Connecticut 2020 Regular Session

Connecticut House Bill HB05236 Compare Versions

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

Old	New	Differences
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4	4	LCO No. 1455 1 of 7
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6	6	General Assembly Raised Bill No. 5236
7	7	February Session, 2020
8	8	LCO No. 1455
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10	10
11	11	Referred to Committee on HUMAN SERVICES
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13	13
14	14	Introduced by:
15	15	(HS)
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20	20	AN ACT CONCERNING TH E TRANSITION TO A MEDICAID NURSING
21	21	HOME FACILITY CASE MIX PAYMENT SYSTEM.
22	22	Be it enacted by the Senate and House of Representatives in General
23	23	Assembly convened:
24	24
25	25	Section 1. Section 17b-340d of the general statutes is repealed and the 1
26	26	following is substituted in lieu thereof (Effective July 1, 2020): 2
27	27	(a) For purposes of this section, "Minimum Data Set", or "MDS" 3
28	28	means a federally mandated process for clinical assessments of the 4
29	29	functional capabilities and health needs of residents in a nursing home 5
30	30	facility certified by Medicare or Medicaid. The Commissioner of Social 6
31	31	Services may implement an acuity-based methodology for Medicaid 7
32	32	reimbursement of nursing home services, which shall be known as the 8
33	33	Medicaid nursing home facility case mix payment system. In the course 9
34	34	of developing such a system, the commissioner shall review the skilled 10
35	35	nursing facility prospective payment system developed by the Centers 11
36	36	for Medicare and Medicaid Services, as well as other methodologies 12
37	37	used nationally, and shall consider recommendations from the nursing 13
38	38	home finance advisory committee established pursuant to section 17b-14
39	39	339, as amended by this act, and the nursing home industry. For the 15 Raised Bill No. 5236
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43	43	LCO No. 1455 2 of 7
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45	45	purpose of formulating such recommendations, the commissioner shall 16
46	46	provide to the nursing home finance advisory committee and 17
47	47	representatives of the nursing home industry any (1) MDS provider 18
48	48	data, (2) nursing home facility cost report and rate computation data, (3) 19
49	49	case mix payment models, and (4) other data included in the design, 20
50	50	development, modeling, implementation and operation of the case mix 21
51	51	payment system. 22
52	52	(b) The Commissioner of Social Services may implement policies as 23
53	53	necessary to carry out the provisions of this section while in the process 24
54	54	of adopting the policies as regulations, provided that prior to 25
55	55	implementation the policies are posted on the eRegulations System 26
56	56	established pursuant to section 4-173b and the Department of Social 27
57	57	Services' Internet web site. In no event may the commissioner 28
58	58	implement the provisions of this section prior to federal approval of a 29
59	59	Medicaid state plan amendment and the adoption of state regulations 30
60	60	to implement the transition to a Medicaid nursing home facility case mix 31
61	61	payment system from a cost-based payment system. 32
62	62	(c) The Commissioner of Social Services shall submit a proposed 33
63	63	amendment to the Medicaid state plan to implement the transition to a 34
64	64	Medicaid nursing home facility case mix payment system from a cost-35
65	65	based payment system in accordance with the provisions of section 17b-36
66	66	8, as amended by this act, prior to submission of the Medicaid state plan 37
67	67	amendment to the federal government. 38
68	68	(d) The Medicaid state plan amendment implementing the transition 39
69	69	to a Medicaid nursing home facility case mix payment system shall 40
70	70	include, but not be limited to, the following components: 41
71	71	(1) A fiscal impact evaluation providing the assurance of (A) 42
72	72	adequate funding to achieve quality and access to care; (B) an evaluation 43
73	73	of any funding shortfall for Medicaid-certified nursing home facilities, 44
74	74	including, but not limited to, the accumulated impact of previous 45
75	75	adopted restraints on cost-based nursing home facility rate increases as 46
76	76	well as any anticipated funding shortfall in the case mix payment 47 Raised Bill No. 5236
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80	80	LCO No. 1455 3 of 7
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82	82	system; and (C) provisions for an annual inflationary adjustment and 48
83	83	periodic rebasing of the rates; 49
84	84	(2) A facility-by-facility specific impact analysis, including a 50
85	85	comparison of current cost-based provider rates to rates under a case 51
86	86	mix payment system; 52
