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Adopts a new methodology for Medicaid managed care organization reimbursement and fee-for-service reimbursement rates to better align Medicaid rates to Medicare rates.
Amends the provisions governing refugee medical assistance (RMA) to shorten the period that assistance is granted through the refugee medical assistance (RMA) program from one year to four months.
Amends the provisions governing inpatient hospital services, to allow reimbursement for gene therapies for sickle cell disease outside the per diem rate and paid based on the actual acquisition cost in order to take advantage of a federal rebate.
Amends the provisions governing reimbursement for Nursing Facilities to revise the language and to replace resource utilization group resident classification system with the patient driven payment model (PDPM). The PDPM shifts the focus from therapy-based payments to a more patient-centered approach that takes into account the individual needs and conditions of residents. This action is being taken to comply with federal requirements.
Amends the provisions governing intermediate care facilities for persons with intellectual disabilities (ICF/IID) to extend the temporary rates for (ICFs/IID) that have a cooperative endeavor agreement with the Office for Citizens with Developmental Disabilities and have a high concentration of people who have intellectual developmental disabilities, significant behavioral health needs, and high risk behavior resulting in previous interface with the judicial system, and for whom no other private ICFs/IID provider is able to support. This action is being taken to promote the health and welfare of Medicaid recipients by ensuring that eligible ICFs/IID are able to maintain the current level of service.
Amends the provisions governing intermediate care facilities for persons with intellectual disabilities (ICF/IID) to eliminate the expiration date on an increased per diem rate for ICFs/IID that downsized from over 100 beds to less than 35 beds prior to December31, 2010, without the benefit of a cooperative endeavor agreement or transitional rate and that incurred excessive capital costs.
Provides for reimbursement methodology to ensure that other rural hospitals remain financially viable so that the access to medical care that they provide to Medicaid beneficiaries in their communities will continue to be available and will improve in the future.
Provides for reimbursement methodology to ensure that other rural hospitals remain financially viable so that the access to medical care that they provide to Medicaid beneficiaries in their communities will continue to be available and will improve in the future.
Amends the provisions of the May 12, 2023 Emergency Rule which extended provisions for long term-personal care services and certain home and community-based services waivers which were relaxed throughout the duration of the Coronavirus Disease 2019 (COVID-19) public health emergency in order to continue provisions and/or options under the Adult Day Health Care Waiver beyond the original extension date.
Amends the provisions in the Medical Transportation Program governing American Rescue Plan Act (ARPA) bonus payments to providers of non-emergency medical transportation (NEMT) services in order to establish the guidelines the department will utilize to oversee the administration and distribution of ARPA bonus payment funds to eligible NEMT providers by the Medicaid managed care organizations.
Amends the provisions governing the standards for payment and reimbursement for nursing facilities in order to implement the required transition from the current resource utilization group (RUG-III/RUG-IV) case-mix classification model used under the Medicare skilled nursing facility prospective payment system to the patient driven payment model which was delayed by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) until October 1, 2023 due to the COVID-19 public health emergency and to mandate use of the optional state assessment.
Amends the July 1, 2023 Emergency Rule which amended the provisions governing reimbursement in the Medical Transportation Program in order to align the reimbursement rates established for emergency ambulance services and providers with current practice for Medicaid managed care and fee-for-service.