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Oklahoma House Bill HB3480

Oklahoma 2022 Regular Session

Oklahoma House Bill HB3480 Compare Versions

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2828 STATE OF OKLAHOMA
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3030 2nd Session of the 58th Legislature (2022)
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3232 HOUSE BILL 3480 By: Stark
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3838 AS INTRODUCED
3939
4040 An Act relating to long-term care facilities;
4141 amending 63 O.S. 2021, Section 1-1925.2, which
4242 relates to long-term care facility reimbursem ents;
4343 modifying policy; and providing an effective date.
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5050 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
5151 SECTION 1. AMENDATORY 63 O.S. 2021, Section 1-1925.2, is
5252 amended to read as follows :
5353 Section 1-1925.2 A. The Oklahoma Health Care Authority shall
5454 fully recalculate and reimburse nursing facilities and Intermediate
5555 Care Facilities for Individuals with Intellectual Disabilities
5656 (ICFs/IID) from the Nursing Facility Quality of Care Fund beginning
5757 October 1, 2000, the average actual, audited costs reflected in
5858 previously submitted cost reports for the cost -reporting period that
5959 began July 1, 1998, and ended June 30, 1999, inflated by the
6060 federally published inflationary factors for the two (2) years
6161 appropriate to reflect present-day costs at the midpoint of the July
6262 1, 2000, through June 30, 2001, rate year.
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8989 1. The recalculations provided for in this subsection shall be
9090 consistent for both nursing facilities and Intermediate Care
9191 Facilities for Individuals with Int ellectual Disabilities
9292 (ICFs/IID).
9393 2. The recalculated re imbursement rate shall be implemented
9494 September 1, 2000.
9595 B. 1. From September 1, 2000, through August 31, 2001, all
9696 nursing facilities subject to the Nursing Home Care Act, in addition
9797 to other state and federal requirements related to the staffing of
9898 nursing facilities, shall maintain the following minimum direct -
9999 care-staff-to-resident ratios:
100100 a. from 7:00 a.m. to 3:00 p.m., one direct -care staff to
101101 every eight residents, or major fraction thereof ,
102102 b. from 3:00 p.m. to 11:00 p.m., one direct -care staff to
103103 every twelve residents, or major fraction thereof, and
104104 c. from 11:00 p.m. to 7:00 a.m., one direct -care staff to
105105 every seventeen residents, or major fraction thereof.
106106 2. From September 1, 2001, t hrough August 31, 2003, nursing
107107 facilities subject to the Nursing Home Care Act and Intermediate
108108 Care Facilities for Individuals with Intellectual Disabilities
109109 (ICFs/IID) with seventeen or more beds shall maintain, in addition
110110 to other state and federal re quirements related to the staffing of
111111 nursing facilities, the following minimum direct -care-staff-to-
112112 resident ratios:
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139139 a. from 7:00 a.m. to 3:00 p.m., one direct -care staff to
140140 every seven residents, or major fraction thereof,
141141 b. from 3:00 p.m. to 11:00 p.m. , one direct-care staff to
142142 every ten residents, or major f raction thereof, and
143143 c. from 11:00 p.m. to 7:00 a.m., one direct -care staff to
144144 every seventeen residents, or major fraction thereof.
145145 3. On and after October 1, 2019, nursing facilities subject to
146146 the Nursing Home Care Act and Intermediate Care Facilities for
147147 Individuals with Intellectual Disabilities (ICFs/IID) with sevente en
148148 or more beds shall maintain, in addition to other state and federal
149149 requirements related to the staffing of nursing facilitie s, the
150150 following minimum direct -care-staff-to-resident ratios:
151151 a. from 7:00 a.m. to 3:00 p.m., one direct -care staff to
152152 every six residents, or major fraction thereof,
153153 b. from 3:00 p.m. to 11:00 p.m., one direct -care staff to
154154 every eight residents, or majo r fraction thereof, and
155155 c. from 11:00 p.m. to 7:00 a.m., o ne direct-care staff to
156156 every fifteen residents, or major fraction the reof.