87	87	(3) A facility-by-facility comparison of the calculated model case mix 53
88	88	rates prior to adjustment based on available state resources versus such 54
89	89	rates adjusted for available state resources; 55
90	90	(4) A provision to provide adequate reimbursement in the case mix 56
91	91	payment methodology for costs, including, but not limited to, those 57
92	92	related to dementia and Alzheimer's disease care, ventilator usage, 58
93	93	bariatric conditions, HIV/AIDS treatment, behavioral health and 59
94	94	substance use disorders; 60
95	95	(5) A provision to address distinct needs of facilities with an 61
96	96	occupancy rate of ninety-five per cent or higher with residents 62
97	97	predominantly supported by Medicaid; 63
98	98	(6) A provision for the establishment of value-based performance 64
99	99	incentives to reward quality performance measured by quality metrics, 65
100	100	provided the incentives are paid for from supplemental funding and not 66
101	101	obtained through withholding rate increases for facilities; 67
102	102	(7) An analysis of data concerning access to care to ensure a sufficient 68
103	103	supply of nursing home facility beds and services, including specialty 69
104	104	care services; 70
105	105	(8) A phased-in implementation schedule, including a stop loss 71
106	106	provision to limit the amount a rate can be reduced within an 72
107	107	established time period; 73
108	108	(9) A rate differential based on geographic location of the nursing 74
109	109	home facilities located in Fairfield county; 75
110	110	(10) For the purpose of achieving voluntary licensed bed reductions, 76 Raised Bill No. 5236
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114	114	LCO No. 1455 4 of 7
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116	116	a provision to require the recalculation of the base rates within the 2018 77
117	117	cost report year for nursing homes that reduce their licensed bed 78
118	118	capacity effective June 30, 2020, or before; and 79
119	119	(11) Initial and annual training for nursing home facility staff in the 80
120	120	new Medicaid nursing facility case mix payment system. 81
121	121	(e) Not later than January 1, 2021, the Commissioner of Social Services 82
122	122	shall submit a report, in accordance with section 11-4a, to the joint 83
123	123	standing committees of the General Assembly having cognizance of 84
124	124	matters relating to human services, public health and appropriations 85
125	125	and the budgets of state agencies, on the implementation of the 86
126	126	transition to a Medicaid nursing home facility case mix payment system 87
127	127	from a cost-based payment system. Such report shall include, but not be 88
128	128	limited to, an evaluation of each component of the transition to a 89
129	129	Medicaid nursing home facility case mix payment system. 90
130	130	Sec. 2. Subsection (a) of section 17b-8 of the general statutes is 91
131	131	repealed and the following is substituted in lieu thereof (Effective July 1, 92
132	132	2020): 93
133	133	(a) The Commissioner of Social Services shall submit an application 94
134	134	for a federal waiver or renewal of such waiver of any assistance program 95
135	135	requirements, except such application pertaining to routine operational 96
136	136	issues, and any proposed amendment to the Medicaid state plan to (1) 97
137	137	make a change in program requirements that would have required a 98
138	138	waiver were it not for the passage of the Patient Protection and 99
139	139	Affordable Care Act, P.L. 111-148, and the Health Care and Education 100
140	140	Reconciliation Act of 2010, P.L. 111-152, or (2) implement the transition 101
141	141	to a Medicaid nursing home facility case mix payment system from a 102
142	142	cost-based payment system, to the joint standing committees of the 103
143	143	General Assembly having cognizance of matters relating to human 104
144	144	services and appropriations and the budgets of state agencies prior to 105
145	145	the submission of such application or proposed amendment to the 106
146	146	federal government. Not later than thirty days after the date of their 107
147	147	receipt of such application or proposed amendment, the joint standing 108 Raised Bill No. 5236
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153	153	committees shall: [(1)] (A) Hold a public hearing on the waiver 109
154	154	application, or [(2)] (B) in the case of a proposed amendment to the 110
155	155	Medicaid state plan, notify the Commissioner of Social Services whether 111
156	156	or not said joint standing committees intend to hold a public hearing. 112
157	157	Any notice to the commissioner indicating that the joint standing 113
158	158	committees intend to hold a public hearing on a proposed amendment 114
159	159	to the Medicaid state plan shall state the date on which the joint standing 115
160	160	committees intend to hold such public hearing, which shall not be later 116
