1 HB285
2 216689-2
3 By Representative Clouse
4 RFD: Ways and Means General Fund
5 First Read: 08-FEB-22
Page 0 HB285
1
2 ENROLLED, An Act,
3 Relating to the privilege assessment for nursing
4 homes; to amend Section 40-26B-21, Code of Alabama 1975; to
5 extend the supplemental privilege assessment, the secondary
6 supplemental privilege assessment, and the surcharge through
7 August 31, 2025; and provide that the Medicaid nursing
8 facility program be administered by the Alabama Medicaid
9 Agency during the period that the privilege assessment is
10 levied and collected.
11 BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
12 Section 1. Section 40-26B-21, Code of Alabama 1975,
13 is amended to read as follows:
14 "ยง40-26B-21.
15 "To provide further for the availability of indigent
16 health care, the operation of the Medicaid program, and the
17 maintenance and expansion of medical services:
18 "(a) There is levied and shall be collected a
19 privilege assessment on the business activities of every
20 nursing facility in the State of Alabama. The privilege
21 assessment imposed is in addition to all other taxes and
22 assessments, and shall be at the annual rate of one thousand
23 eight hundred ninety-nine dollars and ninety-six cents
24 ($1,899.96) for each bed in the nursing facility. Beginning
25 September 1, 2020, the privilege assessment shall be increased
Page 1 HB285
1 from one thousand eight hundred ninety-nine dollars and
2 ninety-six cents ($1,899.96) for each bed in the nursing
3 facility, by an addition to the privilege assessment equal to
4 three hundred twenty-seven dollars and forty-eight cents
5 ($327.48) per annum. The addition to the privilege assessment
6 shall be paid in equal monthly installments and shall merge
7 into and be a part of the privilege assessment described in
8 this subsection. The payment to nursing facilities of the
9 determined allowable costs in respect to the addition to the
10 privilege assessment described in this subsection shall be
11 included in Medicaid per diem rates for services provided
12 commencing as of October 1, 2020, and shall continue to be
13 included in such Medicaid per diem rates in the same manner
14 that reimbursement for the privilege assessment is included in
15 Medicaid per diem rates. For each Medicaid nursing facility,
16 in determining the October 1, 2020 adjustment to the Medicaid
17 per diem for the allowable costs associated with the addition
18 to the privilege assessment, the Medicaid Agency shall divide
19 the total addition to the privilege assessment by the total of
20 all incurred resident days (regardless of payor class)
21 reported by each nursing facility in its Medicaid cost report
22 filed for the period then ended June 30, 2019. Notwithstanding
23 the foregoing, in the event that the June 30, 2019 cost report
24 is for a period of less than one year, the resident days
25 reported shall be annualized. After the October 1, 2020
Page 2 HB285
1 adjustment under this subsection, the addition to the
2 privilege assessment shall be fully merged into the privilege
3 assessment and reimbursed in accordance with the method set
4 forth for calculating the reimbursement for the privilege
5 assessment. In the event that any portion of the privilege
6 assessment paid by a facility cannot be included in the
7 computation of Medicaid per diem rate because of the effect of
8 any cost ceiling provision of the reimbursement methodology,
9 the cost ceiling shall be adjusted to ensure continued
10 treatment of the total privilege assessments as an allowable
11 cost.
12 "(b) For the period September 1, 2010, through
13 August 31, 2022 2025, there is levied and shall be collected a
14 supplemental privilege assessment on the business activities
15 of every nursing facility in the State of Alabama. The
16 supplemental privilege assessment imposed is in addition to
17 all other taxes and assessments, including without limitation,
18 the privilege taxes provided for under this article, and from
19 September 1, 2010, through August 31, 2011, shall be at the
20 annual rate of one thousand and sixty-three dollars and eight
21 cents ($1,063.08) for each bed in the nursing facility, and
22 one thousand six hundred three dollars and eight cents
23 ($1,603.08) for the period of September 1, 2011, through
24 August 31, 2022 2025, except that beginning with the monthly
25 payment for the supplemental privilege assessment due
Page 3 HB285
1 beginning May 20, 2012, and ending August 31, 2022 2025, there
2 shall be a monthly surcharge due with each monthly payment of
3 the supplemental privilege assessment. The initial monthly
4 surcharge shall be one hundred thirty-one dollars and
5 twenty-five cents ($131.25) per licensed bed. Beginning with
6 the monthly payment of the supplemental privilege assessment
7 due on September 20, 2012, the monthly surcharge shall be
8 reduced to forty-three dollars and seventy-five cents ($43.75)
9 per month.
