SENATE BILL REPORT

                                   ESHB 1226

             AS REPORTED BY COMMITTEE ON HEALTH & LONG-TERM CARE,

                                 APRIL 4, 1991

Brief Description:  Making provisions for nursing home residents' discharge for temporary hospitalization.

SPONSORS:House Committee on Health Care (originally sponsored by Representatives Prentice, Wood, Franklin, Braddock, May, Brekke, Leonard, Belcher, Day, Brough, R. Meyers, Morris, Pruitt, Silver, D. Sommers, Dellwo, Jones, Riley, Scott, Sheldon, Phillips, Orr, Basich, Ogden and Cantwell).

HOUSE COMMITTEE ON HEALTH CARE

HOUSE COMMITTEE ON APPROPRIATIONS

SENATE COMMITTEE ON HEALTH & LONG‑TERM CARE

Majority Report:  Do pass as amended.

      Signed by Senators West, Chairman; L. Smith, Vice Chairman; Amondson, Johnson, L. Kreidler, Niemi, and Wojahn.

Staff:  Don Sloma (786‑7414)

Hearing Dates:April 1, 1991; April 4, 1991

BACKGROUND:

Some nursing home residents need periodic hospitalization.  The current Medicaid reimbursement system does not pay the nursing home to hold the unoccupied bed while a Medicaid resident is hospitalized.  As a result, Medicaid residents lose their resident status in the nursing home because of the nursing homes' need to fill the empty bed.

DSHS has authorized reimbursement to nursing homes for up to 18 days for Medicaid residents who take social leave.  If a resident leaves the nursing home to be hospitalized, however, no social leave time can be applied towards Medicaid reimbursement and the bed occupied does not have to be held for them. 

SUMMARY:

Nursing homes must hold a Medicaid resident's bed for up to four days while the resident is hospitalized.  During this period, the nursing home will be reimbursed its full rate for the first three days plus the day of discharge.  The full amount a nursing home will be reimbursed is equal to the facility assigned Medicaid rate, less the amount the resident is required to pay.  Reimbursement for the days the resident's bed is vacant only applies to nursing homes with an occupancy rate of 95 percent or higher. The total days a bed is held vacant for a resident for the purpose of hospitalization, will be included as part of the total 18 days per year a resident can currently use for social leave.  The resident who is discharged to a hospital must be readmitted to the same bed occupied before discharge to the hospital, unless readmitted into a Medicare bed or the physician requests admittance into a heavy care bed.

DSHS must develop a tracking system to identify the days a Medicaid bed is held vacant due to social time and hospitalization.

Appropriation:  none

Revenue:  none

Fiscal Note:  requested March 21, 1991

SUMMARY OF PROPOSED SENATE AMENDMENT:

Provisions requiring DSHS to pay nursing homes for beds held when patients are hospitalized are removed.

TESTIMONY FOR:

This is needed to provide increased residential stability and peace of mind to nursing home residents who are hospitalized.

TESTIMONY AGAINST:

Payment provisions in the bill are inadequate for nursing home operators.  Funds for the bill are not provided in the Governor's budget.

TESTIFIED:  Marilyn Tausend, Amy Hanson, Kris Bolt, Washington Nursing Home Advisory Council (pro); Ralph Smith, Department of Social and Health Services (con); Hilke Faber, Washington State NH Resident Councils (pro); Karen L. Tywes, Washington Association of Homes for the Aging (con); Kary W. Hyre, State Long-Term Care Ombudsman (pro)