161	161	than sixty days after the joint standing committees' receipt of the 117
162	162	proposed amendment. At the conclusion of a public hearing held in 118
163	163	accordance with the provisions of this section, the joint standing 119
164	164	committees shall advise the commissioner of their approval, denial or 120
165	165	modifications, if any, of the commissioner's waiver application or 121
166	166	proposed amendment. If the joint standing committees advise the 122
167	167	commissioner of their denial of the commissioner's waiver application 123
168	168	or proposed amendment, the commissioner shall not submit the 124
169	169	application for a federal waiver or proposed amendment to the federal 125
170	170	government. If such committees do not concur, the committee 126
171	171	chairpersons shall appoint a committee of conference which shall be 127
172	172	composed of three members from each joint standing committee. At 128
173	173	least one member appointed from each joint standing committee shall 129
174	174	be a member of the minority party. The report of the committee of 130
175	175	conference shall be made to each joint standing committee, which shall 131
176	176	vote to accept or reject the report. The report of the committee of 132
177	177	conference may not be amended. If a joint standing committee rejects 133
178	178	the report of the committee of conference, that joint standing committee 134
179	179	shall notify the commissioner of the rejection and the commissioner's 135
180	180	waiver application or proposed amendment shall be deemed approved. 136
181	181	If the joint standing committees accept the report, the committee having 137
182	182	cognizance of matters relating to appropriations and the budgets of state 138
183	183	agencies shall advise the commissioner of their approval, denial or 139
184	184	modifications, if any, of the commissioner's waiver application or 140
185	185	proposed amendment. If the joint standing committees do not so advise 141
186	186	the commissioner during the thirty-day period, the waiver application 142
187	187	or proposed amendment shall be deemed approved. Any application 143 Raised Bill No. 5236
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191	191	LCO No. 1455 6 of 7
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193	193	for a federal waiver, waiver renewal or proposed amendment submitted 144
194	194	to the federal government by the commissioner, pursuant to this section, 145
195	195	shall be in accordance with the approval or modifications, if any, of the 146
196	196	joint standing committees of the General Assembly having cognizance 147
197	197	of matters relating to human services and appropriations and the 148
198	198	budgets of state agencies. 149
199	199	Sec. 3. Subsection (b) of section 17b-339 of the general statutes is 150
200	200	repealed and the following is substituted in lieu thereof (Effective July 1, 151
201	201	2020): 152
202	202	(b) The committee shall (1) evaluate any information and data 153
203	203	available, including, but not limited to, (A) quality of care, (B) acuity, 154
204	204	(C) census, and (D) staffing levels of nursing homes operating in the 155
205	205	state to assess the (i) transition to a Medicaid nursing home facility case 156
206	206	mix payment system from a cost-based payment system, and (ii) the 157
207	207	overall infrastructure and projected needs of such homes, and (2) 158
208	208	recommend appropriate action consistent with the goals, strategies and 159
209	209	long-term care needs set forth in the strategic plan developed pursuant 160
210	210	to subsection (c) of section 17b-369 to the Commissioner of Social 161
211	211	Services and the Commissioner of Public Health. The Commissioner of 162
212	212	Social Services shall submit quarterly reports to the committee 163
213	213	concerning pending nursing home requests for interim rate increases. 164
214	214	Such reports shall, without identifying any requesting facility by name, 165
215	215	list the amount of each increase requested, the reason for the request and 166
216	216	the rate that will result if the request is granted. 167
217	217	This act shall take effect as follows and shall amend the following
218	218	sections:
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220	220	Section 1 July 1, 2020 17b-340d
221	221	Sec. 2 July 1, 2020 17b-8(a)
222	222	Sec. 3 July 1, 2020 17b-339(b)
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224	224	Statement of Purpose:
225	225	To ensure the transition to a new Medicaid payment system for nursing
226	226	home facilities is equitable, efficient and adequately funded. Raised Bill No. 5236
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230	230	LCO No. 1455 7 of 7
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232	232	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
233	233	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
234	234	underlined.]
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