HB279INTRODUCED
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2YF5SI-1
By Representative South
RFD: Ways and Means General Fund
First Read: 11-Apr-23
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5 2YF5SI-1 04/06/2023 PMG (L)tgw 2023-1392
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SYNOPSIS:
Certain nursing facilities provide health care
services to Medicaid patients and are reimbursed at
specific rates. The Alabama Medicaid Agency, with
guidance from state law, sets by rule the methodology
used to establish reimbursement rates and the ceiling
for those rates.
Under an existing administrative rule of the
Alabama Medicaid Agency, once the ceiling is
established, the ceiling may not be revised for that
fiscal year except for material error.
This bill would authorize the Alabama Medicaid
Agency to revise the ceiling during a fiscal year if
nursing facilities are unable to be reimbursed for
increases in allowable costs that were required to be
expended by nursing facilities due to certain
unforeseen circumstances.
This bill would also make nonsubstantive,
technical revisions to update the existing code
language to current style.
A BILL
TO BE ENTITLED
AN ACT
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Relating to Medicaid; to amend Section 40-26B-26, Code
of Alabama 1975, to revise the circumstances under which the
Alabama Medicaid Agency may revise the ceiling for the
Medicaid reimbursement rate to nursing facilities during a
given fiscal year; and to make nonsubstantive, technical
revisions to update the existing code language to current
style.
BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
Section 1. Section 40-26B-26, Code of Alabama 1975, is
amended to read as follows:
"ยง40-26B-26
(a) No revenues resulting from the privilege assessment
established by this article and applied to increases in
covered services or reimbursement levels or other enhancements
of the Medicaid program shall be subject to reduction or
elimination while the privilege assessment is in effect.
(b) Every nursing facility participating in the
Medicaid program in the State of Alabama shall be reimbursed
according to the reimbursement methodology contained in
Chapter 560-X-22 of the Alabama Medicaid Agency Administrative
Code (Supp. 12/31/95) on January 31, 1998 , which methodology
is incorporated by reference herein, except that the following
shall apply:
(1) The ceiling for the operating cost center described
in Title Rule 560-X-22-.06 (2)(a) of the Alabama Medicaid
Agency Administrative Code (Supp. 12/95) shall be computed at
the median plus five percent.
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(2) The ceiling for the direct patient care cost center
described in Title Rule 560-X-22-.06 (2)(b) of the Alabama
Medicaid Agency Administrative Code (Supp. 12/95) shall be
computed at the median plus 10 percent, and the provider's
actual allowable reported cost per patient day plus 11
percent, or the established ceiling plus 11 percent, whichever
is less, will be used for each provider's rate computation.
(3) The Medicaid Inflation Index described in Title
Rule 560-X-22-.07 of the Alabama Medicaid Agency
Administrative Code (Supp. 12/95) shall be computed without
regard to the trend factor variance described in Title Rule
560-X-22-.07 (5)(4) of the Alabama Medicaid Agency
Administrative Code (Supp. 12/95).
(4) In calculating the ceiling for the operating cost
center, the direct patient care cost center or the indirect
patient care cost center, any increase in that ceiling over
such ceiling set in the year next preceding, shall not exceed
an amount equal to the product of such ceiling for the
previous year times the sum of the Medicaid Inflation Index,
described in Title Rule 560-X-22-.07 of the Alabama Medicaid
Agency Administrative Code (Supp. 12/95), plus four percent.
(5) In determining the reimbursement in any fiscal year
to a nursing facility for certain specialized medical
equipment as described in Title Rule 560-X-22-.14 (19) of the
Alabama Medicaid Agency Administrative Code (Supp. 12/95),
there shall be added to the daily Medicaid per diem rate
computed for that fiscal year, without regard to the cost of
such specialized medical equipment, an amount equal to the
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actual cost of such specialized medical equipment utilized for
Medicaid residents during the fiscal year next preceding and
divided by the actual number of Medicaid patient days incurred
during that preceding fiscal year. For the purpose of this
subdivision, the terms Medicaid patient days, Medicaid per
diem rate, and fiscal year shall have the meanings assigned to
them in Title Chapter 560-X-22 et seq. of the Alabama Medicaid
Agency Administrative Code (Supp. 12/95).
(6) For the period that the federal financial
participation under Title XIX of the Social Security Act for
certain intergovernmental transfers is available to the
Alabama Medicaid program, the commissioner of the agency may
pay an enhancement, not to exceed the upper limits for
Medicare nursing facility payments, to rural hospital
connected nursing facilities under governmental authority or
control. Notwithstanding the foregoing, the enhancement shall
not be limited by the provisions of Title Chapter 560-X-22 of
the Alabama Medicaid Agency Administrative Code.
(7) Notwithstanding subdivision (3), from October 1,
2011, through September 30, 2014, in applying the inflation
factor, zero percent shall be used to compute overall rates.
