Oklahoma 2024 Regular Session

Oklahoma House Bill HB1659 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
2	2
3		-	HB1659 HFLR Page 1
4		-	BOLD FACE denotes Committee Amendments. 1
	3	+	Req. No. 7883 Page 1 1
5	4		2
6	5		3
7	6		4
8	7		5
9	8		6
10	9		7
11	10		8
12	11		9
13	12		10
14	13		11
15	14		12
16	15		13
17	16		14
18	17		15
19	18		16
20	19		17
21	20		18
22	21		19
23	22		20
24	23		21
25	24		22
26	25		23
27	26		24
28	27
29		-	HOUSE OF REPRESENTATIVES - FLOOR VERSION
30		-
31	28		STATE OF OKLAHOMA
32	29
33	30		1st Session of the 59th Legislature (2023)
34	31
35	32		COMMITTEE SUBSTITUTE
36	33		FOR
37		-	HOUSE BILL NO. 1659 By: McEntire ~~of the House~~
	34	+	HOUSE BILL NO. 1659 By: McEntire
38	35
39		-	and
40	36
41		-	Rosino of the Senate
42	37
43	38
44	39
45	40		COMMITTEE SUBSTITUTE
46	41
47	42		An Act relating to public health and safety; amending
48	43		63 O.S. 2021, Section 1-1925.2, which relates to
49	44		recalculation and reimbursement from the Nursing
50	45		Facility Quality Care Fund ; removing the advisory
51	46		committee; removing the purpose of the committee; and
52	47		providing an effective date.
53	48
54	49
55	50
56	51
	52	+
	53	+
57	54		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLA HOMA:
58	55		SECTION 1. AMENDATORY 63 O.S. 202 1, Section 1-1925.2, is
59	56		amended to read as follows:
60	57		Section 1-1925.2 A. The Oklahoma Health Care Authority shall
61	58		fully recalculate and reimburse nursing facilities and Intermediate
62	59		Care Facilities for Individuals with Intellectual Disabilities
63	60		(ICFs/IID) from the Nursing Facility Quality of Care Fund beginning
64	61		October 1, 2000, the average actual, audited costs reflected in
65	62		previously submitted cost reports for the cost -reporting period that
66	63		began July 1, 1998, and ended June 30, 1999, inflated by the
	64	+	federally published inflationa ry factors for the two (2) years
67	65
68		-	HB1659 HFLR Page 2
69		-	BOLD FACE denotes Committee Amendments. 1
	66	+	Req. No. 7883 Page 2 1
70	67		2
71	68		3
72	69		4
73	70		5
74	71		6
75	72		7
76	73		8
77	74		9
78	75		10
79	76		11
80	77		12
81	78		13
82	79		14
83	80		15
84	81		16
85	82		17
86	83		18
87	84		19
88	85		20
89	86		21
90	87		22
91	88		23
92	89		24
93	90
94		-	federally published inflationa ry factors for the two (2) years
95	91		appropriate to reflect present -day costs at the midpoint of the July
96	92		1, 2000, through June 30, 2001, rate year.
97	93		1. The recalculations provi ded for in this subsection shall be
98	94		consistent for both nursing facilities and Inte rmediate Care
99	95		Facilities for Individual s with Intellectual Disabilities
100	96		(ICFs/IID).
101	97		2. The recalculated re imbursement rate shall be implemented
102	98		September 1, 2000.
103	99		B. 1. From September 1, 2000, through August 31, 2001, all
104	100		nursing facilities subject to t he Nursing Home Care Act, in addition
105	101		to other state and federal requirements related to the staffing of
106	102		nursing facilities, shall maintain the following minimum direct -
107	103		care-staff-to-resident ratios:
108	104		a. from 7:00 a.m. to 3:00 p.m., one direct -care staff to
109	105		every eight residents, or major fracti on thereof,
110	106		b. from 3:00 p.m. to 11:00 p.m., one direct -care staff to
111	107		every twelve residents, or major fraction thereof, and
112	108		c. from 11:00 p.m. to 7:00 a.m., one direct-care staff to
113	109		every seventeen residents, or majo r fraction thereof.
