ARC 2076C
HUMAN SERVICES DEPARTMENT[441]
Notice of Intended Action
Twenty-five interested persons, a governmental subdivision, an agency or association of 25 or more persons may demand an oral presentation hereon as provided in Iowa Code section 17A.4(1)“b.”
Notice is also given to the public that the Administrative Rules Review Committee may, on its own motion or on written request by any individual or group, review this proposed action under section 17A.8(6) at a regular or special meeting where the public or interested persons may be heard.
Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services proposes to amend Chapter 79, “Other Policies Relating to Providers of Medical and Remedial Care,” Iowa Administrative Code.
This amendment changes the current threshold for inpatient hospital readmissions combined into a single claim from 7 days to 30 days, effective July 1, 2015. As a function of the amendment, the Iowa Medicaid program will combine claims for a given member’s inpatient readmissions to the same hospital for the same conditions occurring within 30 days.
This amendment implements a cost-savings initiative that is part of the basis for the Department’s budgets for state fiscal years 2016 and 2017, beginning July 1, 2015, as appropriated by the Iowa Legislature in 2015 Iowa Acts, Senate File 505. The change to a 30-day standard, which is the policy of the Medicare program, was incorporated into the Governor’s budget as proposed to the Legislature and used by the Legislature’s Conference Committee in estimating the needs to be met by the Medicaid budget. In both the Governor’s and the Committee’s budget, it was assumed that the change would be effective for dates of service on or after July 1, 2015. Therefore, this amendment provides that the change will be effective for dates of service on or after July 1, 2015. To the extent necessary, the policy will be applied to hospital claims retroactively after the effective date of the amendment.
This amendment will result in cost savings over the current 7-day standard because it will allow a greater number of inpatient readmissions for the same condition to be combined with the original inpatient hospital stay.
Any interested person may make written comments on the proposed amendment on or before August 25, 2015. Comments should be directed to Harry Rossander, Bureau of Policy Coordination, Department of Human Services, Hoover State Office Building, Fifth Floor, 1305 East Walnut Street, Des Moines, Iowa 50319-0114. Comments may be sent by fax to (515)281-4980 or by e-mail to policyanalysis@dhs.state.ia.us.
This amendment does not provide for waivers in specified situations because requests for the waiver of any rule may be submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).
This amendment was also Adopted and Filed Emergency and is published herein as ARC 2075C. The purpose of this Notice is to solicit comments on that submission, the subject matter of which is incorporated by reference.
The Administrative Rules Review Committee reviewed this Notice of Intended Action in conjunction with ARC 2075C on July 14, 2015.
After analysis and review of this rule making, no impact on jobs has been found.
This amendment is intended to implement Iowa Code section 249A.4.