(8) Beginning with the setting of Medicaid nursing
facility rates based on the cost reporting period ended June
30, 2020, the current asset value ,(as described in Rule
560-X-22-.14(11) of the Alabama Medicaid Agency Administrative
Code), for each nursing facility, after applying the July 1,
2020, rebasing as provided under Rule 560-X-22-.14(11) of the
Alabama Medicaid Administrative Code, used to calculate
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nursing facility rates, shall be recalculated by adding to
each respective nursing facility's current asset value an
amount equal to the product derived by multiplying the June
30, 2020, rebasing as provided under Rule 560-X-22-.14(11) of
the Alabama Medicaid Agency Administrative Code by 41.03%. The
current asset value as adjusted herein, shall be rebased each
subsequent year in accordance with Rule 560-X-22.14 of the
Alabama Administrative Code, and applied to calculate Medicaid
nursing facility rates each subsequent cost reporting year.
Notwithstanding anything to the contrary in the foregoing, for
the purposes of applying the recalculated current asset value
to calculate a nursing facility's Medicaid rate for the cost
reporting year beginning July 1, 2020, any resulting rate
increase shall be effective for services provided on or after
October 1, 2020. No nursing facility Medicaid rate increase
for the recalculation of current asset value described in this
subdivision shall be effective for services provided prior to
October 1, 2020.
(9) For purposes of revising or adjusting the ceiling
under Rule 560-X-22-.06(3) of the Alabama Administrative Code,
once the ceiling has been established for a fiscal year, it
shall be final and not subject to revision or adjustment
during that year, except as provided in this subdivision. At
the discretion of the agency, the ceiling may be revised or
adjusted upon either the discovery of a material error or upon
a determination by the commissioner that it is necessary to
increase one or more of the ceilings in the event nursing
facilities are unable to be reimbursed for increases in
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allowable costs that were required to be expended by nursing
facilities to meet a nationwide or statewide public health
emergency or because of a new federal or state law or
regulation or a statewide uncontrollable catastrophic event
affecting a majority of nursing facilities, and the resulting
increase in allowable costs would not be reimbursed due to the
annual ceiling increase limitation set forth in Rule
560-X-22-.06(2) of the Alabama Administrative Code. Because
the ceiling rate is based on information provided in the cost
reports, it is to the benefit of each provider to ensure that
the provider's information is correct and accurate. If obvious
errors are detected during the desk audit process, providers
shall be given an opportunity to submit corrected data to the
agency.
(c) Payments by the Medicaid program to each nursing
facility for nursing home services shall be sufficient to
cover the costs determined by cost reporting principles
incurred by each such nursing facility in providing care in an
economical and efficient manner and that is adequate to permit
the provision of care and services necessary to attain or
maintain the highest practicable, physical, mental, and
psychosocial well-being of each resident eligible for Alabama
Medicaid nursing home benefits in conformity with applicable
state and federal laws, rules, and regulations and quality and
safety standards.
(d) Notwithstanding subsection (b), Medicaid shall be
empowered to create a special reimbursement model to
accommodate enhanced reimbursed care provided in dedicated
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ventilator units in nursing facilities that meet special
physical plant requirements such as dedicated emergency power
generation, through-the-wall medical gases and suction,
24-hour per day staffing with trained licensed respiratory
therapists, and medical direction through contract with or
employment of an Alabama licensed physician who is a board
certified pulmonologist.
(e)(1) Notwithstanding subsection (b), the Alabama
Medicaid Agency may create a quality incentive program for
nursing facilities that meet certain quality measures during
the scoring year. For the purpose of this subsection, the
scoring year for any year is the cost reporting year beginning
July 1 and ending June 30. The first scoring period shall be
July 1, 2020, through June 30, 2021. The quality incentive
shall be paid to nursing facilities in a lump sum on or before
February 1, following the scoring period ended the immediately
prior June 30. For each scoring year, the Alabama Medicaid
Agency shall establish a quality incentive fund of not less
than $5,000,000, from which quality incentive awards will be
awarded and paid to those nursing facilities qualifying for a
quality incentive award. Quality incentive scoring for each
scoring period shall be determined from certain measures
selected by the Alabama Medicaid Agency from both of the
following:
a. Five of the MDS Quality Measures compiled by the
Centers for Medicare and Medicaid Services (CMS), Department
of Health and Human Services.
b. Three of customer satisfaction survey categories
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that are independently gathered and prepared by NRC Health, or
another nationally recognized satisfaction survey company with
experience in the long term care field.
(2) The Alabama Medicaid Agency shall determine the
manner that scoring points are awarded, provided that to be
eligible to earn points for any category, a nursing facility
must do either of the following:
a. Show improvement in that category during the current
scoring period over the most recent prior scoring period.
b. Rank for that category at or above the established
national average."
Section 2. This act shall become effective on the first
day of the third month following its passage and approval by
the Governor, or its otherwise becoming law.
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