services required by the individual, geography and other
relevant factors.
(5) Remain actively engaged and seek to obtain admission
of the individual until a placement has been secured.
(6) Once a responsible entity has exhausted its network
and appropriate out-of-network options, or after another 48
hours has elapsed from a request for assistance, the
responsible entity shall notify the department of the failure
to find the necessary placement.
(c) Department responsibilities.--The department shall,
after being notified of the failure to find medically
appropriate placement under subsection (b)(6):
(1) Establish an internal team to work with the
responsible entity to determine next steps to address
barriers to a postacute placement in a timely matter.
(2) If a barrier is clinically based, convene
conversations with clinical leaders of the responsible entity
to understand and resolve these barriers.
(3) If a barrier to admission requires other State
agencies to resolve the issue, convene a conference call with
the appropriate State agency representatives, providers,
responsible entities and other payors as well as others
needed to resolve the issues.
(4) If a barrier concerns payment, facilitate a
discussion with the responsible entity, the Insurance
Department and the department, as appropriate. The department
and the Insurance Department shall TO address network
adequacy and payment issues with the responsible entity AND
CONSULT WITH THE INSURANCE DEPARTMENT, AS MAY BE APPROPRIATE,
TO ADDRESS NETWORK ADEQUACY ISSUES.
20210HB1644PN3043 - 4 -
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