HB 421 Summary

• Extends the automatic repeal date of Division of Medicaid statutes from July 1, 2012 to July 1, 2013 for multiple Medicaid program provisions including coverage services and dental care benefits.

• Authorizes the Division of Medicaid to implement APR-DRG reimbursement for inpatient hospital services and APC payment methodology for outpatient hospital services.

• Increases the managed care program enrollment cap from 15% to 45% of Medicaid beneficiaries and authorizes additional managed care program types including coordinated care organizations, patient-centered medical homes, and accountable care organizations.

• Freezes nursing facility reimbursement rates at January 1, 2012 levels and allows single-source drugs to count outside the two-drug limit if less expensive than generic equivalents.

• Authorizes reimbursement up to 100% of Medicare rates for physician, nurse practitioner, and physician assistant services provided after normal working hours; increases UPL payment to freestanding psychiatric hospitals to $850 per day.