WSR 15-18-089

[Filed August 31, 2015, 11:54 a.m.]

Title or Subject: Medicaid State Plan Amendment (SPA) 15-0031.

Effective Date: January 1, 2016.

Description: Potentially preventable admissions.

The agency intends to submit SPA 15-0031 to implement a payment policy that adjusts inpatient hospital payments based on each hospital's readmissions the previous year. The policy is intended to promote the quality of care received in the inpatient hospital setting and after discharge to prevent readmissions.

The agency will use 3M's Potentially Preventable Readmissions (PPR) software to calculate each hospital's readmission rate and establish an expected statewide rate. Hospitals above this rate will have a payment reduction the following year based on the number of PPRs above the expected statewide rate that occur during the prior year. Hospitals with PPRs below the expected statewide rate will have no payment reduction. The agency anticipates this policy will have very little effect, if any, or [on] its annual aggregate expenditures.

The SPA is in the development process; therefore a copy is not yet available for review. To contact the agency or to request a copy of the SPA when it becomes available, please contact Gail Kreiger, Health Care Services, 626 8th Avenue S.E., Olympia, WA 98501, phone (360) 725-1681, TDD/TTY 1-800-725-5429, fax (360) 725-1152, e-mail gail.kreiger@hca.wa.gov, web site hca.wa.gov.