AB1088: Bill Text

AB1088,,65 (2) Complex patient pilot program.

AB1088,,66 (a) In this subsection:

AB1088,,67 1. “Department” means the department of health services.

AB1088,,68 2. “Partnership group” means one or more hospitals in partnership with one or more post-acute facilities.

AB1088,,69 (b) The department shall use a competitive grant selection process to select partnership groups to be designated as participating sites for a complex patient pilot program under this subsection and, from the appropriation under s. 20.435 (7) (d), award grants to the groups selected.

AB1088,,70 (c) The department shall solicit feedback regarding the complex patient pilot program from representatives of healthcare system organizations, long-term care provider organizations, long-term care operator organizations, patient advocate groups, insurers, and any other organization determined to be relevant by the secretary of health services.

AB1088,,71 (d) The department shall require that each partnership group that applies to the department to be designated as a site for the complex patient pilot program shall address all of the following issues in its application:

AB1088,,72 1. The number of complex patient care beds that will be set aside in a post-acute facility or through implementation of an innovative model of patient care in a post-acute facility to which participating hospitals agree, such as dedicated staffing for dementia or a behavioral health unit.

AB1088,,73 2. Defined goals and measurable outcomes of the partnership group during the pilot program and after the pilot program.

AB1088,,74 3. The types of complex patients for whom care will be provided, which may include patients needing total care for multiple conditions or comorbidities such as cardiac and respiratory diseases, obesity, mental health, substance use, or dementia.

AB1088,,75 4. An operating budget for the proposed site that details how fiscal responsibility will be shared among members of the partnership group and includes all of the following:

AB1088,,76 a. Estimated patient revenues from other sources, including the Medical Assistance program under subch. IV of ch. 49, and estimated total costs.

AB1088,,77 b. A margin to account for reserved beds.

AB1088,,78 5. The partnership group’s expertise to successfully implement the proposal, which may include a discussion of the following issues:

AB1088,,79 a. Documented experience of the partners working together to serve complex patients.

AB1088,,80 b. The implementation timeline and the plan for post-acute facilities to accept admissions and transfer patients within 72 hours of a request submitted by a hospital.

AB1088,,81 c. The plan for an interdisciplinary team that will staff the unit in the post-acute facility, including the availability of staff with appropriate expertise that includes physicians, nurses, advance practice health professionals, pharmacists, physical therapists, occupational therapists, and social workers.

AB1088,,82 d. Ability to electronically exchange health information.

AB1088,,83 e. Resources to conduct patient intake and discharge planning from the post-acute facility, including case managers and social workers.

AB1088,,84 f. Ability to conduct monthly case management reviews with the interdisciplinary team for every complex care patient that cover care plan progress and any readmissions to an acute care hospital.

AB1088,,85 g. Ability to conduct monthly quality assurance reviews.

AB1088,,86 h. Ability of the treatment model to be replicated by other healthcare systems.

AB1088,,87 i. Plans to document decreases in lengths of stay for complex patients in hospitals and avoided hospital days.

AB1088,,88 j. Documentation of stable finances among partnership group members to support the proposal, including matching funds that could be dedicated to the pilot program under this subsection. No applicant may be required to provide matching funds or a contribution, but the department may take into consideration the availability of matching funds or a contribution in evaluating an application.

AB1088,,89 k. Description of anticipated impediments to successful implementation and how the partnership group intends to overcome the anticipated impediments.

AB1088,,90 (e) In implementing this subsection, the department shall do all of the following:

AB1088,,91 1. Reserve 10 percent of the funding appropriated under s. 20.435 (7) (d) for the complex patient pilot program for reconciliation to help address unanticipated costs.

AB1088,,92 2. Develop a methodology to evaluate the complex patient pilot program and contract with an independent organization to complete the evaluation. The department may pay the fee of the organization selected from the appropriation under s. 20.435 (7) (d).

AB1088,,93 3. Give additional weight to partnership groups that would ensure geographic diversity.

AB1088,,94 (end)