114	110		2. From September 1, 2001, through August 31, 2003, nursing
115	111		facilities subject to the Nursing Home Care Act and Intermediate
116	112		Care Facilities for Individ uals with Intellectual Disabilities
117	113		(ICFs/IID) with seventeen or more beds shall ma intain, in addition
	114	+	to other state and federal requirements related to the staffing of
118	115
119		-	HB1659 HFLR Page 3
120		-	BOLD FACE denotes Committee Amendments. 1
	116	+	Req. No. 7883 Page 3 1
121	117		2
122	118		3
123	119		4
124	120		5
125	121		6
126	122		7
127	123		8
128	124		9
129	125		10
130	126		11
131	127		12
132	128		13
133	129		14
134	130		15
135	131		16
136	132		17
137	133		18
138	134		19
139	135		20
140	136		21
141	137		22
142	138		23
143	139		24
144	140
145		-	to other state and federal requirements related to the staffing of
146	141		nursing facilities, the following minimum direct-care-staff-to-
147	142		resident ratios:
148	143		a. from 7:00 a.m. to 3:00 p.m., one direct-care staff to
149	144		every seven residents, or major fraction thereof,
150	145		b. from 3:00 p.m. to 11:00 p.m., one direct -care staff to
151	146		every ten residents, or major f raction thereof, and
152	147		c. from 11:00 p.m. to 7:00 a.m., one direct -care staff to
153	148		every seventeen residents, or major fraction thereof.
154	149		3. On and after October 1, 2019, nursing facilities su bject to
155	150		the Nursing Home Care Act and Intermediate Care Facilities for
156	151		Individuals with Intellectual Disabilities (ICFs/IID) with sev enteen
157	152		or more beds shall maintain, in addition to other state and federal
158	153		requirements related to the staffing of nursing facilities, the
159	154		following minimum direct -care-staff-to-resident ratios:
160	155		a. from 7:00 a.m. to 3:00 p.m., one direct -care staff to
161	156		every six residents, or major fraction thereof,
162	157		b. from 3:00 p.m. to 11:00 p.m., one di rect-care staff to
163	158		every eight resident s, or major fraction thereof, and
164	159		c. from 11:00 p.m. to 7:00 a.m., o ne direct-care staff to
165	160		every fifteen residents, or major fraction thereof.
166	161		4. Effective immediately, facilities shall have the option of
167	162		varying the starting times for the eight -hour shifts by one (1) hour
	163	+	before or one (1) hour after the times designate d in this section
	164	+	without overlapping shifts.
168	165
169		-	HB1659 HFLR Page 4
170		-	BOLD FACE denotes Committee Amendments. 1
	166	+	Req. No. 7883 Page 4 1
171	167		2
172	168		3
173	169		4
174	170		5
175	171		6
176	172		7
177	173		8
178	174		9
179	175		10
180	176		11
181	177		12
182	178		13
183	179		14
184	180		15
185	181		16
186	182		17
187	183		18
188	184		19
189	185		20
190	186		21
191	187		22
192	188		23
193	189		24
194	190
195		-	before or one (1) hour after the times designat ed in this section
196		-	without overlapping shifts.
197	191		5. a. On and after January 1, 2020, a facility may implement
198	192		twenty-four-hour-based staff scheduling; p rovided,
199	193		however, such facility shall c ontinue to maintain a
200	194		direct-care service rate of at least two and nine
201	195		tenths (2.9) ninety one-hundredths (2.90) hours of
202	196		direct-care service per resident per day, the same to
203	197		be calculated based on average direct care staff
204	198		maintained over a tw enty-four-hour period.
205	199		b. At no time shall direct-care staffing ratios in a
206	200		facility with twenty-four-hour-based staff-scheduling
207	201		privileges fall below one direct-care staff to every
208	202		fifteen residents or major fraction thereof, and at
209	203		least two direct-care staff shall be on duty and awake
210	204		at all times.
211	205		c. As used in this paragraph, "twenty-four-hour-based-
212	206		staff scheduling" means maintaining:
213	207		(1) a direct-care-staff-to-resident ratio based on
214	208		overall hours of direct-care service per resident
215	209		per day rate of not le ss than two and ninety one -
216	210		hundredths (2.90) hours per day,
217	211		(2) a direct-care-staff-to-resident ratio of at least
218	212		one direct-care staff person on duty to every
	213	+	fifteen residents or major fraction t hereof at
	214	+	all times, and
219	215
220		-	HB1659 HFLR Page 5
221		-	BOLD FACE denotes Committee Amendments. 1
	216	+	Req. No. 7883 Page 5 1
222	217		2
223	218		3
224	219		4
225	220		5
226	221		6
227	222		7
228	223		8
229	224		9
230	225		10
231	226		11
232	227		12
233	228		13
234	229		14
235	230		15
236	231		16
237	232		17
238	233		18
239	234		19
240	235		20
241	236		21
242	237		22
243	238		23
244	239		24
245	240
246		-	fifteen residents or major fraction t hereof at
247		-	all times, and
248	241		(3) at least two direct-care staff persons on duty
249	242		and awake at all times .