157157 4. Effective immediately, facilities shall have the option of
158158 varying the starting times for the eight -hour shifts by one (1) hour
159159 before or one (1) hour after the times designate d in this section
160160 without overlapping shifts.
161161 5. a. On and after January 1, 2020, a facility may implement
162162 twenty-four-hour-based staff scheduling; provided,
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189189 however, such facility shall continue to maintain a
190190 direct-care service rate of at least two and n ine
191191 tenths (2.9) hours of direct -care service per resident
192192 per day, the same to be calculated based on average
193193 direct care staff maintained over a twenty -four-hour
194194 period.
195195 b. At no time shall direct -care staffing ratios in a
196196 facility with twenty -four-hour-based staff-scheduling
197197 privileges fall below one direct -care staff to every
198198 fifteen residents or major fraction thereof, and at
199199 least two direct-care staff shall be on duty and awake
200200 at all times.
201201 c. As used in this paragraph, "twenty-four-hour-based-
202202 scheduling" means maintaining:
203203 (1) a direct-care-staff-to-resident ratio based on
204204 overall hours of direct -care service per resident
205205 per day rate of not less than two and ninety one -
206206 hundredths (2.90) hour s per day,
207207 (2) a direct-care-staff-to-resident ratio of at least
208208 one direct-care staff person on duty to every
209209 fifteen residents or major fraction thereof at
210210 all times, and
211211 (3) at least two direct-care staff persons on duty
212212 and awake at all times.
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239239 6. a. On and after January 1, 2004, the State Department of
240240 Health shall require a facility to maintain the shift -
241241 based, staff-to-resident ratios provided in paragraph
242242 3 of this subsection if the facility has been
243243 determined by the Department to be deficient with
244244 regard to:
245245 (1) the provisions of paragraph 3 of this subse ction,
246246 (2) fraudulent reporting of staffing on the Quality
247247 of Care Report, or
248248 (3) a complaint or survey investigation that has
249249 determined substandard quality of care as a
250250 result of insufficient staf fing.
251251 b. The Department shall require a facility described in
252252 subparagraph a of this paragraph to achieve and
253253 maintain the shift-based, staff-to-resident ratios
254254 provided in paragraph 3 of this subsection for a
255255 minimum of three (3) months before being consi dered
256256 eligible to implement twenty -four-hour-based staff
257257 scheduling as defined in subparagraph c of paragraph 5
258258 of this subsection.
259259 c. Upon a subsequent determination by the Department that
260260 the facility has achieved and maintained for at least
261261 three (3) months the shift-based, staff-to-resident
262262 ratios described in paragraph 3 of this subsection,
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289289 and has corrected any deficiency des cribed in
290290 subparagraph a of this paragraph, the Department shall
291291 notify the facility of its eligibility to implement
292292 twenty-four-hour-based staff-scheduling privileges.
293293 7. a. For facilities that utilize twenty-four-hour-based
294294 staff-scheduling privileges, t he Department shall
295295 monitor and evaluate facility compliance with the
296296 twenty-four-hour-based staff-scheduling staffing
297297 provisions of paragraph 5 of this subsection through
298298 reviews of monthly staffing reports, results of
299299 complaint investigations and inspect ions.
300300 b. If the Department identifies any quality -of-care
301301 problems related to insufficient staffing in such
302302 facility, the Depart ment shall issue a directed plan
303303 of correction to the faci lity found to be out of
304304 compliance with the provisions of this subsect ion.
