5160-2-14 Potentially preventable readmissions.

 

 

 

PUBLIC HEARING NOTICE OHIO DEPARTMENT OF MEDICAID

 

DATE:                         November 17, 2016

TIME:                        11 AM

LOCATION:             Lazarus Building, Room A401

50 W. Town St., Columbus, Ohio 43215-3414

 

Pursuant to section 5164.02 and Chapter 119. of the Ohio Revised Code, the director of the Ohio Department of Medicaid (department) gives notice of the department's intent to adopt, amend, or rescind the Ohio Administrative Code (OAC) rule identified below and of a public hearing thereon.

 

OAC rule 5160-2-14, entitled Potentially preventable readmissions, is being proposed for adoption. This rule sets forth general provisions regarding the implementation of the Potentially Preventable Readmissions (PPR) program. The purposes of the program are to reduce preventable readmissions, encourage hospitals to improve the level of care provided during a patient's inpatient admission and improve the discharge planning process. Additionally, the proposed rule is intended to continue the modernization of Medicaid reimbursement for hospital services, incentivize hospitals to improve quality outcomes for Medicaid recipients, encourage increased efficiencies in the delivery of services, and help balance state resources among competing demands while continuing to assure access to quality hospital care to Medicaid recipients in Ohio. All hospitals that are subject to the All Patient Refined Diagnosis Related Groups (APR-DRG) prospective payment methodology utilized by the department are subject to the PPR program. Only hospitals that have twenty or more Medicaid discharges in a reporting year are subject to a hospital-specific rate adjustment that is implemented through the PPR program. In addition, the rule implements recommendations by the department and the General Assembly to build appropriations established in Am. Sub. H.B. 64 of the 131st General Assembly.

 

The department is using PPR software to determine whether a readmission within 30 days of a prior discharge from any hospital is clinically-related and clinically-preventable to the initial admission. If a readmission is deemed clinically-related and clinically-preventable within the 30 day window, then a clinically-related readmission chain is established. A hospital with excess readmissions, which is defined as an actual-to-expected readmissions ratio of greater than one, will be subject to a reduction of their hospital-specific base rate equal to one percent.

 

A copy of the proposed rule is available, without charge, to any person affected by the rule at the address listed below. The rule is also available on the internet at  http://www.registerofohio.state.oh.us/. A public hearing on the proposed rule will be held at the date, time, and location listed at the top of this notice. Both written and oral testimony will be taken at the public hearing. Additionally, written comments submitted or postmarked no later than the date of the public hearing will be treated as testimony.

 

 

 

 

 

 

 

 

Requests for a copy of the proposed rule and testimony on the rule should be submitted by mail to the Ohio Department of Medicaid Rule Administrator, Office of Chief Legal Counsel, 50 W. Town Street, Suite 400, Columbus, Ohio 43215-3414, by fax at (614) 995- 1301, or by e-mail at [e-mail]. Testimony received may be reviewed at this address.