250	243		6. a. On and after January 1, 2004, the State Department of
251	244		Health shall require a facility to m aintain the shift-
252	245		based, staff-to-resident ratios provided i n paragraph
253	246		3 of this subsection if the facility has been
254	247		determined by the Department to be defic ient with
255	248		regard to:
256	249		(1) the provisions of paragraph 3 of this subse ction,
257	250		(2) fraudulent reporting of staffing on the Quality
258	251		of Care Report, or
259	252		(3) a complaint or survey investigation that has
260	253		determined substandard quality of care as a
261	254		result of insufficient staffing.
262	255		b. The Department shall r equire a facility described in
263	256		subparagraph a of this par agraph to achieve and
264	257		maintain the shift-based, staff-to-resident ratios
265	258		provided in paragraph 3 of this subsection for a
266	259		minimum of three (3) months before b eing considered
267	260		eligible to implement twe nty-four-hour-based staff
268	261		scheduling as defined in subpar agraph c of paragraph 5
269	262		of this subsection.
	263	+	c. Upon a subsequent determination by the Department that
	264	+	the facility has achieved and maintained for at least
270	265
271		-	HB1659 HFLR Page 6
272		-	BOLD FACE denotes Committee Amendments. 1
	266	+	Req. No. 7883 Page 6 1
273	267		2
274	268		3
275	269		4
276	270		5
277	271		6
278	272		7
279	273		8
280	274		9
281	275		10
282	276		11
283	277		12
284	278		13
285	279		14
286	280		15
287	281		16
288	282		17
289	283		18
290	284		19
291	285		20
292	286		21
293	287		22
294	288		23
295	289		24
296	290
297		-	c. Upon a subsequent determination by the Department that
298		-	the facility has achieved and maintained for at least
299	291		three (3) months the shift -based, staff-to-resident
300	292		ratios described in paragraph 3 of this subsecti on,
301	293		and has corrected any deficiency described in
302	294		subparagraph a of this paragraph, the Department shall
303	295		notify the facility of its eligibility to implement
304	296		twenty-four-hour-based staff-scheduling privileges.
305	297		7. a. For facilities that utilize twenty -four-hour-based
306	298		staff-scheduling privileges, the Department shall
307	299		monitor and evaluate facility compliance with the
308	300		twenty-four-hour-based staff-scheduling staffing
309	301		provisions of paragraph 5 of this subsec tion through
310	302		reviews of monthly staffing reports, results of
311	303		complaint investigations and inspections.
312	304		b. If the Department identifies any quality -of-care
313	305		problems related to i nsufficient staffing in such
314	306		facility, the Department shall issue a directed pla n
315	307		of correction to the faci lity found to be out of
316	308		compliance with the provisions of this subsection.
317	309		c. In a directed plan of correction, the Department shall
318	310		require a facility described in subparagraph b of this
319	311		paragraph to maintain shift -based, staff-to-resident
320	312		ratios for the following periods of time:
321	313
322		-	HB1659 HFLR Page 7
323		-	BOLD FACE denotes Committee Amendments. 1
	314	+	Req. No. 7883 Page 7 1
324	315		2
325	316		3
326	317		4
327	318		5
328	319		6
329	320		7
330	321		8
331	322		9
332	323		10
333	324		11
334	325		12
335	326		13
336	327		14
337	328		15
338	329		16
339	330		17
340	331		18
341	332		19
342	333		20
343	334		21
344	335		22
345	336		23
346	337		24
347	338
348	339		(1) the first determination shall require that shift -
349	340		based, staff-to-resident ratios be maintained
350	341		until full compliance i s achieved,
351	342		(2) the second determinatio n within a two-year period
352	343		shall require that shift-based, staff-to-resident
353	344		ratios be maintained for a minimum period of
354	345		twelve (12) months, and
355	346		(3) the third determination within a two -year period
356	347		shall require that shift-based, staff-to-resident
357	348		ratios be maintained. The facility may apply fo r
358	349		permission to use twenty -four-hour staffing
359	350		methodology after two (2) years.
