Alabama 2023 Regular Session

Alabama House Bill HB279 Compare Versions

Only one version of the bill is available at this time.

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1	1	HB279INTRODUCED
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3	3	2YF5SI-1
4	4	By Representative South
5	5	RFD: Ways and Means General Fund
6	6	First Read: 11-Apr-23
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11	11	5 2YF5SI-1 04/06/2023 PMG (L)tgw 2023-1392
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13	13	SYNOPSIS:
14	14	Certain nursing facilities provide health care
15	15	services to Medicaid patients and are reimbursed at
16	16	specific rates. The Alabama Medicaid Agency, with
17	17	guidance from state law, sets by rule the methodology
18	18	used to establish reimbursement rates and the ceiling
19	19	for those rates.
20	20	Under an existing administrative rule of the
21	21	Alabama Medicaid Agency, once the ceiling is
22	22	established, the ceiling may not be revised for that
23	23	fiscal year except for material error.
24	24	This bill would authorize the Alabama Medicaid
25	25	Agency to revise the ceiling during a fiscal year if
26	26	nursing facilities are unable to be reimbursed for
27	27	increases in allowable costs that were required to be
28	28	expended by nursing facilities due to certain
29	29	unforeseen circumstances.
30	30	This bill would also make nonsubstantive,
31	31	technical revisions to update the existing code
32	32	language to current style.
33	33	A BILL
34	34	TO BE ENTITLED
35	35	AN ACT
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65	65	Relating to Medicaid; to amend Section 40-26B-26, Code
66	66	of Alabama 1975, to revise the circumstances under which the
67	67	Alabama Medicaid Agency may revise the ceiling for the
68	68	Medicaid reimbursement rate to nursing facilities during a
69	69	given fiscal year; and to make nonsubstantive, technical
70	70	revisions to update the existing code language to current
71	71	style.
72	72	BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
73	73	Section 1. Section 40-26B-26, Code of Alabama 1975, is
74	74	amended to read as follows:
75	75	"§40-26B-26
76	76	(a) No revenues resulting from the privilege assessment
77	77	established by this article and applied to increases in
78	78	covered services or reimbursement levels or other enhancements
79	79	of the Medicaid program shall be subject to reduction or
80	80	elimination while the privilege assessment is in effect.
81	81	(b) Every nursing facility participating in the
82	82	Medicaid program in the State of Alabama shall be reimbursed
83	83	according to the reimbursement methodology contained in
84	84	Chapter 560-X-22 of the Alabama Medicaid Agency Administrative
85	85	Code (Supp. 12/31/95) on January 31, 1998 , which methodology
86	86	is incorporated by reference herein, except that the following
87	87	shall apply:
88	88	(1) The ceiling for the operating cost center described
89	89	in Title Rule 560-X-22-.06 (2)(a) of the Alabama Medicaid
90	90	Agency Administrative Code (Supp. 12/95) shall be computed at
91	91	the median plus five percent.
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121	121	(2) The ceiling for the direct patient care cost center
122	122	described in Title Rule 560-X-22-.06 (2)(b) of the Alabama
123	123	Medicaid Agency Administrative Code (Supp. 12/95) shall be
124	124	computed at the median plus 10 percent, and the provider's
125	125	actual allowable reported cost per patient day plus 11
126	126	percent, or the established ceiling plus 11 percent, whichever
127	127	is less, will be used for each provider's rate computation.
128	128	(3) The Medicaid Inflation Index described in Title
129	129	Rule 560-X-22-.07 of the Alabama Medicaid Agency
130	130	Administrative Code (Supp. 12/95) shall be computed without
131	131	regard to the trend factor variance described in Title Rule
132	132	560-X-22-.07 (5)(4) of the Alabama Medicaid Agency
133	133	Administrative Code (Supp. 12/95).
