Req. No. 772 Page 1 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
STATE OF OKLAHOMA
1st Session of the 59th Legislature (2023)
SENATE BILL 412 By: Garvin
AS INTRODUCED
An Act relating to the state Medicaid program ;
amending 56 O.S. 2021, Section 1011.5 , which relates
to the nursing facility incentive rei mbursement rate
plan; modifying quality measures used for payment;
updating terminology; and providing an effective
date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 56 O.S. 2021, Sectio n 1011.5, is
amended to read as follows:
Section 1011.5. A. 1. The Oklahoma Healt h Care Authority
shall develop an incentive reimbursement rate plan for nursing
facilities focused on improving resident outcomes and resident
quality of life.
2. Under the current rate methodology, the Authority shall
reserve Five Dollars ($5.00) per pat ient day designated for the
quality assurance component that nursing facilities can earn for
improvement or performance a chievement of resident -centered outcomes
metrics. To fund the quality assurance component, Two Dollars
($2.00) shall be deducted from each nursing facility’s per diem
Req. No. 772 Page 2 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
rate, and matched with Three Dollars ($3.00) per day funded by the
Authority. Payments to nursing facilities that achieve specific
metrics shall be treated as an “add back” to their net reimbursement
per diem. Dollar valu es assigned to each metric shall be determined
so that an average of the five -dollar-quality incentive is made to
qualifying nursing facilities.
3. Pay-for-performance payments may be earned quarterly and
based on facility-specific performance achievement of four equally-
weighted, Long-Stay Quality Measures as defined by the Centers for
Medicare and Medicaid Services (CMS) the measures listed in
paragraph 7 of this subsecti on.
4. Contracted Medicaid long -term care providers may earn
payment by:
a. for the Centers for Medicare and Medicaid Services
(CMS) nursing home Long-Stay Quality Measures listed
in subparagraph a of par agraph 7 of this subsection,
achieving either five percent (5%) relative
improvement each quar ter from baseline or by achieving
the National Average Benc hmark or better for each
individual quality metric , and
b. for the categories listed in subparagraph b of
paragraph 7 of this subsection , meeting or exceeding
the state average cost for each such category based on
information reported to the Authority.
Req. No. 772 Page 3 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
5. Pursuant to federal Medicaid approval, any funds that remain
as a result of providers failing to meet the quality assurance
metrics shall be pooled and redistributed to those who achieve the
quality assurance metrics each quarter. If federal approval is not
received, any remaining funds shall be deposit ed in the Nursing
Facility Quality of Care Fund autho rized in Section 2002 of this
title.
6. The Authority shall establish an advisory group with
consumer, provider and state agency representation to recom mend
quality measures to be included in the pay -for-performance program
and to provide feedback on prog ram performance and recommendations
for improvement. The quality measures shall be reviewed annually
and shall be subject to change every three (3) year s through the
agency’s promulgation of rules. The Authority shall insure
adherence to the following cr iteria in determining the quality
measures:
a. provides direct benefit to resident care outcomes,
b. applies to long-stay residents, and
c. addresses a need for quality improvement using the
Centers for Medicare and Medicaid Services (CMS)
ranking for Oklahoma.
7. The Authority shall begin the pay-for-performance program
focusing on:
Req. No. 772 Page 4 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
a. improving the following CMS nursing home quality
measures Long-Stay Quality Measures:
a. percentage of long-stay, high-risk residents with
pressure ulcers,
b. percentage of long-stay residents who lose too much
weight,
c. percentage of long-stay residents with a urinary tract
infection, and
d. percentage of long-stay residents who got an
antipsychotic medication
(1) Percent of Residents Who Lose Too Much Weight ,
and
(2) Percent of Residents with a Urinary Tract
Infection, and
b. meeting or exceeding the state average cost for each
of the following categories based on information
reported to the Authority:
(1) insurance costs,
(2) capital-related costs, and
(3) staff development and training, provided that the
training includes all of the following:
(a) wound and pressure ulcer prevention,
(b) fall prevention,
(c) understanding restorative therapy,
Req. No. 772 Page 5 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
(d) managing residents with mental health
disorders,
(e) identification and reporting of physical and
mental function declines, and
(f) weight loss prevention .
B. The Oklahoma Health Care Authority s hall negotiate with the
Centers for Medicare and Medicaid Services to include the author ity
to base provider reimbursement rates for nursing facilities on the
criteria specified in subsec tion A of this section.
C. The Oklahoma Health Care Authority shall audit the program
to ensure transparency and integrity.
D. The Oklahoma Health Care Aut hority shall provide an annual
report of the incentive reimbursement rate plan to the Governor, the
Speaker of the House of Representatives, and the President Pro
Tempore of the Senate by December 31 of each year. The report shall
include, but not be limi ted to, an analysis of the previous fiscal
year including incentive payments, ratings, and notable trends.
SECTION 2. This act shall become effective November 1, 2023.
59-1-772 DC 1/16/2023 12:50:05 PM