ARC 2167C
HUMAN SERVICES DEPARTMENT[441]
Adopted and Filed
Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services hereby amends 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 budgets, 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 retroactively to hospital claims after that date.
This amendment will result in cost savings over the current 7-day standard because it allows a greater number of inpatient readmissions for the same condition to be combined with the original inpatient hospital stay.
Notice of Intended Action for this amendment was published in the Iowa Administrative Bulletin as ARC 2076C on August 5, 2015. The amendment was also Adopted and Filed Emergency and published as ARC 2075C on the same date and became effective July 15, 2015. The Department received no comments during the comment period. This amendment is identical to the one published under Notice of Intended Action and Adopted and Filed Emergency.
The Council on Human Services adopted this amendment on September 9, 2015.
This amendment does not provide for waivers because requests for waiver of any rule may be submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).
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.
This amendment will become effective November 4, 2015, at which time the Adopted and Filed Emergency amendment is hereby rescinded.
The following amendment is adopted.
	Amend subparagraph 79.1(5)“g”(5) as follows:
	(5)	Inpatient readmissions within seven 30 days for same condition. When Effective for dates of service on or after July 1, 2015, when an inpatient is discharged or transferred from an acute care hospital and is readmitted as an inpatient to the same hospital within seven 30 days for the same condition, any claim for the subsequent inpatient stay shall be combined with the claim for the original inpatient stay and payment shall be under a single DRG for both stays.
[Filed 9/10/15, effective 11/4/15]
[Published 9/30/15]
Editor’s Note: For replacement pages for IAC, see IAC Supplement 9/30/15.