No. SB 648
Filed under Healthcare.
Medicaid Reimbursement for Private Duty Nursing Services; Defining the term “pediatric continuing care integrated community” for purposes of the state Medicaid program; requiring Medicaid managed care plans to reimburse licensed home health agencies for private duty nursing services provided in a community residential group home at a certain rate; requiring Medicaid managed care plans to negotiate rates with affiliated businesses at least annually, etc.
Plain English Summary
AI-GENERATEDThe bill defines a new Medicaid category: commonly-owned networks combining a children's group home, home health agency, pediatric extended care center, durable-equipment supplier, and therapy clinic that together serve medically fragile kids under 21.
Medicaid managed care plans must pay home health agencies the full prevailing hourly nursing rate for each child in a community residential group home, no matter how many children share the home.
Plans cannot cut that rate because several Medicaid-eligible children in the same home receive nursing care in the same space or on the same day. Plans and the affiliated businesses must renegotiate rates at least yearly.
AHCA must ask federal regulators to approve these changes within 30 days of the act becoming law, and cannot put the reimbursement mandate into effect until that federal approval comes through.
AICreates the term 'pediatric continuing care integrated community' for a group of commonly-owned businesses -- a children's group home, home health agency, pediatric extended care center, equipment supplier, and therapy clinic -- serving medically fragile Medicaid patients under 21.
AIMedicaid managed care plans must reimburse home health agencies for private duty nursing in a community residential group home at the full prevailing hourly rate for that geographic area, not a reduced or shared rate.
AIPlans cannot lower reimbursement because multiple Medicaid-eligible children in the group home receive private duty nursing in the same dwelling space or on the same day, blocking a common cost-control practice for shared care.
AIManaged care plans and the affiliated businesses making up the integrated community must sit down at least once a year to renegotiate the rates paid for medical services delivered within the community.
AIAHCA must apply for any necessary federal sign-off, such as a state plan amendment or waiver, within 30 days of the act taking effect, and the changes only take hold once that approval arrives.