(Doc Name h:\legwork\house\amend\h-wm\001\hou2 cico.docx):
EXPLANATION: provide parameters for coordinated and integrated care organizations to participate in the s.c. healthy connections prime program
Amend the bill, as and if amended, Part IB, Section 33,
DEPARTMENT OF HEALTH & HUMAN SERVICES, page 428, after line
6, by adding an appropriately numbered paragraph to read:
/ (DHHS: Coordinated and Integrated
Care Organizations) Coordinated and Integrated Care
Organizations (CICO) chosen by the Department of Health and
Human Services to participate in the South Carolina Healthy
Connections Prime Program Dually Eligible Demonstration Project
may contract with licensed and certified nursing homes for the
care of Medicaid patients enrolled in the demonstration project
in facilities who do not hold a Medicaid nursing home permit as
defined in Section 44-7-80 of the 1976 Code. As a condition for
participation, the CICO and the facility shall at no time
contract for more than five percent of their licensed bed
capacity or five Medicaid patients, whichever is greater, the
provisions of Section 44-7-82 notwithstanding. The percentage
calculation shall be based annually on the number of licensed
beds beginning on the date of the first admission of duals
eligible project participants to the facility. The department
shall on a monthly basis monitor each non- Medicaid permit
facility participating in the program for compliance. Should a
facility exceed the allowable number or percentage of patients,
seventy percent of the daily payment for excess Medicaid patient
days made to the facility shall be withheld. The exception to
Article 2, Chapter 7, Title 44 of the 1976 Code expires at the
end of the demonstration project but no later than February 1,
2019. For purposes of the demonstration project the facilities
that do not currently hold a Medicaid Permit shall have a base
Medicaid rate of the most current average Medicaid rate of all
nursing homes participating in the Medicaid program as developed
by the department./
Renumber sections to conform.
Amend totals and titles to conform.