Resolve, Directing the Department of Health and Human Services To Amend Its Rules Governing Reimbursement to Hospitals for Patients Awaiting Placement in Nursing Facilities

Sec. 1. Department of Health and Human Services; reimbursement for days awaiting placement; reimbursement for hospitals other than critical access hospitals. Resolved: That the Department of Health and Human Services shall amend the rules under Chapter 101: MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services to provide reimbursement to hospitals other than critical access hospitals for each day that a MaineCare-eligible individual is in the care of a hospital while awaiting placement in a nursing facility. The Department of Health and Human Services shall reimburse hospitals prospectively at the statewide average rate per member day for nursing facility services. The Department of Health and Human Services shall compute the statewide average rate per member day based on the simple average of the nursing facility rate per member day for the applicable state fiscal year or years and prorated for the hospital's fiscal year. Reimbursement for days awaiting placement pursuant to this section is limited to a period of 5 years and to a maximum of $500,000 of combined General Fund funds and federal funds for the entire 5-year period.

summary

This resolve, which is a recommendation of the Commission To Study Difficult-to-place Patients, directs the Department of Health and Human Services to amend the rules under Chapter 101: MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services to provide reimbursement to hospitals other than critical access hospitals for each day that a MaineCare-eligible individual is in the care of a hospital other than a critical access hospital while awaiting placement in a nursing facility. The reimbursement is to be paid prospectively at the statewide average rate per member day for nursing facility services. The department is directed to implement this reimbursement for days awaiting placement for a period of no more than 5 years and is limited to a maximum of $500,000 of combined General Fund funds and federal funds for the entire 5-year period.