Current Status Introducing Body:House Bill Number:3233 Primary Sponsor:Boan Committee Number:27 Type of Legislation:GB Subject:Hospital prospective payment system Residing Body:House Current Committee:Medical, Military, Public and Municipal Affairs Companion Bill Number:493 Date Tabled:Feb 04, 1992 Computer Document Number:CYY/18030.SD Introduced Date:Jan 17, 1991 Last History Body:House Last History Date:Feb 04, 1992 Last History Type:Tabled in Committee Scope of Legislation:Statewide All Sponsors:Boan McElveen Type of Legislation:General Bill
Bill Body Date Action Description CMN
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3233 House Feb 04, 1992 Tabled in Committee 27
3233 House Jan 17, 1991 Introduced, read first time, 27
referred to Committee
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TO AMEND SECTION 44-6-140, AS AMENDED, CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO THE MEDICAID HOSPITAL PROSPECTIVE PAYMENT SYSTEM, SO AS TO PROVIDE FOR CERTAIN EXCEPTIONS TO COST CONTAINMENT INCENTIVES AND TO FURTHER PROVIDE FOR ALLOWABLE PAYMENTS.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Section 44-6-140 of the 1976 Code, as last amended by Act 189 of 1989, is further amended to read:
"Section 44-6-140. (A) To provide cost containment incentives for providers of care to Medicaid recipients, the commission shall convert the Medicaid hospital reimbursement system from a retrospective payment system to a prospective payment system by October 1, 1985, with the exception of those hospitals described in subsection (C). The prospective payment system includes, at a minimum the following elements:
(1) a maximum allowable payment amount established for individual hospital products, services, patient diagnoses, patient day, patient admission, or per patient, or any combination thereof of them, which is preset at the beginning of the state's fiscal year and fixed for the entirety of the state's fiscal year. This payment must be based on hospital costs rather than hospital charges and must be adjusted at least every two years to reflect the most recent audited cost data available. The commission shall set by regulation those circumstances under which a hospital may seek an exception those circumstances under which a hospital may seek an exception. The maximum allowable payment amount must be weighted to allow for the costs of medical education and primary, secondary, or tertiary care considerations;
(2) payment on a timely basis to the hospital by the commission or patient, or both, of the maximum allowable payment amount determined by the commission; and
(3) acceptance by the hospital of the maximum payment amount as payment in full, which includes any a deductible or copayment provided for in the state Medicaid program.
(B) The commission shall at the same time shall implement other cost containment measures which include, but are not limited to:
(1) utilization reviews for appropriateness of treatment and length of stay;
(2) preadmission certification of nonemergency admissions;
(3) mandatory outpatient surgery in appropriate cases;
(4) a second surgical opinion pilot study; and
(5) procedures for encouraging the use of outpatient services.
The commission, to the fullest extent possible, shall utilize information required in this subsection in the form hospitals presently are presently submitting the information to other governmental agencies or in the form hospitals presently are presently utilizing the information within the hospital.
(C) To assure access to health care services in rural areas, the commission shall reimburse under a cost-based system those hospitals which agree to restrict the provision of inpatient care to no more than twelve beds.
(1) The facility need not meet hospital standards relating to number of hours of operation except to provide limited emergency care on a twenty-four hour basis.
(2) The facility may provide these emergency services or inpatient services by a physician's assistant or a nurse practitioner under protocols established by a physician.
(3) Nothing in this definition limits a facility from furnishing an unlimited number of beds for extended long-term care services (swing beds or distinct part units).
(4) To receive this reimbursement, a facility must have a plan for restructuring services to interact with the county health department and other appropriate agencies within the county."
SECTION 2. This act takes effect upon approval by the Governor.