This bill requires the Department of Health Services to provide reimbursement
or a supplemental payment to hospitals under the Medical Assistance program for
providing nursing-facility-level custodial care. To receive reimbursement or a
supplemental payment, the hospital must notify DHS that it is participating as a
swing bed hospital under the Medical Assistance program and providing custodial
care for which federal financial participation is approved to an individual who is
eligible for discharge after receiving inpatient care in the hospital, who needs
nursing-facility-level care, and for whom the hospital is unable to locate a nursing
facility that accepts the individual for admission. If providing reimbursement
instead of a supplemental payment, DHS must pay the hospital the statewide
average per-diem rate paid to nursing facilities. DHS must use the same standards
and eligibility criteria as the federal Medicare program uses to determine
reimbursement for swing beds or, for hospitals that are not critical access hospitals,
the terms of a federal waiver issued during the federally declared national
emergency related to the 2019 novel coronavirus. This requirement to reimburse

hospitals for providing nursing facility care applies until January 1, 2022, or until
the termination of any public health emergency declared by the secretary of the
federal Department of Health and Human Services related to the 2019 novel
coronavirus, whichever is earlier.

The bill requires DHS to provide reimbursement or a supplemental payment
through the Medical Assistance program to a hospital for services provided on an
outpatient basis that are usually reimbursed when provided at the hospital's
inpatient facility but are provided at the hospital's outpatient facility due to the 2019
novel coronavirus pandemic. To receive reimbursement or supplemental payment
under the bill, the outpatient services must be approved for federal financial
participation and must be provided in a facility that is operated by the hospital and
is certified for outpatient services under the federal Medicare program, including
under the terms of a federal waiver issued during the federally declared national
emergency related to the 2019 novel coronavirus. DHS must seek any federal
approval necessary to provide the reimbursement or supplemental payment. The
payment requirement applies until the conclusion of a public health emergency
declared by the secretary of the federal Department of Health and Human Services
in response to the 2019 novel coronavirus or until January 1, 2022, whichever is
earlier.

The bill requires DHS to provide, semiannually, to any health care data
aggregator all fee-for-service and managed care encounter claims data and data
specifications for the Medical Assistance program. A health care data aggregator is
a data organization or entity that collects, analyzes, and disseminates health care
information under current law and requests that DHS provide the data to it. Current
law provides that a data organization contracts with the state to analyze and report
health care claims information collected from insurers and administrators and
provides that an entity is under contract to collect, analyze, and disseminate claims
and other health information from hospitals and ambulatory surgery centers. Either
the data organization, the entity, or both could be a health care data aggregator
under the bill.

Under the bill, after DHS provides a health care data aggregator with the
Medical Assistance data, the health care data aggregator, within five days or a longer
period specified by DHS, must create a data set with information from which has
been eliminated the ability to trace the information back to a specific patient and
then destroy the original data. Once the patient information cannot be traced back
to a specific patient the information is known as de-identified health information.
The health care data aggregator must make the de-identified data set available to
the public and may disseminate custom data sets and reports containing
de-identified health information. This de-identified health information must meet
the requirements in the federal Health Insurance Portability and Accountability
Act, or HIPAA, for ensuring that patient information is not individually identifiable.
HIPAA generally requires that health information that identifies a specific
individual be kept confidential except for treatment, billing, and other limited

purposes but allows the use of health information if it cannot identify the individual.
The health care data aggregator, in its treatment of the Medical Assistance data
received under the bill, must comply with the same patient confidentiality
requirements as apply to its collection of data under current law.

The bill specifies standards for certain services provided by hospitals in a home
setting and reimbursement under the Medical Assistance program for those
services. These “hospital-associated services” are defined in the bill as health care
services that are the same type of services as those provided by a hospital in an
inpatient or outpatient facility, that are of the type for which a federal Medicare
payment could be claimed as a hospital service, and that are provided in a home
setting and not in a setting that is approved as a hospital by DHS. If the federal
Centers of Medicare and Medicaid Services (CMS) has approved a hospital to provide
any hospital-associated service, DHS may apply and enforce as the state standard
for the service the CMS rule or standard on the hospital. A hospital that complies
with the bill is not required to be licensed as a home health agency to provide
hospital-associated services.

The Medical Assistance program is a joint federal and state program that
provides health services to individuals who have limited financial resources, and the
Medical Assistance program certifies and provides reimbursement to providers,
including hospitals, for those health services that are covered by the program. The
bill specifies that hospital-associated services provided by a hospital in accordance
with the bill and that are of the type for which Medicare payment could be claimed
as inpatient hospital services must be included and reimbursed or paid as inpatient
services under the Medical Assistance program. All of the bill's provisions regarding
services provided by a hospital in a home setting apply only before January 1, 2022.

The bill authorizes, in certain situations, health care providers licensed in
another state or territory to provide services for which they are licensed or certified.
Under the bill, a person who satisfies certain requirements and holds a valid,
unexpired credential in another state or territory as any of the following may provide
services in this state: 1) a physician, physician assistant, or perfusionist; 2) a nurse;
3) a dentist; 4) a pharmacist; 5) a psychologist; 6) a social worker, marriage and
family therapist, professional counselor, or clinical substance abuse counselor; 7) a
chiropractor; 8) a physical therapist; 9) a podiatrist; 10) a dietitian; 11) an athletic
trainer; 12) an occupational therapist; 13) an optometrist; 14) an acupuncturist; 15)
a speech-language pathologist or audiologist; or 16) a massage or bodywork
therapist. Generally, these practitioners may practice in this state and the
Department of Safety and Professional Services must grant them a temporary
credential if they apply for a temporary credential within 30 days of beginning to
practice for a health care employer.