Bill Summaries: H382 (2021)

  • Summary date: Mar 24 2021 - View summary

    Sets out the NCGA's intent to provide funding to hospitals for behavioral health services provided to Medicaid beneficiaries while those beneficiaries await discharge to a more appropriate setting.

    Requires the Department of Health and Human Services, Division of Health Benefits (Division), to develop a clinical coverage policy, or amend an existing policy as applicable; assign a CPT code; and develop billing instructions for Medicaid coverage of the services described in this act that are provided to a beneficiary when: (1) the beneficiary no longer meets criteria for observation under the specified Medicaid Clinical Coverage policy; (2) the beneficiary is not currently receiving inpatient behavioral health services covered under the specified Medicaid Clinical Coverage policy; and (3) a physician, physician assistant, or nurse practitioner has determined that one of the following is action appropriate for the beneficiary: admission to an inpatient psychiatric or behavioral health facility; admission to a facility, other than an inpatient facility, for care for psychiatric or behavioral health needs; or arrangement for community-based services or supports without which the beneficiary cannot be safely discharged to the beneficiary's home due to the beneficiary's psychiatric or behavioral health needs. Requires the clinical coverage policy to provide Medicaid coverage of the following services in an acute care hospital setting when medically necessary and ordered by a physician or other appropriate provider: (1) treatment, including assessment and medication management, of both psychiatric and behavioral health conditions and physical health conditions; (2) crisis stabilization and support; (3) ongoing monitoring of a beneficiary's medical status and medical clearance; (4) nursing services and support; (5) reasonable and appropriate efforts to maintain patient safety; (6) provision of community resource information and psychoeducation, including connections to the relevant local management entity/managed care organization (LME/MCO); (7) development of a safety plan, and plan revisions; and (8) coordination with the beneficiary or the beneficiary's legal representative and the LME/MCO to establish a safe discharge or transfer plan. Requires other ancillary services to continue to be eligible to be billed as separate and additional services.

    Requires the Division to submit to the Centers for Medicaid and Medicare Services (CMS) any State Plan amendments that are necessary to establish Medicaid reimbursement or rates for services outlined in this act. Requires the new Medicaid covered services and rates to be implemented as soon as practicable but not before receiving CMS approval. Specifies that the new Medicaid covered services and rates will only be implemented to the extent CMS allows.