HI HB93

Requires insurers contracting with the Department of Human Services to provide a medically complex add-on payment equal to 40 percent of the Medicaid base rate for long-term care facility patients with complex medical, behavioral, mental health, or cognitive needs who are waitlisted at acute care hospitals.

Establishes qualifying conditions for the add-on payment including severe medical conditions, mental/behavioral health conditions, traumatic brain injury, medically fragile status, significant physical/nutritional needs, and conditions requiring enhanced supports or direct service worker resources.

Requires long-term care facilities to maintain clinical documentation in patient records justifying the add-on payment determination and demonstrating at least one qualifying condition with severity and resource needs.

Appropriates funds from general revenues for fiscal years 2017-2018 and 2018-2019 to implement the medically complex add-on payment program for qualified waitlisted Medicaid enrollees.

Effective date of July 1, 2075 (note: this appears to be a drafting error).