WSHA was notified by Health Care Authority (HCA) staff that the Centers for Medicare and Medicaid Services (CMS) approved a State Plan Amendment (SPA) for changes to Medicaid payment under Senate Bill 5103. SB 5103 requires separate payment to the hospital for medically necessary ancillary services in addition to the per diem administrative day rate when a Medicaid patient that no longer requires inpatient care cannot be discharged to a more appropriate facility. SB 5103 was one of WSHA’s major legislative initiatives for the 2023 session.
Effective for admissions on or after January 1, 2024, HCA and the Medicaid managed care organizations (MCOs) will cover as separate expenses medically necessary laboratory, radiology, and dialysis, and therapy services billed under the following revenue codes:
300, 301, 305, 306, 307, 309, 310, 311, 312, 314, 320, 324, 350, 351, 352, 420, 424, 429, 430, 434, 440, 441, 444, 615, 800, 801, 802, 803, 809, 829, 881
HCA will release an updated billing guide to reflect the changes and is working with the MCOs to ensure standardization of the approval and payment process for administrative days. (Andrew Busz, andrewb@wsha.org)
