Bill Text: NH SB137 | 2025 | Regular Session | Introduced
Bill Title: Relative to hospital stays covered under the state Medicaid plan.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2025-01-29 - Hearing: 02/05/2025, Room 101, Legislative Office Building, 09:45 am; Senate Calendar 8 [SB137 Detail]
Download: New_Hampshire-2025-SB137-Introduced.html
SB 137-FN - AS INTRODUCED
2025 SESSION
25-1151
05/09
SENATE BILL 137-FN
AN ACT relative to hospital stays covered under the state Medicaid plan.
SPONSORS: Sen. Prentiss, Dist 5
COMMITTEE: Health and Human Services
-----------------------------------------------------------------
ANALYSIS
This bill directs the department of health and human services to establish under the state Medicaid program, an administrative day rate and swing bed rate for certain types of hospital stays, including minimum stays for mothers of newborns.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
25-1151
05/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Five
AN ACT relative to hospital stays covered under the state Medicaid plan.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Coverage for Hospital Stays under the State Medicaid Plan. Amend RSA 126-A by inserting after section 18-b the following new section:
126-A:18-c Coverage for Hospital Stays under the State Medicaid Plan.
Hospital stays shall be covered under the state Medicaid plan as follows:
I.(a) The department shall establish an administrative day rate for those days of hospital stay in which a client does not meet criteria for acute inpatient level of care, but is not discharged because:
(1) An appropriate placement outside the hospital is not available; or
(2) The postpartum parent's newborn remains on an inpatient claim for monitoring post-in utero exposure to substances that may lead to physiologic dependence and continuous care by the postpartum parent is the appropriate first-line treatment. "Postpartum parent" means the client who delivered the baby or babies.
(b) The department shall use the annual statewide weighted average nursing facility Medicaid payment rate to update the all-inclusive administrative day rate on November 1st of each year.
(c) The administrative day rate shall include pharmacy services, pharmaceuticals, and medically necessary ancillary services, as determined by the department, when these services are provided during administrative days.
(d) The department shall identify administrative days during the length of stay review process after the client's discharge from the hospital.
(e) The state Medicaid plan shall cover up to 5 newborn administrative days and may include additional days with expedited prior authorization (EPA). For EPA, the hospital shall establish that the clinically appropriate EPA criteria outlined in the department's published billing guides have been met, and the hospital shall use the appropriate EPA number for billing purposes.
(f) The department shall pay the administrative day rate starting with the date of hospital admission if the admission is solely for a no placement administrative day stay.
(g) The department shall pay the hospital the newborn administrative day rate only if:
(1) The postpartum parent rooms with their newborn and provides parental support/care; and
(2) The hospital provides all prescribed medications to the postpartum parent for the duration of the stay, including medications prescribed to treat substance use disorder.
II. ?The department shall establish a swing bed day rate for those days when a client is receiving department-approved nursing service level of care in a swing bed.
(a) The department shall not pay a hospital the rate applicable to the acute inpatient level of care for those days of a hospital stay when a client is receiving department-approved nursing service level of care in a swing bed.
(b) The department's allowed amount for those ancillary services not covered under the swing bed day rate shall be based on the payment methods provided in rules adopted under RSA 541-A. These ancillary services may be billed by the hospital on an outpatient hospital claim, except for pharmacy services and pharmaceuticals.
(c) The department shall allow pharmacy services and pharmaceuticals not covered under the swing bed day rate, that are provided to a client receiving department-approved nursing service level of care, to be billed directly by a pharmacy through the point of sale system. The department shall not allow those pharmacy services and pharmaceuticals to be paid to the hospital through submission of a hospital outpatient claim.
III. The department shall adopt rules under RSA 541-A to establish the rate setting methodology and criteria required under this section.
2 Effective Date. This act shall take effect July 1, 2025.
25-1151
1/20/25
SB 137-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to the hospital stays covered under the state Medicaid plan.
FISCAL IMPACT:
The Office of Legislative Budget Assistant is unable to complete a fiscal note for this bill as it is awaiting information from the Department of Health and Human Services. The Department was contacted on 1/8/25 for a fiscal note worksheet. When completed, the fiscal note will be forwarded to the Senate Clerk's Office.
AGENCIES CONTACTED:
Department of Health and Human Services
