Readmission Payment Policy for Inpatient Hospitals
[41 Pa.B. 4818]
[Saturday, September 3, 2011]
The Department of Public Welfare (Department) is announcing revisions to the Medical Assistance (MA) payment policy for inpatient acute care general hospital readmissions consistent with the statutory amendments to the Public Welfare Code (62 P. S. §§ 101—1503) as set forth in the act of June 30, 2011 (P. L. 89, No. 22) (Act 22).
Act 22 amends section 443.9 of the Public Welfare Code (62 P. S. § 443.9), regarding payments for readmission to a hospital paid through diagnosis—related groups, by increasing the time period for review of readmissions from 14 days to 30 days from the date of discharge. All other requirements relating to readmissions continue to apply. These requirements are as follows:
1. If the readmission is for the treatment of conditions that could or should have been treated during the previous admission, the Department shall make no payment in addition to the hospital's original payment. If the combined hospital stay qualifies as an outlier, an outlier payment shall be made.
2. If the readmission is due to complications of the original diagnosis and the result is a different diagnosis related group (DRG) with a higher payment, the Department shall pay the higher DRG payment rather than the original DRG payment.
3. If the readmission is due to conditions unrelated to the previous admission, the Department shall consider the readmission as a new admission for payment purposes.
The Department will review inpatient hospital admissions occurring within 30 days of the date of discharge of a prior admission as previously detailed.
The Department intends to promulgate regulations to amend 55 Pa. Code § 1163.57 (relating to payment policy for readmissions) to reflect the statutory changes to section 443.9 of the Public Welfare Code.
The Fiscal Year 2011-2012 fiscal impact, as a result of this change to the MA Program payment policy for readmissions, is a savings of $0.826 million ($0.371 million in State General Funds and $0.455 million in Federal Funds upon approval by the Centers for Medicare and Medicaid Services).
Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent revision to this notice.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
GARY D. ALEXANDER,
Fiscal Note: 14-NOT-713. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 11-1516. Filed for public inspection September 2, 2011, 9:00 a.m.]
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