of federal Medicaid law to receive federal matching funds for the supplemental

payments to hospitals under the bill. The bill also provides that DHS must

implement the supplemental payments regardless of whether federal approval is

received.

The bill also requires DHS, during the 2023-25 fiscal biennium, to develop an

enhanced rate for reimbursement under the Medical Assistance program for

bariatric and extensive wound care needs for nursing home residents who are

admitted on or after July 1, 2024. Under the bill, the calculated cost of the enhanced

rate developed by the department may not exceed $10,000,000. The bill provides that

once DHS has developed an enhanced rate, DHS must implement that rate. Under

the bill, in seeking reimbursement under any enhanced rate implemented, a nursing

home may claim only one enhanced rate type for a resident and may not claim both

a bariatric care needs enhanced reimbursement rate and an extensive wound care

enhanced reimbursement rate for the same resident at the same time.

The bill requires that DHS apply certain standards with respect to the

enhanced rates developed. For the bariatric care needs enhanced rate, a nursing