134	134	(4) In calculating the ceiling for the operating cost
135	135	center, the direct patient care cost center or the indirect
136	136	patient care cost center, any increase in that ceiling over
137	137	such ceiling set in the year next preceding, shall not exceed
138	138	an amount equal to the product of such ceiling for the
139	139	previous year times the sum of the Medicaid Inflation Index,
140	140	described in Title Rule 560-X-22-.07 of the Alabama Medicaid
141	141	Agency Administrative Code (Supp. 12/95), plus four percent.
142	142	(5) In determining the reimbursement in any fiscal year
143	143	to a nursing facility for certain specialized medical
144	144	equipment as described in Title Rule 560-X-22-.14 (19) of the
145	145	Alabama Medicaid Agency Administrative Code (Supp. 12/95),
146	146	there shall be added to the daily Medicaid per diem rate
147	147	computed for that fiscal year, without regard to the cost of
148	148	such specialized medical equipment, an amount equal to the
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178	178	actual cost of such specialized medical equipment utilized for
179	179	Medicaid residents during the fiscal year next preceding and
180	180	divided by the actual number of Medicaid patient days incurred
181	181	during that preceding fiscal year. For the purpose of this
182	182	subdivision, the terms Medicaid patient days, Medicaid per
183	183	diem rate, and fiscal year shall have the meanings assigned to
184	184	them in Title Chapter 560-X-22 et seq. of the Alabama Medicaid
185	185	Agency Administrative Code (Supp. 12/95).
186	186	(6) For the period that the federal financial
187	187	participation under Title XIX of the Social Security Act for
188	188	certain intergovernmental transfers is available to the
189	189	Alabama Medicaid program, the commissioner of the agency may
190	190	pay an enhancement, not to exceed the upper limits for
191	191	Medicare nursing facility payments, to rural hospital
192	192	connected nursing facilities under governmental authority or
193	193	control. Notwithstanding the foregoing, the enhancement shall
194	194	not be limited by the provisions of Title Chapter 560-X-22 of
195	195	the Alabama Medicaid Agency Administrative Code.
196	196	(7) Notwithstanding subdivision (3), from October 1,
197	197	2011, through September 30, 2014, in applying the inflation
198	198	factor, zero percent shall be used to compute overall rates.
199	199	(8) Beginning with the setting of Medicaid nursing
200	200	facility rates based on the cost reporting period ended June
201	201	30, 2020, the current asset value ,(as described in Rule
202	202	560-X-22-.14(11) of the Alabama Medicaid Agency Administrative
203	203	Code), for each nursing facility, after applying the July 1,
204	204	2020, rebasing as provided under Rule 560-X-22-.14(11) of the
205	205	Alabama Medicaid Administrative Code, used to calculate
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235	235	nursing facility rates, shall be recalculated by adding to
236	236	each respective nursing facility's current asset value an
237	237	amount equal to the product derived by multiplying the June
238	238	30, 2020, rebasing as provided under Rule 560-X-22-.14(11) of
239	239	the Alabama Medicaid Agency Administrative Code by 41.03%. The
240	240	current asset value as adjusted herein, shall be rebased each
241	241	subsequent year in accordance with Rule 560-X-22.14 of the
242	242	Alabama Administrative Code, and applied to calculate Medicaid
243	243	nursing facility rates each subsequent cost reporting year.
244	244	Notwithstanding anything to the contrary in the foregoing, for
245	245	the purposes of applying the recalculated current asset value
246	246	to calculate a nursing facility's Medicaid rate for the cost
247	247	reporting year beginning July 1, 2020, any resulting rate
248	248	increase shall be effective for services provided on or after
249	249	October 1, 2020. No nursing facility Medicaid rate increase
250	250	for the recalculation of current asset value described in this
251	251	subdivision shall be effective for services provided prior to
252	252	October 1, 2020.
