SENATE DOCKET, NO. 440        FILED ON: 1/16/2013

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 565

 

The Commonwealth of Massachusetts

_________________

PRESENTED BY:

Karen E. Spilka

_________________

To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act to address inequities in MassHealth readmission penalties.

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PETITION OF:

 

Name:

District/Address:

Karen E. Spilka

Second Middlesex and Norfolk

Michael R. Knapik

Second Hampden and Hampshire


SENATE DOCKET, NO. 440        FILED ON: 1/16/2013

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 565

By Ms. Spilka, a petition (accompanied by bill, Senate, No. 565) of Karen E. Spilka and Michael R. Knapik for legislation to prevent inequities in MassHealth readmission penalties.  Health Care Financing.

 

The Commonwealth of Massachusetts

 

_______________

In the Year Two Thousand Thirteen

_______________

 

An Act to address inequities in MassHealth readmission penalties.

 

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1: Notwithstanding chapter 118E of the General Laws, or any other general or special law or rule or regulation to the contrary, any financial penalty applied by the Executive Office of Health and Human Services related to hospital readmissions shall be assessed solely on the number of actual potentially preventable readmissions that exceed the number of expected potentially preventable readmissions as determined by the executive office using a statewide average and adjusting for individual hospital case-mix.  Such financial penalty shall not exceed the product of the number of discharges exceeding the expected number of potentially preventable readmissions multiplied by no more than 75 percent of the hospital’s Medicaid reimbursement rate for inpatient services. 

Provided further, for any hospital where the ratio of the number of actual potentially preventable readmissions compared to the number of expected potentially preventable readmissions is less than the ratio the executive office determined in the previous year, such financial penalty shall not exceed the product of the number of discharges exceeding the expected number of potentially preventable readmissions multiplied by no more than 37.5 percent of the hospital’s Medicaid reimbursement rate for inpatient services.