Bedday Allocation Plan

1. Bedday Allocation Plan July 1, 2003

2. BAP 1996 • In preparation for planned Medicaid waiver, State hospital bedday allocation plan implemented July 1, 1996 • Allocation of beddays at 5% over FY95 utilization level, for adults only • No incentives for lower bedday utilization

3. Current Utilization

4. State Hospital Target Populations • Acute adult admissions • Long-term adult • Acute adolescent admissions • Acute older adult admissions • Adults with MI/SA

5. Special Populations • Forensic patients • Research protocol patients • Deaf consumers

6. Services to be Discontinued • Skilled and intermediate nursing • Geriatric long-term • Latency child • PRTF (adolescent residential)

7. Services to be Reduced • Adult long-term • Adolescent admissions • Adult admissions • Medical

8. FY2001 Average Daily Census

9. Downsizing Schedule All Hospitals

10. Downsizing Schedule for Broughton

11. Downsizing Schedule for Cherry

12. Downsizing Schedule for Dix

13. Downsizing Schedule for Umstead

14. Target Bed Capacity FY2007

15. BAP Re-Development • In Session 2001, SB 1005, Section 21.68A directed DHHS to develop and implement plan to allocate hospital beds among counties • BAP developed in early 2003 by workgroup of representatives of DMH, the hospitals, and area programs.

16. Plan Distribution • March 2003, draft BAP distributed to area programs and hospitals for review • May 2003 distribution to area programs and hospitals. • Allocation of beddays for FY2004 • Projected allocation of beddays for FY2005-2007 • BAP

17. Basis for Allocation • Tracks hospital bed downsizing schedule • Transitions from utilization to per capita allocation basis • Starts at average utilization for FYs2000-2002

18. Allocation Categories • Adult admissions • Adult long-term • Geriatric admissions • Adolescent

19. Allocation Change

20. Authorization Types • Initial authorization • Re-authorization • Standardized number format to be announced

21. Authorization Minimums • Adult admissions = 3 days • Geriatric = 3 days • Adolescent admission = 6 days • Adult long-term = 30 days

22. Non-Authorized Services • Nursing facility • Research • TB Unit • Medical/Infirmary • Forensic • Out of state • LOA • Deaf Services Unit

23. Authorization Timelines • Referred patients: authorization to accompany referral • Non-referred patients: authorization issued within 1 hour of notification of hospital assessment for admission • Emergency admissions: authorization issued within 1 hour of notification by hospital

24. Re-Authorization Timelines • Long-term patients: re-auth request to be submitted 2 weeks prior to expiration, with response within 1 week • Admission patients: re-auth request to be submitted 1 working day prior to expiration, with response within 1 working day

25. Authorization Pending D/C Approval • For patients leaving long-term units subject to discharge plan approval by DMH, authorization must be continued until discharge plan is approved. • LME may appeal delay of development of discharge plan if indicated.

26. Responsible LME • LME responsible for authorization based on 10 NCAC 15A .0117 • County of responsibility = county of residence as defined by 10 NCAC 15A .0116 and G.S. 122C-3.

27. Tracking Utilization • Bedday utilization tracked by category • For over-utilization, a charge per bedday per category will be applied at fiscal year-end • Over-utilization charge reverts to DMH for use in further service capacity development

28. Authorization of Current Patients • Need to authorize stays for patients in-house effective July 1 • Hospitals to send to area programs list of current patients by service category by June 15 and updated list on June 30 • Authorizations based on minimums by category to be sent to hospital by July 1.