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Bedday Allocation Plan. July 1, 2003. BAP 1996. In preparation for planned Medicaid waiver, State hospital bedday allocation plan implemented July 1, 1996 Allocation of beddays at 5% over FY95 utilization level, for adults only No incentives for lower bedday utilization. Current Utilization.
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Bedday Allocation Plan July 1, 2003
BAP 1996 • In preparation for planned Medicaid waiver, State hospital bedday allocation plan implemented July 1, 1996 • Allocation of beddays at 5% over FY95 utilization level, for adults only • No incentives for lower bedday utilization
State Hospital Target Populations • Acute adult admissions • Long-term adult • Acute adolescent admissions • Acute older adult admissions • Adults with MI/SA
Special Populations • Forensic patients • Research protocol patients • Deaf consumers
Services to be Discontinued • Skilled and intermediate nursing • Geriatric long-term • Latency child • PRTF (adolescent residential)
Services to be Reduced • Adult long-term • Adolescent admissions • Adult admissions • Medical
BAP Re-Development • In Session 2001, SB 1005, Section 21.68A directed DHHS to develop and implement plan to allocate hospital beds among counties • BAP developed in early 2003 by workgroup of representatives of DMH, the hospitals, and area programs.
Plan Distribution • March 2003, draft BAP distributed to area programs and hospitals for review • May 2003 distribution to area programs and hospitals. • Allocation of beddays for FY2004 • Projected allocation of beddays for FY2005-2007 • BAP
Basis for Allocation • Tracks hospital bed downsizing schedule • Transitions from utilization to per capita allocation basis • Starts at average utilization for FYs2000-2002
Allocation Categories • Adult admissions • Adult long-term • Geriatric admissions • Adolescent
Authorization Types • Initial authorization • Re-authorization • Standardized number format to be announced
Authorization Minimums • Adult admissions = 3 days • Geriatric = 3 days • Adolescent admission = 6 days • Adult long-term = 30 days
Non-Authorized Services • Nursing facility • Research • TB Unit • Medical/Infirmary • Forensic • Out of state • LOA • Deaf Services Unit
Authorization Timelines • Referred patients: authorization to accompany referral • Non-referred patients: authorization issued within 1 hour of notification of hospital assessment for admission • Emergency admissions: authorization issued within 1 hour of notification by hospital
Re-Authorization Timelines • Long-term patients: re-auth request to be submitted 2 weeks prior to expiration, with response within 1 week • Admission patients: re-auth request to be submitted 1 working day prior to expiration, with response within 1 working day
Authorization Pending D/C Approval • For patients leaving long-term units subject to discharge plan approval by DMH, authorization must be continued until discharge plan is approved. • LME may appeal delay of development of discharge plan if indicated.
Responsible LME • LME responsible for authorization based on 10 NCAC 15A .0117 • County of responsibility = county of residence as defined by 10 NCAC 15A .0116 and G.S. 122C-3.
Tracking Utilization • Bedday utilization tracked by category • For over-utilization, a charge per bedday per category will be applied at fiscal year-end • Over-utilization charge reverts to DMH for use in further service capacity development
Authorization of Current Patients • Need to authorize stays for patients in-house effective July 1 • Hospitals to send to area programs list of current patients by service category by June 15 and updated list on June 30 • Authorizations based on minimums by category to be sent to hospital by July 1.