An Act To Require Reimbursement to Hospitals for Patients Awaiting Placement in Nursing Facilities

Sec. 1. 22 MRSA §3174-ZZ  is enacted to read:

§ 3174-ZZ.  Reimbursement for days awaiting placement; reimbursement for hospitals other than critical access hospitals

The department shall provide reimbursement to hospitals other than critical access hospitals for each day after the 10th day that a MaineCare-eligible individual is in the care of a hospital while awaiting placement in a nursing facility. The department shall reimburse hospitals prospectively at the statewide average rate per MaineCare member day for nursing facility services. The department shall compute the statewide average rate per MaineCare member day based on the simple average of the nursing facility rate per MaineCare member day for the applicable state fiscal year or years 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 each year of the 5-year period. For purposes of this section, "critical access hospital" has the same meaning as in section 7932, subsection 10.

Sec. 2. MaineCare Benefits Manual. The Department of Health and Human Services shall amend the rules under Chapter 101: MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services to implement the Maine Revised Statutes, Title 22, section 3174-ZZ. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.

summary

This bill directs the Department of Health and Human Services to provide reimbursement to hospitals other than critical access hospitals for each day after the 10th day that a MaineCare-eligible individual is in the care of a hospital while awaiting placement in a nursing facility. The reimbursement is to be paid prospectively at the statewide average rate per MaineCare member day for nursing facility services. The department is directed to implement this reimbursement for days awaiting placement for a period limited to 5 years. Reimbursement is limited to a maximum of $500,000 of combined General Fund funds and federal funds for each year of the 5-year period.