360	351		C. Effective September 1, 2002, facil ities shall post the names
361	352		and titles of direct -care staff on duty each day in a conspicuous
362	353		place, including the name and title of the sup ervising nurse.
363	354		D. The State Commissioner of Health shal l promulgate rules
364	355		prescribing staffing requirements for Int ermediate Care Facilities
365	356		for Individuals with Intellectual Disabilities serving six or fewer
366	357		clients (ICFs/IID-6) and for Intermediate Car e Facilities for
367	358		Individuals with Intellectual Disabiliti es serving sixteen or fewer
368	359		clients (ICFs/IID-16).
369	360		E. Facilities shall have the right to appeal and to the
370	361		informal dispute resolution process with regard to penalties and
371	362		sanctions imposed due to s taffing noncompliance.
372	363
373		-	HB1659 HFLR Page 8
374		-	BOLD FACE denotes Committee Amendments. 1
	364	+	Req. No. 7883 Page 8 1
375	365		2
376	366		3
377	367		4
378	368		5
379	369		6
380	370		7
381	371		8
382	372		9
383	373		10
384	374		11
385	375		12
386	376		13
387	377		14
388	378		15
389	379		16
390	380		17
391	381		18
392	382		19
393	383		20
394	384		21
395	385		22
396	386		23
397	387		24
398	388
399	389		F. 1. When the state Medicaid pr ogram reimbursement rate
400	390		reflects the sum of Ninety -four Dollars and eleven cents ($94.11),
401	391		plus the increases in actua l audited costs over and above the actu al
402	392		audited costs reflected in the cost re ports submitted for the mos t
403	393		current cost-reporting period and the costs estimated by the
404	394		Oklahoma Health Care Author ity to increase the direct -care, flexible
405	395		staff-scheduling staffing level from two and eighty -six one-
406	396		hundredths (2.86) hours per day per o ccupied bed to three and tw o-
407	397		tenths (3.2) hours per day p er occupied bed, all nursing facilities
408	398		subject to the provi sions of the Nursing Home Care Act and
409	399		Intermediate Care Fa cilities for Individuals with Intellect ual
410	400		Disabilities (ICFs/IID) with seventee n or more beds, in addition to
411	401		other state and federal re quirements related to the staffing of
412	402		nursing facilities, sh all maintain direct-care, flexible staff -
413	403		scheduling staffing levels based on an overall three and two-tenths
414	404		(3.2) hours per day per occupi ed bed.
415	405		2. When the state Medicaid program reimbursement rate reflects
416	406		the sum of Ninety-four Dollars and eleven cen ts ($94.11), plus the
417	407		increases in actual audited costs ove r and above the actual audited
418	408		costs reflected in the cost reports submitted for the most current
419	409		cost-reporting period and the costs est imated by the Oklahoma Health
420	410		Care Authority to increase the direct-care flexible staff-scheduling
421	411		staffing level from three and two-tenths (3.2) hours per da y per
422	412		occupied bed to three and eight -tenths (3.8) hours per day per
423	413
424		-	HB1659 HFLR Page 9
425		-	BOLD FACE denotes Committee Amendments. 1
	414	+	Req. No. 7883 Page 9 1
426	415		2
427	416		3
428	417		4
429	418		5
430	419		6
431	420		7
432	421		8
433	422		9
434	423		10
435	424		11
436	425		12
437	426		13
438	427		14
439	428		15
440	429		16
441	430		17
442	431		18
443	432		19
444	433		20
445	434		21
446	435		22
447	436		23
448	437		24
449	438
450	439		occupied bed, all nursing fac ilities subject to the provisions of
451	440		the Nursing Home Care A ct and Intermediate Care Facilities for
452	441		Individuals with Intellectual Disabilities (ICFs/IID) with seventeen
453	442		or more beds, in addition to o ther state and federal requ irements
454	443		related to the staffi ng of nursing facilities, shall maintain
455	444		direct-care, flexible staff-scheduling staffing levels based on an
456	445		overall three and eight-tenths (3.8) hours per day per occupied bed.