253	253	(9) For purposes of revising or adjusting the ceiling
254	254	under Rule 560-X-22-.06(3) of the Alabama Administrative Code,
255	255	once the ceiling has been established for a fiscal year, it
256	256	shall be final and not subject to revision or adjustment
257	257	during that year, except as provided in this subdivision. At
258	258	the discretion of the agency, the ceiling may be revised or
259	259	adjusted upon either the discovery of a material error or upon
260	260	a determination by the commissioner that it is necessary to
261	261	increase one or more of the ceilings in the event nursing
262	262	facilities are unable to be reimbursed for increases in
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292	292	allowable costs that were required to be expended by nursing
293	293	facilities to meet a nationwide or statewide public health
294	294	emergency or because of a new federal or state law or
295	295	regulation or a statewide uncontrollable catastrophic event
296	296	affecting a majority of nursing facilities, and the resulting
297	297	increase in allowable costs would not be reimbursed due to the
298	298	annual ceiling increase limitation set forth in Rule
299	299	560-X-22-.06(2) of the Alabama Administrative Code. Because
300	300	the ceiling rate is based on information provided in the cost
301	301	reports, it is to the benefit of each provider to ensure that
302	302	the provider's information is correct and accurate. If obvious
303	303	errors are detected during the desk audit process, providers
304	304	shall be given an opportunity to submit corrected data to the
305	305	agency.
306	306	(c) Payments by the Medicaid program to each nursing
307	307	facility for nursing home services shall be sufficient to
308	308	cover the costs determined by cost reporting principles
309	309	incurred by each such nursing facility in providing care in an
310	310	economical and efficient manner and that is adequate to permit
311	311	the provision of care and services necessary to attain or
312	312	maintain the highest practicable, physical, mental, and
313	313	psychosocial well-being of each resident eligible for Alabama
314	314	Medicaid nursing home benefits in conformity with applicable
315	315	state and federal laws, rules, and regulations and quality and
316	316	safety standards.
317	317	(d) Notwithstanding subsection (b), Medicaid shall be
318	318	empowered to create a special reimbursement model to
319	319	accommodate enhanced reimbursed care provided in dedicated
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349	349	ventilator units in nursing facilities that meet special
350	350	physical plant requirements such as dedicated emergency power
351	351	generation, through-the-wall medical gases and suction,
352	352	24-hour per day staffing with trained licensed respiratory
353	353	therapists, and medical direction through contract with or
354	354	employment of an Alabama licensed physician who is a board
355	355	certified pulmonologist.
356	356	(e)(1) Notwithstanding subsection (b), the Alabama
357	357	Medicaid Agency may create a quality incentive program for
358	358	nursing facilities that meet certain quality measures during
359	359	the scoring year. For the purpose of this subsection, the
360	360	scoring year for any year is the cost reporting year beginning
361	361	July 1 and ending June 30. The first scoring period shall be
362	362	July 1, 2020, through June 30, 2021. The quality incentive
363	363	shall be paid to nursing facilities in a lump sum on or before
364	364	February 1, following the scoring period ended the immediately
365	365	prior June 30. For each scoring year, the Alabama Medicaid
366	366	Agency shall establish a quality incentive fund of not less
367	367	than $5,000,000, from which quality incentive awards will be
368	368	awarded and paid to those nursing facilities qualifying for a
369	369	quality incentive award. Quality incentive scoring for each
370	370	scoring period shall be determined from certain measures
371	371	selected by the Alabama Medicaid Agency from both of the
372	372	following:
373	373	a. Five of the MDS Quality Measures compiled by the
374	374	Centers for Medicare and Medicaid Services (CMS), Department
375	375	of Health and Human Services.
376	376	b. Three of customer satisfaction survey categories
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406	406	that are independently gathered and prepared by NRC Health, or
407	407	another nationally recognized satisfaction survey company with
408	408	experience in the long term care field.
409	409	(2) The Alabama Medicaid Agency shall determine the
410	410	manner that scoring points are awarded, provided that to be
411	411	eligible to earn points for any category, a nursing facility
412	412	must do either of the following:
413	413	a. Show improvement in that category during the current
414	414	scoring period over the most recent prior scoring period.
415	415	b. Rank for that category at or above the established
416	416	national average."
417	417	Section 2. This act shall become effective on the first
418	418	day of the third month following its passage and approval by
419	419	the Governor, or its otherwise becoming law.
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