305305 c. In a directed plan of correction, the Department shall
306306 require a facility described in subparagraph b of this
307307 paragraph to maintain shift-based, staff-to-resident
308308 ratios for the following periods of time:
309309 (1) the first determination shall require t hat shift-
310310 based, staff-to-resident ratios be maintained
311311 until full compliance is achieved,
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338338 (2) the second determination within a two-year period
339339 shall require that shift -based, staff-to-resident
340340 ratios be maintained for a minimum period of
341341 twelve (12) months, and
342342 (3) the third determination within a two -year period
343343 shall require that shift -based, staff-to-resident
344344 ratios be maintained. The facility may apply for
345345 permission to use twenty -four-hour staffing
346346 methodology after two (2) years.
347347 C. Effective September 1, 2002, facilities shall post the names
348348 and titles of direct -care staff on duty each day in a conspicuous
349349 place, including the name and title of the supervising nurse.
350350 D. The State Commissioner of Health shall promulgate rules
351351 prescribing staffing requirements for Intermediate Care Facilities
352352 for Individuals with Intellectual Disabilities serving six or fewer
353353 clients (ICFs/IID-6) and for Intermediate Care Facilities for
354354 Individuals with Intellectual Disabilities serving sixteen or fewer
355355 clients (ICFs/IID-16).
356356 E. Facilities shall have the right to appeal and to the
357357 informal dispute resolution process with regard to penalties and
358358 sanctions imposed due to staffing noncompliance.
359359 F. 1. When the state Medicaid program reimbursement rate
360360 reflects the sum of Ninety-four Dollars and eleven cents ($94.11),
361361 plus the increases in actual audited costs over and above the actual
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388388 audited costs reflected in the cost reports submitted for the mos t
389389 current cost-reporting period and the costs estimated by the
390390 Oklahoma Health Care Authority to increase the direct -care, flexible
391391 staff-scheduling staffing level from two and eighty -six one-
392392 hundredths (2.86) hours per day per occupied bed to three and tw o-
393393 tenths (3.2) hours per day per occupied bed, all nursing facilities
394394 subject to the provisions of the Nursing Home Care Act and
395395 Intermediate Care Facilities for Individuals with Intellectual
396396 Disabilities (ICFs/IID) with seventeen or more beds, in addition to
397397 other state and federal requirements related to the staffing of
398398 nursing facilities, shall maintain direct -care, flexible staff -
399399 scheduling staffing levels based on an overall three and two -tenths
400400 (3.2) hours per day per occupied bed.
401401 2. When the state Medicaid program reimbursement rate reflects
402402 the sum of Ninety-four Dollars and eleven cents ($94.11), plus the
403403 increases in actual audited costs over and above the actual audited
404404 costs reflected in the cost reports submitted for the most current
405405 cost-reporting period and the costs estimated by the Oklahoma Health
406406 Care Authority to increase the direct -care flexible staff-scheduling
407407 staffing level from three and two -tenths (3.2) hours per day per
408408 occupied bed to three and eight -tenths (3.8) hours per day per
409409 occupied bed, all nursing facilities subject to the provisions of
410410 the Nursing Home Care Act and Intermediate Care Facilities for
411411 Individuals with Intellectual Disabilities (ICFs/IID) with seventeen
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438438 or more beds, in addition to other state and federal requ irements
439439 related to the staffing of nursing facilities, shall maintain
440440 direct-care, flexible staff -scheduling staffing levels based on an
441441 overall three and eight -tenths (3.8) hours per day per occup ied bed.
442442 3. When the state Medicaid program reimbursement rate reflects
443443 the sum of Ninety-four Dollars and eleven cents ($94.11 ), plus the
444444 increases in actual audited costs over and above the actual audited
445445 costs reflected in the cost reports submitted fo r the most current
446446 cost-reporting period and the costs est imated by the Oklahoma Health
447447 Care Authority to increase the direct -care, flexible staff-
448448 scheduling staffing level from three and eight -tenths (3.8) hours
449449 per day per occupied bed to four and one -tenth (4.1) hours per day
450450 per occupied bed, all nursing faci lities subject to the provisions
451451 of the Nursing Home Care Act and Inte rmediate Care Facilities for
452452 Individuals with Intellectual Disabilities (ICFs/IID) with seventeen
453453 or more beds, in addition to o ther state and federal requirements
454454 related to the staffin g of nursing facilities, shall maintain
455455 direct-care, flexible staff -scheduling staffing levels based on an
456456 overall four and one -tenth (4.1) hours per day per occupied bed.