457	446		3. When the state Med icaid program reimbursement rate reflects
458	447		the sum of Ninety-four Dollars and eleven cents ($94.11), plus the
459	448		increases in actual audited costs over and above the actual audited
460	449		costs reflected in the cost reports su bmitted for the most current
461	450		cost-reporting period and the costs est imated by the Oklahoma Health
462	451		Care Authority to increase the direct-care, flexible staff -
463	452		scheduling staffing level from three and eight -tenths (3.8) hours
464	453		per day per occupied bed to four and one-tenth (4.1) hours per day
465	454		per occupied bed, all nursing faci lities subject to the provisio ns
466	455		of the Nursing Home Care Act and Intermediate Care Facili ties for
467	456		Individuals with Intellectual Disabilities (ICFs/I ID) with seventeen
468	457		or more beds, in add ition to other state and federal requirem ents
469	458		related to the staffin g of nursing facilities, shall maintain
470	459		direct-care, flexible staff -scheduling staffing le vels based on an
471	460		overall four and one -tenth (4.1) hours per day per occupied bed.
472	461		4. The Commissioner shall promulgate rules for shift -based,
473	462		staff-to-resident ratios for noncompliant facilities denoting the
474	463
475		-	HB1659 HFLR Page 10
476		-	BOLD FACE denotes Committee Amendments. 1
	464	+	Req. No. 7883 Page 10 1
477	465		2
478	466		3
479	467		4
480	468		5
481	469		6
482	470		7
483	471		8
484	472		9
485	473		10
486	474		11
487	475		12
488	476		13
489	477		14
490	478		15
491	479		16
492	480		17
493	481		18
494	482		19
495	483		20
496	484		21
497	485		22
498	486		23
499	487		24
500	488
501	489		incremental increases reflected in direct -care, flexible staff-
502	490		scheduling staffing levels.
503	491		5. In the event that the state Medicaid program reimb ursement
504	492		rate for facilities subject to t he Nursing Home Care Act, a nd
505	493		Intermediate Care Facilitie s for Individuals with Intellectual
506	494		Disabilities (ICFs/IID) having with seventeen or more beds is
507	495		reduced below actual audit ed costs, the requirements for staffing
508	496		ratio levels shall be adjusted to t he appropriate levels provided i n
509	497		paragraphs 1 through 4 of this subsection.
510	498		G. For purposes of this subsection:
511	499		1. "Direct-care staff" means any nursing or therapy staff who
512	500		provides direct, hands-on care to residents in a nursing facility;
513	501		2. Prior to September 1, 2003, activity and social services
514	502		staff who are not providing direct, hands-on care to residents may
515	503		be included in the direct-care-staff-to-resident ratio in any shi ft.
516	504		On and after September 1, 2003, su ch persons shall not be included
517	505		in the direct-care-staff-to-resident ratio, regardless of th eir
518	506		licensure or certification status; and
519	507		3. The administrator shall not be counted in the direct -care-
520	508		staff-to-resident ratio regardless of the administrator 's licensure
521	509		or certification status.
522	510		H. 1. The Oklahoma Health Care Authority shall require a ll
523	511		nursing facilities subject to the provisions of the Nursing Ho me
524	512		Care Act and Intermediate Care Facilities for Individual s with
525	513
526		-	HB1659 HFLR Page 11
527		-	BOLD FACE denotes Committee Amendments. 1
	514	+	Req. No. 7883 Page 11 1
528	515		2
529	516		3
530	517		4
531	518		5
532	519		6
533	520		7
534	521		8
535	522		9
536	523		10
537	524		11
538	525		12
539	526		13
540	527		14
541	528		15
542	529		16
543	530		17
544	531		18
545	532		19
546	533		20
547	534		21
548	535		22
549	536		23
550	537		24
551	538
552	539		Intellectual Disabilities (ICFs/ IID) with seventeen or more beds to
553	540		submit a monthly report on staff ing ratios on a form that the
554	541		Authority shall develop.
555	542		2. The report shall document the e xtent to which such
556	543		facilities are meeting or are failing t o meet the minimum direct -
557	544		care-staff-to-resident ratios specified by this s ection. Such
558	545		report shall be available to the public upo n request.
559	546		3. The Authority may assess administrative penalties for the
560	547		failure of any facility to submit the report as req uired by the
561	548		Authority. Provided, howe ver:
562	549		a. administrative penalties sha ll not accrue until the
563	550		Authority notifies the facility i n writing that the
564	551		report was not timely submitted as required, a nd
565	552		b. a minimum of a one-day penalty shall be assessed in
566	553		all instances.
567	554		4. Administrative penalt ies shall not be assessed for
568	555		computational errors made in preparing the report.