10 "For the period October 1, 2015, through August 31,
11 2022 2025, there shall be collected a secondary supplemental
12 privilege assessment on the business activities of every
13 nursing facility in the State of Alabama. The secondary
14 supplemental privilege assessment imposed in this paragraph is
15 contingent upon the minimum appropriation provided in Section
16 2 of Act 2015-536, and is in addition to all other taxes and
17 assessments, including without limitation, the privilege taxes
18 provided for under this article, and beginning October 1,
19 2015, shall be at the annual rate of four hundred one dollars
20 and twenty-eight cents ($401.28) for each bed in the nursing
21 facility, payable monthly.
22 "(c) The total privilege assessment (and the
23 addition to the privilege assessment), supplemental privilege
24 assessment, secondary privilege assessment, (privilege
25 assessments) and surcharge paid by a nursing facility pursuant
Page 4 HB285
1 to this article shall be considered an allowable cost, as that
2 term is defined in the reimbursement methodology for nursing
3 facilities contained in Title 560 of the Alabama
4 Administrative Code, and, to the extent permitted under
5 applicable federal law governing the Alabama Medicaid nursing
6 home program, the total privilege assessments paid must be
7 included in the computation of the Medicaid per diem rate
8 determined under the reimbursement methodology for nursing
9 facilities contained in Title 560 of the Alabama
10 Administrative Code. The payment to nursing facilities of the
11 determined allowable costs in respect to the supplemental
12 privilege assessment described in subsection (b) shall be
13 included in Medicaid per diem rates for services provided
14 commencing as of January 1, 2011, and shall continue to be
15 included in such Medicaid per diem rates for a period equal to
16 the number of months during which the supplemental assessments
17 shall have been in effect. For each Medicaid nursing facility,
18 in determining the adjustment to the Medicaid per diem for the
19 allowable costs associated with the supplemental assessment,
20 the Medicaid Agency shall divide the total supplemental
21 assessment due under subsection (b) by the total of all
22 incurred resident days (regardless of payor class) reported by
23 such nursing facility in its Medicaid cost report filed for
24 the period then ended June 30, 2010. To accommodate the
25 increase in the supplemental assessment and the surcharge
Page 5 HB285
1 described in subsection (b), the agency shall use the
2 mechanism described herein to adjust each nursing facility's
3 rate effective as of October 1, 2011, regarding the privilege
4 assessment, and May 1, 2012, regarding the surcharge.
5 Notwithstanding the foregoing, in the event that such cost
6 report shall be for a period less than one year, the resident
7 days reported shall be annualized. In the event that any
8 portion of the privilege assessment paid by a facility cannot
9 be included in the computation of the Medicaid per diem rate
10 because of the effect of any cost ceiling provision of the
11 reimbursement methodology, the cost ceiling must be adjusted
12 to ensure continued treatment of the total privilege
13 assessments as an allowable cost.
14 "(d) The privilege assessment rate or the
15 supplemental privilege assessment rate or the surcharge rate
16 shall be reduced by the department upon the advice of the
17 Medicaid Agency if, but only if, such reduction is required to
18 ensure that the total revenues to the State of Alabama
19 produced by this privilege assessment or, if the supplemental
20 privilege assessment and surcharge are in effect, the
21 aggregate of the supplemental privilege assessment and
22 surcharge and the privilege assessment, during any state
23 fiscal year are less than or equal to six percent of the total
24 revenues received by the nursing facilities in the state
25 subject to the assessment during that same fiscal year. In the
Page 6 HB285
1 event that the supplemental privilege assessment or surcharge
2 are reduced as provided in the preceding sentence, then for
3 each Medicaid nursing facility a corresponding reduction shall
4 be made to the Medicaid per diem adjustment described in
5 subsection (c) to ensure that only the amount of supplemental
6 privilege assessment or surcharge actually paid is used in
7 computing that Medicaid nursing facility's allowable costs.
8 "(e) The Medicaid nursing facility program shall
9 continue to be administered directly by the Medicaid Agency
10 until at least October 1, 2022 during the period in which the
11 provider assessment provided by this section is levied and
12 collected."
13 Section 2. This act shall become effective
14 immediately following its passage and approval by the
15 Governor, or its otherwise becoming law.
Page 7 HB285
1
2
3
4
Speaker of the House of Representatives
5
6 President and Presiding Officer of the Senate
House of Representatives7
I hereby certify that the within Act originated in8
9 and was passed by the House 17-FEB-22.
10
11 Jeff Woodard
12 Clerk
13
14
15
Senate16 02-MAR-22 Passed
17
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