457457 4. The Commissioner shall promulgate rules for shift -based,
458458 staff-to-resident ratios for noncompliant facilities denoting the
459459 incremental increases refle cted in direct-care, flexible staff -
460460 scheduling staffing levels.
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487487 5. In the event that the state Medicaid program reimbursement
488488 rate for facilities subject to the Nursing Home Care Act, a nd
489489 Intermediate Care Facilities for Individuals with Intellectual
490490 Disabilities (ICFs/IID) having seventeen or more beds is reduced
491491 below actual audited costs, the requirements for staffing ratio
492492 levels shall be adjusted to the appropriate levels provided i n
493493 paragraphs 1 through 4 of this subsection.
494494 G. For purposes of this subsection:
495495 1. "Direct-care staff" means any nursing or therapy staff who
496496 provides direct, hands -on care to residents in a nurs ing facility;
497497 2. Prior to September 1, 2003, activity and social services
498498 staff who are not providing direct, hands -on care to residents may
499499 be included in the direct -care-staff-to-resident ratio in any shift.
500500 On and after September 1, 2003, such persons shall not be included
501501 in the direct-care-staff-to-resident ratio, regardless of their
502502 licensure or certification status; and
503503 3. The administrator shall not be counted in the direct -care-
504504 staff-to-resident ratio regardless of the administrator 's licensure
505505 or certification status.
506506 H. 1. The Oklahoma Health Care Authority shall require all
507507 nursing facilities subject to the provisio ns of the Nursing Home
508508 Care Act and Intermediate Care Facilities for Individuals with
509509 Intellectual Disabilities (ICFs/IID) with seventeen or more beds to
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536536 submit a monthly report on staff ing ratios on a form that the
537537 Authority shall develop.
538538 2. The report shall document the extent to which such
539539 facilities are meeting or are failing to meet the minimum direct -
540540 care-staff-to-resident ratios specified by this section. Such
541541 report shall be available to the public upon request.
542542 3. The Authority may assess admin istrative penalties for the
543543 failure of any facility to submit the report as required by the
544544 Authority. Provided, however:
545545 a. administrative penalties shall not accrue until the
546546 Authority notifies the facility in writing that the
547547 report was not timely subm itted as required, and
548548 b. a minimum of a one-day penalty shall be assessed in
549549 all instances.
550550 4. Administrative penalties shall not be assessed for
551551 computational errors made in preparing the report.
552552 5. Monies collected from administrative penalties shall be
553553 deposited in the Nursing Facility Quality of Care Fund and utilized
554554 for the purposes specified in the Oklahoma Healthcare Ini tiative
555555 Act.
556556 I. 1. All entities regulated by this state that provide long-
557557 term care services shall utilize a single assessment tool to
558558 determine client services needs. The tool shall be developed by the
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585585 Oklahoma Health Care Authority in consultation wit h the State
586586 Department of Health.
587587 2. a. The Oklahoma Nursing Facility Funding Advisory
588588 Committee is hereby created and shall con sist of the
589589 following:
590590 (1) four members selected by the Oklahoma Association
591591 of Health Care Providers,
592592 (2) three members selecte d by the Oklahoma
593593 Association of Homes and Services for th e Aging,
594594 and
595595 (3) two members selected by the State Council on
596596 Aging.
597597 The Chair shall be elected by the committee. No state
598598 employees may be appointed to serve.
