68-1010.

Patients with complex health needs; transfer; pilot program.

(1) The Department of Health and Human Services shall contract with, or provide a grant to, an eligible entity to implement a pilot program to facilitate the transfer of patients with complex health needs from eligible acute care hospitals to appropriate post-acute care settings, including facilities that provide skilled nursing or long-term care.

(2) The purposes of the pilot program are to ensure that:

(a) Patients with complex health needs are able to access timely transition from an acute care hospital to a post-acute care setting;

(b) Patients receive the appropriate type of care at the appropriate time to best meet their needs; and

(c) Acute-care hospitals have available capacity to meet the needs of patients.

(3) For purposes of this section:

(a) Eligible acute care hospital means a facility that is not designated as a critical access hospital by the federal Centers for Medicare and Medicaid Services and must satisfactorily demonstrate to the eligible entity that it has reached or exceeded eighty percent of available staffed capacity for adult intensive-care-unit beds and acute care inpatient medical-surgical beds;

(b) Eligible entity means a nonprofit statewide association whose members include eligible acute care hospitals; and

(c) Patient means a person who is medically stable and who the provider believes, with a reasonable medical probability and in accordance with recognized medical standards, is safe to be discharged or transferred and is not expected to have his or her condition negatively impacted during, or as a result of, the discharge or transfer.

(4) The eligible entity responsible for developing the pilot program shall:

(a) Determine criteria to define patients with complex health needs;

(b) Develop a process for eligible acute care hospitals to determine capacity and the manner and frequency of reporting changes in capacity;

(c) Develop a process to ensure funding is utilized for the purposes described in this section and in compliance with all applicable state and federal laws;

(d) Include regular consultation with the department and representatives of acute care hospitals, skilled nursing facilities, and nursing facilities; and

(e) Include quarterly updates to the department.

(5) The pilot program may include direct payments to post-acute care facilities that support care to patients with complex health needs.

(6) Funding utilized under the pilot program shall comply with all medicaid and medicare reimbursement policies for skilled nursing facilities, nursing facilities, and swing-bed hospitals.

(7) It is the intent of the Legislature to appropriate one million dollars from the General Fund to carry out this section. No more than two and one-half percent of the contracted amount shall be used to administer the pilot program.