569	556		5. Monies collected from administrative penalties shall be
570	557		deposited in the Nursing Facility Quality of Care Fund and utilized
571	558		for the purposes specified in the Oklahoma Heal thcare Initiative
572	559		Act.
573	560		I. 1. All entities regulated by this state that provide long-
574	561		term care services shall utilize a single assessment tool to
575	562		determine client services needs. The tool shall be developed by the
576	563
577		-	HB1659 HFLR Page 12
578		-	BOLD FACE denotes Committee Amendments. 1
	564	+	Req. No. 7883 Page 12 1
579	565		2
580	566		3
581	567		4
582	568		5
583	569		6
584	570		7
585	571		8
586	572		9
587	573		10
588	574		11
589	575		12
590	576		13
591	577		14
592	578		15
593	579		16
594	580		17
595	581		18
596	582		19
597	583		20
598	584		21
599	585		22
600	586		23
601	587		24
602	588
603	589		Oklahoma Health Care Authority in consul tation with the State
604	590		Department of Health.
605	591		2. a. The Oklahoma Nursing Facility Funding Advis ory
606	592		Committee is hereby created and shall consist of the
607	593		following:
608	594		(1) four members selected by the Oklahoma Association
609	595		of Health Care Providers,
610	596		(2) three members selected by the Oklahoma
611	597		Association of Homes and Services for th e Aging,
612	598		and
613	599		(3) two members selected by the State Council on
614	600		Aging.
615	601		The Chair shall be el ected by the committee. No state
616	602		employees may be appointe d to serve.
617	603		b. The purpose of the advis ory committee will be to
618	604		develop a new methodology for calculating s tate
619	605		Medicaid program rei mbursements to nursing facilities
620	606		by implementing facility -specific rates based on
621	607		expenditures relating to direct care staf fing. No
622	608		nursing home will receive les s than the current rate
623	609		at the time of implementation of facility -specific
624	610		rates pursuant to this subparagraph.
625	611		c. The advisory committee shall be staffed and advised by
626	612		the Oklahoma Health Care Authority.
627	613
628		-	HB1659 HFLR Page 13
629		-	BOLD FACE denotes Committee Amendments. 1
	614	+	Req. No. 7883 Page 13 1
630	615		2
631	616		3
632	617		4
633	618		5
634	619		6
635	620		7
636	621		8
637	622		9
638	623		10
639	624		11
640	625		12
641	626		13
642	627		14
643	628		15
644	629		16
645	630		17
646	631		18
647	632		19
648	633		20
649	634		21
650	635		22
651	636		23
652	637		24
653	638
654	639		d. The new methodology will be submitted for appr oval to
655	640		the Board of the Oklahoma Hea lth Care Authority by
656	641		January 15, 2005, and shall be f inalized by July 1,
657	642		2005. The new methodology will apply only to new
658	643		funds that become available for Medicaid nursing
659	644		facility reimbursement after the methodology o f this
660	645		paragraph has been finalized. Existing funds paid to
661	646		nursing homes will not be subj ect to the methodology
662	647		of this paragraph. The methodology as out lined in
663	648		this paragraph will only be applied to any new fundi ng
664	649		for nursing facilities appropriated above and beyond
665	650		the funding amounts effective on January 15, 2005.
666	651		e. The new methodology shall divide the payment into two
667	652		components:
668	653		(1) direct care which includes allowable costs for
669	654		registered nurses, licensed p ractical nurses,
670	655		certified medication a ides and certified nurse
671	656		aides. The direct care component of the rat e
672	657		shall be a facility-specific rate, directly
673	658		related to each facility 's actual expenditures on
674	659		direct care, and
675	660		(2) other costs.
676	661		f.