599599 b. The purpose of the advisory commit tee will be to
600600 develop a new methodology for calculating s tate
601601 Medicaid program reimbursements to nursing facilities
602602 by implementing facility-specific rates based on
603603 expenditures relating to direct -care staffing. No
604604 nursing home will receive less than the current rate
605605 at the time of implementation of facility -specific
606606 rates pursuant to this subparagraph.
607607 c. The advisory committee shall be staffed and advised by
608608 the Oklahoma Health Care Authority.
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635635 d. The new methodology will be submitted for approval to
636636 the Board of the Oklahoma Health Care Authority by
637637 January 15, 2005, and shall be finalized by July 1,
638638 2005. The new methodology w ill apply only to new
639639 funds that become available for Medicaid nursing
640640 facility reimbursement after the methodology of this
641641 paragraph has been finalized. Existing funds paid to
642642 nursing homes will not be subject to the methodology
643643 of this paragraph. The m ethodology as outlined in
644644 this paragraph will only be applied to any new funding
645645 for nursing facilities appropriated above and b eyond
646646 the funding amounts effective on January 15, 2005.
647647 e. The new methodology shall divide the payment into two
648648 components:
649649 (1) direct care which includes allowable costs for
650650 registered nurses, licensed practical nurses,
651651 certified medication aides and ce rtified nurse
652652 aides. The direct care component of the rat e
653653 shall be a facility-specific rate, directly
654654 related to each facility 's actual expenditures on
655655 direct care, and
656656 (2) other costs.
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683683 f. The Oklahoma Health Care Authority, in calculating the
684684 base year prospective direct care rate component,
685685 shall use the following criteria:
686686 (1) to construct an array of facility per diem
687687 allowable expenditures on direct care, the
688688 Authority shall use the most recent data
689689 available. The limit on this array shall be no
690690 less than the ninetieth percentile,
691691 (2) each facility's direct care base-year component
692692 of the rate shall be the lesser of the faci lity's
693693 allowable expenditures on direct care or the
694694 limit,
695695 (3) other rate components shall be determined by the
696696 Oklahoma Nursing Facility Funding Advisory
697697 Committee in accordance with fe deral regulations
698698 and requirements,
699699 (4) prior to July 1, 2020, the Aut hority shall seek
700700 federal approval to calculate the upper payment
701701 limit under the authority of CMS utilizing the
702702 Medicare equivalent payment rate, and
703703 (5) if Medicaid payment rates to pr oviders are
704704 adjusted, nursing home rates and Intermediate
705705 Care Facilities for Individuals with Intellectual
706706 Disabilities (ICFs/IID) rates shall not be
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733733 adjusted less favorably than the average
734734 percentage-rate reduction or increase applicable
735735 to the majority of other provider groups.
736736 g. (1) Effective October 1, 2019, if suffic ient funding
737737 is appropriated for a rate increase, a new
738738 average rate for nursing facilities shall be
739739 established. The rate shal l be equal to the
740740 statewide average cost as derived from a udited
741741 cost reports for SFY 2018, ending June 30, 2018,
742742 after adjustment for inflation. After such new
743743 average rate has been established, the facility
744744 specific reimbursement rate shall be as follows:
745745 (a) amounts up to the existing base rate amount
746746 and shall continue to be distributed as a
747747 part of the base rate in accordance wit h the
748748 existing State Plan, and
749749 (b) to the extent the new rate exceeds the rate
750750 effective before the effective date of this
751751 act, fifty percent (50%) of the resulting
752752 increase on October 1 , 2019, shall be
753753 allocated toward an increase of the existing
754754 base reimbursement rate and distributed
755755 accordingly. The remaining fifty percent
756756 (50%) of the increase shall be allocated in
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783783 accordance with the currently approved 70/30
784784 reimbursement rate meth odology as outlined
785785 in the existing State Plan .
