Bedday Allocation Plan

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Bedday Allocation Plan

• July 1, 2003

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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

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Current Utilization
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State Hospital Target Populations

• Acute adult admissions
• Long-term adult
• Acute adolescent admissions
• Acute older adult admissions
• Adults with MI/SA

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Special Populations

• Forensic patients
• Research protocol patients
• Deaf consumers

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Services to be Discontinued

• Skilled and intermediate nursing
• Geriatric long-term
• Latency child
• PRTF (adolescent residential)

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Services to be Reduced

• Adult long-term
• Adolescent admissions
• Adult admissions
• Medical

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FY2001 Average Daily Census
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Downsizing Schedule All Hospitals
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Downsizing Schedule for Broughton
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Downsizing Schedule for Cherry
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Downsizing Schedule for Dix
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Downsizing Schedule for Umstead
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Target Bed Capacity FY2007
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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.

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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

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Basis for Allocation

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

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Allocation Categories

• Adult admissions
• Adult long-term
• Geriatric admissions
• Adolescent

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Allocation Change
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Authorization Types

• Initial authorization
• Re-authorization
• Standardized number format to be announced

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Authorization Minimums

• Adult admissions 3 days
• Geriatric 3 days
• Adolescent admission 6 days
• Adult long-term 30 days

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Non-Authorized Services

• Nursing facility
• Research
• TB Unit
• Medical/Infirmary
• Forensic
• Out of state
• LOA
• Deaf Services Unit

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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

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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

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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.

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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.

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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

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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.

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