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53	53	STATE OF OKLAHOMA
54	54
55	55	1st Session of the 59th Legislature (2023)
56	56
57	57	SENATE BILL 412 By: Garvin
58	58
59	59
60	60
61	61
62	62
63	63	AS INTRODUCED
64	64
65	65	An Act relating to the state Medicaid program ;
66	66	amending 56 O.S. 2021, Section 1011.5 , which relates
67	67	to the nursing facility incentive rei mbursement rate
68	68	plan; modifying quality measures used for payment;
69	69	updating terminology; and providing an effective
70	70	date.
71	71
72	72
73	73
74	74
75	75	BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
76	76	SECTION 1. AMENDATORY 56 O.S. 2021, Sectio n 1011.5, is
77	77	amended to read as follows:
78	78	Section 1011.5. A. 1. The Oklahoma Healt h Care Authority
79	79	shall develop an incentive reimbursement rate plan for nursing
80	80	facilities focused on improving resident outcomes and resident
81	81	quality of life.
82	82	2. Under the current rate methodology, the Authority shall
83	83	reserve Five Dollars ($5.00) per pat ient day designated for the
84	84	quality assurance component that nursing facilities can earn for
85	85	improvement or performance a chievement of resident -centered outcomes
86	86	metrics. To fund the quality assurance component, Two Dollars
87	87	($2.00) shall be deducted from each nursing facility’s per diem
88	88
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139	139	rate, and matched with Three Dollars ($3.00) per day funded by the
140	140	Authority. Payments to nursing facilities that achieve specific
141	141	metrics shall be treated as an “add back” to their net reimbursement
142	142	per diem. Dollar valu es assigned to each metric shall be determined
143	143	so that an average of the five -dollar-quality incentive is made to
144	144	qualifying nursing facilities.
145	145	3. Pay-for-performance payments may be earned quarterly and
146	146	based on facility-specific performance achievement of four equally-
147	147	weighted, Long-Stay Quality Measures as defined by the Centers for
148	148	Medicare and Medicaid Services (CMS) the measures listed in
149	149	paragraph 7 of this subsecti on.
150	150	4. Contracted Medicaid long -term care providers may earn
151	151	payment by:
152	152	a. for the Centers for Medicare and Medicaid Services
153	153	(CMS) nursing home Long-Stay Quality Measures listed
154	154	in subparagraph a of par agraph 7 of this subsection,
155	155	achieving either five percent (5%) relative
156	156	improvement each quar ter from baseline or by achieving
157	157	the National Average Benc hmark or better for each
158	158	individual quality metric , and
159	159	b. for the categories listed in subparagraph b of
160	160	paragraph 7 of this subsection , meeting or exceeding
161	161	the state average cost for each such category based on
162	162	information reported to the Authority.
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214	214	5. Pursuant to federal Medicaid approval, any funds that remain
215	215	as a result of providers failing to meet the quality assurance
216	216	metrics shall be pooled and redistributed to those who achieve the
217	217	quality assurance metrics each quarter. If federal approval is not
218	218	received, any remaining funds shall be deposit ed in the Nursing
219	219	Facility Quality of Care Fund autho rized in Section 2002 of this
220	220	title.
221	221	6. The Authority shall establish an advisory group with
222	222	consumer, provider and state agency representation to recom mend
223	223	quality measures to be included in the pay -for-performance program
224	224	and to provide feedback on prog ram performance and recommendations
225	225	for improvement. The quality measures shall be reviewed annually
226	226	and shall be subject to change every three (3) year s through the
227	227	agency’s promulgation of rules. The Authority shall insure
228	228	adherence to the following cr iteria in determining the quality
229	229	measures:
230	230	a. provides direct benefit to resident care outcomes,
231	231	b. applies to long-stay residents, and
232	232	c. addresses a need for quality improvement using the
233	233	Centers for Medicare and Medicaid Services (CMS)
234	234	ranking for Oklahoma.
235	235	7. The Authority shall begin the pay-for-performance program
236	236	focusing on:
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288	288	a. improving the following CMS nursing home quality
289	289	measures Long-Stay Quality Measures:
290	290	a. percentage of long-stay, high-risk residents with
291	291	pressure ulcers,
292	292	b. percentage of long-stay residents who lose too much
293	293	weight,
294	294	c. percentage of long-stay residents with a urinary tract
295	295	infection, and
296	296	d. percentage of long-stay residents who got an
297	297	antipsychotic medication
298	298	(1) Percent of Residents Who Lose Too Much Weight ,
299	299	and
300	300	(2) Percent of Residents with a Urinary Tract
301	301	Infection, and
302	302	b. meeting or exceeding the state average cost for each
303	303	of the following categories based on information
304	304	reported to the Authority:
305	305	(1) insurance costs,
306	306	(2) capital-related costs, and
307	307	(3) staff development and training, provided that the
308	308	training includes all of the following:
309	309	(a) wound and pressure ulcer prevention,
310	310	(b) fall prevention,
311	311	(c) understanding restorative therapy,
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363	363	(d) managing residents with mental health
364	364	disorders,
365	365	(e) identification and reporting of physical and
366	366	mental function declines, and
367	367	(f) weight loss prevention .
368	368	B. The Oklahoma Health Care Authority s hall negotiate with the
369	369	Centers for Medicare and Medicaid Services to include the author ity
370	370	to base provider reimbursement rates for nursing facilities on the
371	371	criteria specified in subsec tion A of this section.
372	372	C. The Oklahoma Health Care Authority shall audit the program
373	373	to ensure transparency and integrity.
374	374	D. The Oklahoma Health Care Aut hority shall provide an annual
375	375	report of the incentive reimbursement rate plan to the Governor, the
376	376	Speaker of the House of Representatives, and the President Pro
377	377	Tempore of the Senate by December 31 of each year. The report shall
378	378	include, but not be limi ted to, an analysis of the previous fiscal
379	379	year including incentive payments, ratings, and notable trends.
380	380	SECTION 2. This act shall become effective November 1, 2023.
381	381
382	382	59-1-772 DC 1/16/2023 12:50:05 PM

Oklahoma 2023 Regular Session

Oklahoma Senate Bill SB412 Compare Versions