786786 (2) Any subsequent rate increases, as determined
787787 based on the provisions set forth in this
788788 subparagraph, shall be allocated in accordance
789789 with the currently approved 70/30 reimbursement
790790 rate methodology. The rate shall not exceed the
791791 upper payment limit established by the Medi care
792792 rate equivalent established by the federal CMS
793793 Upon the effective date of this act , the Oklahoma
794794 Health Care Authority shall submit a State Plan
795795 Amendment to modify the current 70/ 30
796796 reimbursement rate methodology to a 90/10
797797 reimbursement rate methodology consistent with
798798 the provisions allowed for in the existing 70/30
799799 reimbursement rate methodology.
800800 (3) The State Plan Amendment 90/10 reimbursement rate
801801 methodology shall apply to al l state and federal
802802 funds received, inclu ding, but not limited to,
803803 American Rescue Plan Act of 2021 funding, and
804804 subsequent federal funding as allow ed for by law
805805 and any funds received from the State Treasury as
806806 allowed for by law.
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833833 h. Effective October 1, 2019, in coordination with the
834834 rate adjustments identified in the preceding section,
835835 a portion of the funds s hall be utilized as follows:
836836 (1) effective October 1, 2019, the Oklahoma Health
837837 Care Authority shall increase the personal needs
838838 allowance for residents of nursing homes and
839839 Intermediate Care Facilities for Individuals with
840840 Intellectual Disabilities (ICFs/ IID) from Fifty
841841 Dollars ($50.00) per month to Seventy -five
842842 Dollars ($75.00) per month per resident. The
843843 increase shall be funded by Medicaid nursi ng home
844844 providers, by way of a reduction of eighty-two
845845 cents ($0.82) per day deducted from the base
846846 rate. Any additional cost shall be funded by the
847847 Nursing Facility Quality of Care Fund, and
848848 (2) effective January 1, 2020, all clinical employees
849849 working in a licensed nursing facility shall be
850850 required to receive at least four (4) hours
851851 annually of Alzheimer 's or dementia training, to
852852 be provided and paid for by the facilities.
853853 3. The Department of Human Services shall expand its statewide
854854 toll-free, Senior-Info Line for senior citizen services to include
855855 assistance with or information on long -term care services in this
856856 state.
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883883 4. The Oklahoma Health Care Authority shall develop a nursing
884884 facility cost-reporting system that reflects the most current costs
885885 experienced by nursing and specialized fa cilities. The Oklahoma
886886 Health Care Authority shall utilize the most current cost report
887887 data to estimate costs in determining daily per diem rates.
888888 5. The Oklahoma Health Care Authority shall provide access to
889889 the detailed Medicaid payment audit adjustme nts and implement an
890890 appeal process for disputed payment audit adjust ments to the
891891 provider. Additionally, the Oklahoma Health Care Authority shall
892892 make sufficient revisions to the nursing facility cost reporting
893893 forms and electronic data input system so a s to clarify what
894894 expenses are allowable and appropriate for inclusio n in cost
895895 calculations.
896896 J. 1. When the state Medicaid program reimbursement rate
897897 reflects the sum of Ninety -four Dollars and eleven cents ($94.11 ),
898898 plus the increases in actual audited costs, over and above the
899899 actual audited costs reflected in the cost reports submitted for the
900900 most current cost-reporting period, and the direct -care, flexible
901901 staff-scheduling staffing level has been prospectively funded at
902902 four and one-tenth (4.1) hours per day per occupied bed, the
903903 Authority may apportion funds for the implementation of the
904904 provisions of this section.
905905 2. The Authority shall make applic ation to the United States
906906 Centers for Medicare and Medicaid Service Services for a waiver of
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933933 the uniform requirement on health-care-related taxes as permitted by
934934 Section 433.72 of 42 C.F.R.
935935 3. Upon approval of the waiver, the Authority shall develop a
936936 program to implement the provisions of the waiver as it relates to
937937 all nursing facilities.
938938 SECTION 2. This act shall become effective November 1, 2022.
939939
940940 58-2-9281 KN 01/06/22