Amend the bill, as and if amended, Part IB, Section 21, DEPARTMENT OF HEALTH AND HUMAN SERVICES, page 385, line 24, by striking paragraph 21.46 in its entirety and inserting:
/21.46. (DHHS: In-Home Health Care Systems for Medicaid
Recipients) The Department of Health and Human Services, during
Fiscal Year 2011-12, within the funds appropriated or made
available by the General Assembly or within federal Medicaid
funds made available for this purpose, but not to exceed three
million dollars in the aggregate, upon application by the
department, shall pilot test an in-home health care system in a
minimum of five counties of this State with the highest
incidence of emergency room use during Fiscal Year 2009-10 by
Medicaid recipients. The pilot test must include a statistically
valid sample of Medicaid patients within the counties as
determined by the Director of the Deapartment of Health and
Human Services. This program shall provide a state-of-the-art
in-home health care system which provides around the clock
access to medical assessment care and additionally provides an
emergency response function that gives a Medicaid recipient the
ability to contact a local emergency response center.
The purpose of the program is to reduce the amount of emergency room visits in nonemergency cases and to reduce the amount of visits to other medical care facilities in order to save on the cost of providing this care and in order to provide better health care.
The in-home health care system option must consist of three main components:
(1) the medical console and wireless transmitter;
(2) the medical triage center; and
(3) the emergency response call center.
The medical console and wireless transmitter must have the following capabilities:
(1) the medical console must be capable of communication between two separate call centers, one of which is a monitoring facility to provide certified medical triage care twenty-four hours a day and the other of which is a monitoring facility to provide emergency response services twenty-four hours a day.
(2) the wireless transmitter for the medical console must have two buttons, one for transmitting a signal to the console to contact the emergency response monitoring facility, and the second button also must send a wireless signal to the console to trigger contact with the medical triage center.
(3) the medical console must be able to send a report/event code to the emergency response call center after a medical triage center call has been placed.
(4) an emergency button on the medical console must include Braille for the sight impaired.
The medical triage center must have or be:
(1) open twenty-four hours a day, three hundred sixty-five days a year;
(2) a call center must be located in the United States;
(3) Utilization Review Accreditation Commission (URAC) accredited;
(4) on call availability of a South Carolina licensed physician, twenty-four hours, seven days a week for guidance or review of clinical calls as needed;
(5) registered nurses with a minimum of ten years experience available to answer all calls;
(6) all calls digitally recorded and archived, and a triage report prepared and sent;
(7) daily monitoring of communications with the call center;
(8) fully HIPAA compliant;
(9) bilingual staff in English and Spanish;
(10) a mechanism that ensures that a caller will never receive a busy signal or voice mail when accessing the nurse advice line;
(11) clinical staff able to serve pediatric, adolescent, adult, and senior populations, as well as health care expertise in a variety of clinical areas such as emergency room, pediatrics, critical care, oncology, cardiology, pulmonary, geriatrics, obstetrics/gynecology and general medicine; and
(12) the infrastructure in place to allow the telephone network to digitally communicate with the medical console for incoming call connection, call disconnect, and client file access.
The emergency response call center must:
(1) be open twenty-four hours a day, three hundred sixty-five days a year;
(2) be located in South Carolina;
(3) maintain a digital receiver capable of processing two-way voice audio using multiple formats.
Facilities, emergency response and the medical triage center, shall offer all recipients selected by the department unlimited use of services provided by the emergency monitoring and medical triage facilities at no additional cost burden to the State.
The pilot-testing program must be conducted for the current fiscal year. The department in developing and administering this program is authorized to take such actions as may be required, including making requests for Medicaid waivers when necessary.
The department, in implementing this program on a pilot-testing basis, also is authorized to contract with a third-party provider or vendor to furnish and operate the program or a physician's office that provides a similar patient service. /
Renumber sections to conform.
Amend totals and titles to conform.