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 Section 17b-340d of the general statutes is repealed and the 1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