677	662
678		-	HB1659 HFLR Page 14
679		-	BOLD FACE denotes Committee Amendments. 1
	663	+	Req. No. 7883 Page 14 1
680	664		2
681	665		3
682	666		4
683	667		5
684	668		6
685	669		7
686	670		8
687	671		9
688	672		10
689	673		11
690	674		12
691	675		13
692	676		14
693	677		15
694	678		16
695	679		17
696	680		18
697	681		19
698	682		20
699	683		21
700	684		22
701	685		23
702	686		24
703	687
704	688		a. The Oklahoma Health Care Authority, in calculating the
705	689		base year prospective direct ca re rate component,
706	690		shall use the following criteria:
707	691		(1) to construct an array of facility per diem
708	692		allowable expenditures on direct care, the
709	693		Authority shall use the most recent data
710	694		available. The limit on this array shal l be no
711	695		less than the ninetieth percentile,
712	696		(2) each facility's direct care base-year component
713	697		of the rate shall be the lesser of the facility 's
714	698		allowable expenditures on direct care or the
715	699		limit,
716	700		(3) other rate components shall be determined by the
717	701		Oklahoma Nursing Facility Funding Adv isory
718	702		Committee in accordance with fe deral regulations
719	703		and requirements,
720	704		(4) prior to July 1, 2020, the Authority shal l seek
721	705		federal approval to calculate the upper payment
722	706		limit under the authority of Centers for Medicare
723	707		and Medicaid Services (CMS) utilizing the
724	708		Medicare equivalent payment rate, and
725	709		(5)
726	710		(4) if Medicaid payment rates to providers are
727	711		adjusted, nursing home rates and Intermediate
728	712
729		-	HB1659 HFLR Page 15
730		-	BOLD FACE denotes Committee Amendments. 1
	713	+	Req. No. 7883 Page 15 1
731	714		2
732	715		3
733	716		4
734	717		5
735	718		6
736	719		7
737	720		8
738	721		9
739	722		10
740	723		11
741	724		12
742	725		13
743	726		14
744	727		15
745	728		16
746	729		17
747	730		18
748	731		19
749	732		20
750	733		21
751	734		22
752	735		23
753	736		24
754	737
755	738		Care Facilities for Ind ividuals with Intellectual
756	739		Disabilities (ICFs/IID) rates shall not be
757	740		adjusted less favorably than the average
758	741		percentage-rate reduction or in crease applicable
759	742		to the majority of other provider groups.
760	743		g.
761	744		b. (1) Effective October 1, 2019, if sufficient fun ding
762	745		is appropriated for a rate increase, a new
763	746		average rate for nursi ng facilities shall be
764	747		established. The rate shall be equal to the
765	748		statewide average cost as derived from audited
766	749		cost reports for SFY 2018, ending June 30, 2018,
767	750		after adjustment for i nflation. After such new
768	751		average rate has been established, the facil ity
769	752		specific reimbursement rate shall be as follows:
770	753		(a) amounts up to the existing base rate amount
771	754		shall continue to be distributed as a part
772	755		of the base rate in accordance with the
773	756		existing State Plan, and
774	757		(b) to the extent the new rate exceeds the rate
775	758		effective before the effective date of this
776	759		act, fifty percent (50%) of the resulting
777	760		increase on October 1, 2019, shall be
778	761		allocated toward an increase of the existing
779	762
780		-	HB1659 HFLR Page 16
781		-	BOLD FACE denotes Committee Amendments. 1
	763	+	Req. No. 7883 Page 16 1
782	764		2
783	765		3
784	766		4
785	767		5
786	768		6
787	769		7
788	770		8
789	771		9
790	772		10
791	773		11
792	774		12
793	775		13
794	776		14
795	777		15
796	778		16
797	779		17
798	780		18
799	781		19
800	782		20
801	783		21
802	784		22
803	785		23
804	786		24
805	787
806	788		base reimbursement rate and distributed
807	789		accordingly. The remaining fifty percent
808	790		(50%) of the increase shall be allocated in
809	791		accordance with the currently ap proved 70/30
810	792		reimbursement rate methodology as outlined
811	793		in the existing State Plan.
812	794		(2) Any subsequent rate increa ses, as determined
813	795		based on the provisions set forth in this
814	796		subparagraph, shall be allocated in accordance
815	797		with the currently approved 70/30 reimbursement
816	798		rate methodology. The rate shall not exceed the
817	799		upper payment limit established by the Medicare
818	800		rate equivalent established by the federal CMS.
819	801		h.
820	802		c. Effective October 1, 2 019, in coordination with the
821	803		rate adjustments identified in the prec eding section,
822	804		a portion of the funds shall be utilized as follows:
823	805		(1) effective October 1, 2019, the Oklahoma He alth
824	806		Care Authority shall increase the personal needs
825	807		allowance for residents of nursing homes and
826	808		Intermediate Care Facilities for Individual s with
827	809		Intellectual Disabilities (ICFs/IID) from Fifty
828	810		Dollars ($50.00) per month to Seventy -five
829	811		Dollars ($75.00) per month per resident. The
830	812
831		-	HB1659 HFLR Page 17
832		-	BOLD FACE denotes Committee Amendments. 1
	813	+	Req. No. 7883 Page 17 1
833	814		2
834	815		3
835	816		4
836	817		5
837	818		6
838	819		7
839	820		8
840	821		9
841	822		10
842	823		11
843	824		12
844	825		13
845	826		14
846	827		15
847	828		16
848	829		17
849	830		18
850	831		19
851	832		20
852	833		21
853	834		22
854	835		23
855	836		24
856	837
857	838		increase shall be funded by Medicaid nursin g home
858	839		providers, by way of a reduction of eighty-two
859	840		cents ($0.82) per day deducted from the base
860	841		rate. Any additional cost shall be funded by the
861	842		Nursing Facility Quality of Care F und, and
862	843		(2) effective January 1, 2020, all clinical employees
863	844		working in a licensed nursing facility shall be
864	845		required to receive at least fo ur (4) hours
865	846		annually of Alzheimer's or dementia training, to
866	847		be provided and paid for by the facilities.
867	848		3. 2. The Department of Human Services shall expand its
868	849		statewide, toll-free, Senior-Info Line for senior citizen services
869	850		to include assistance with or information on long-term care services
870	851		in this state.
871	852		4. 3. The Oklahoma Health Care Authority shall develop a
872	853		nursing facility cost -reporting system that reflects the most
873	854		current costs experienced by nursing and specialized fa cilities.
874	855		The Oklahoma Health Care Authority shall utilize the most current
875	856		cost report data to estimate costs in determining daily per d iem
876	857		rates.
877	858		5. 4. The Oklahoma Health Care Authority shall provide access
878	859		to the detailed Medicaid payment audit adjustme nts and implement an
879	860		appeal process for disputed payment audit adjust ments to the
880	861		provider. Additionally, the Oklahoma Health Care Aut hority shall
881	862
882		-	HB1659 HFLR Page 18
883		-	BOLD FACE denotes Committee Amendments. 1
	863	+	Req. No. 7883 Page 18 1
884	864		2
885	865		3
886	866		4
887	867		5
888	868		6
889	869		7
890	870		8
891	871		9
892	872		10
893	873		11
894	874		12
895	875		13
896	876		14
897	877		15
898	878		16
899	879		17
900	880		18
901	881		19
902	882		20
903	883		21
904	884		22
905	885		23
906	886		24
907	887
908	888		make sufficient revisions to the nursing facility cost reporting
909	889		forms and electronic data input system so a s to clarify what
910	890		expenses are allowable and appropriate for inclusio n in cost
911	891		calculations.
912	892		J. 1. When the state Medicaid program re imbursement rate
913	893		reflects the sum of Ninety -four Dollars and eleven cents ($94.11) ,
914	894		plus the increases in actual audited costs, over and abov e the
915	895		actual audited costs reflected in the cost reports submitted for the
916	896		most current cost-reporting period, and the direct-care, flexible
917	897		staff-scheduling staffing level has been prospectively f unded at
918	898		four and one-tenth (4.1) hours per day per occupied bed, the
919	899		Authority may apportion funds for the implementation of the
920	900		provisions of this section.
921	901		2. The Authority shall make application to the United States
922	902		Centers for Medicare and Medica id Service Services for a waiver of
923	903		the uniform requirement on health-care-related taxes as permitted by
924	904		Section 433.72 of 42 C.F.R., Section 433.72.
925	905		3. Upon approval of the waiver, the Authority shall develop a
926	906		program to implement the provisions of the waiver as it relates to
927	907		all nursing facilities.
928	908		SECTION 2. This act shall become effective November 1, 2023.
929	909
930		-	COMMITTEE REPORT BY: COMMITTEE ON ADMINISTRATIVE RULES, dated
931		-	03/02/2023 - DO PASS, As Amended and Coauthored.
	910	+	59-1-7883 LRB 03/02/23
	911	+
	912	+
	913	+	Req. No. 7883 Page 19 1
	914	+	2
	915	+	3
	916	+	4
	917	+	5
	918	+	6
	919	+	7
	920	+	8
	921	+	9
	922	+	10
	923	+	11
	924	+	12
	925	+	13
	926	+	14
	927	+	15
	928	+	16
	929	+	17
	930	+	18
	931	+	19
	932	+	20
	933	+	21
	934	+	22
	935	+	23
	936	+	24
	937	+
	938	+