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STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
HOUSE BILL 3025 By: Humphrey
AS INTRODUCED
An Act relating to public health and safety; amending
56 O.S. 2021, Section 2002, which relates to Nursing
Facilities Quality of Care Fee; terminating fee; and
providing an effective date.
BE IT ENACTED BY THE PEOPLE OF T HE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 56 O.S. 2021, Section 2002, is
amended to read as follows :
Section 2002. A. For the purpose of providing quality care
enhancements, the Oklahoma Health Care Authority is authorized to
and shall assess a Nursing Facilities Quality of Care Fee pursuant
to this section upon each nursing facility licensed in this state.
Facilities operated by the Oklahoma Department of Veterans Affairs
shall be exempt from this fee. Quality of care enhancements
include, but are not limited to, the purposes specified in this
section.
B. As a basis for determining the Nursing Facilities Quality of
Care Fee assessed upon each licensed nursing facility, the Au thority
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shall calculate a uniform per -patient day rate. The rate shall be
calculated by dividing six percent (6%) of the total annual patient
gross receipts of all licensed nursing facilities in this s tate by
the total number of patient days for all licen sed nursing facilities
in this state. The result shall be the per -patient day rate.
Beginning July 15, 2004, the Nursing Facilities Quality of Care Fee
shall not be increased unless specifically autho rized by the
Legislature. Effective November 1 , 2026, the Nursing Facilities
Quality of Care Fee shall be terminated.
C. Pursuant to any approved Medicaid waiver and pursuant to
subsection N of this section, the Nursing Facilities Quality of Care
Fee shall not exceed the amount or rate allowed by federal la w for
nursing home licensed bed days.
D. The Nursing Facilities Quality of Care Fee owed by a
licensed nursing facility shall be calculated by the Authority by
adding the daily patient census of a lic ensed nursing facility, as
reported by the facility for each day of the month, and by
multiplying the ensuing figure by the per -patient day rate
determined pursuant to the provisions of subsection B of this
section.
E. Each licensed nursing facility which is assessed the Nursing
Facilities Quality of Care Fee shall be required to file a report on
a monthly basis with the Authority detailing the daily patient
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census and patient gross receipts at such time and in such manner as
required by the Authority.
F. 1. The Nursing Facilities Qualit y of Care Fee for a
licensed nursing facility for the period beginning October 1, 2000,
shall be determined using the daily patient census and annual
patient gross receipts figures reported to the Authority for the
calendar year 1999 upon forms supplied by the Authority.
2. Annually the Nursing Facilities Quality of Care Fee shall be
determined by:
a. using the daily patient census and patient gross
receipts reports received by the Authority for the
most recent available t welve (12) months, and
b. annualizing those figures.
Each year thereafter, the annualization of the Nursing
Facilities Quality of Care Fee specified in this paragraph shall be
subject to the limitation in subsection B of this section unless the
provision of subsection C of this section is met.
G. The payment of the Nursing Facilities Quality of Care Fee by
licensed nursing facilities shall be an allowable cost for Medicaid
reimbursement purposes.
H. 1. There is hereby created in the State Treasury a
revolving fund to be designated the "Nursing Facility Quali ty of
Care Fund".
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2. The fund shall be a continuing fund, not subject to fiscal
year limitations, and shall consist of:
a. all monies received by the Authority pursuant to this
section and otherwise s pecified or authorized by law,
b. monies received by th e Authority due to federal
financial participation pursuant to Title XIX of the
Social Security Act, and
c. interest attributable to investment of money in the
fund.
3. All monies accruing to the cred it of the fund are hereby
appropriated and shall be bud geted and expended by the Authority
for:
a. reimbursement of the additional costs paid to
Medicaid-certified nursing facilities for purposes
specified by Sections 1 -1925.2 and 5022.2 of Title 63
of the Oklahoma Statutes,
b. reimbursement of the Medicaid ra te increases for
intermediate care facilities for individuals with
intellectual disabilities Intermediate Care Facilities
for Individuals with Intellectual Disabilities
(ICFs/IID),
c. nonemergency transportati on services for Medicaid -
eligible nursing home clients,
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d. eyeglass and denture services for Medicaid -eligible
nursing home clients,
e. fifteen ombudsmen employed by the Department of Human
Services,
f. ten additional nursing facility inspectors employed b y
the State Department of Health,
g. pharmacy and other Medicaid ser vices to qualified
Medicare beneficiaries whose incomes are at or below
one hundred percent (100%) of the federal poverty
level; provided, however, pharmacy benefits authorized
for such qualified Medicare beneficiaries shall be
suspended if the federal gove rnment subsequently
extends pharmacy benefits to this p opulation,
h. costs incurred by the Authority in the administration
of the provisions of this section and any programs
created pursuant to this section,
i. durable medical equipme nt and supplies servic es for
Medicaid-eligible elderly adults, and
j. personal needs allowance increases for residents of
nursing homes and Intermediate Care Facilities for
Individuals with Intellectual Disabi lities (ICFs/IID)
from Thirty Dollars ($30.00) to Fifty Dollars ($50. 00)
per month per resident.
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4. Expenditures from the f und shall be made upon warrants
issued by the State Treasurer against claims filed as prescribed by
law with the Director of the Off ice of Management and Enterprise
Services for approval and payment.
5. The fund and the programs speci fied in this section funded
by revenues collected from the Nursing Facilities Quality of Care
Fee pursuant to this section are exempt from budgetary cuts ,
reductions, or eliminations.
6. The Medicaid rate increases for intermediate care facilities
for individuals with intelle ctual disabilities Intermediate Care
Facilities for Individuals with Intellectual Disabilities (ICFs/IID)
shall not exceed the net M edicaid rate increase for nursing
facilities including, but not limited to, the Medicaid rate increase
for which Medicaid-certified nursing facil ities are eligible due to
the Nursing Facilities Qualit y of Care Fee less the portion of that
increase attributable to treating the Nursing Facilities Quality of
Care Fee as an allowable cost.
7. The reimbursement rate for nursing facilities shall be made
in accordance with Oklahoma 's Medicaid reimbursement r ate
methodology and the provisions of this section.
8. No nursing facility shall be guaranteed, expres sly or
otherwise, that any additional costs reimbursed to the facility will
equal or exceed the am ount of the Nursing Facilities Qua lity of Care
Fee paid by the nursing facility.
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I. 1. In the event that fede ral financial participation
pursuant to Title XIX of the Social Security Act is not available to
the Oklahoma Medicaid program, for purposes of m atching expenditures
from the Nursing Facility Quality of Care Fund at the approved
federal medical assistance percentage for the applicable fiscal
year, the Nursing Facilities Quality of Care Fee shall be null and
void as of the date of the nonavailabilit y of such federal funding,
through and during any perio d of nonavailability.
2. In the event of an invalidatio n of this section by any court
of last resort under circumstances not covered in subsection J of
this section, the Nursing Facilities Quality of Care Fee shall be
null and void as of the effective dat e of that invalidation.
3. In the event that the Nursin g Facilities Quality of Care Fee
is determined to be null and void for any of the reasons enumerated
in this subsection, any Nursing Facilities Q uality of Care Fee
assessed and collected for any perio ds after such invalidation shall
be returned in full wit hin sixty (60) days by the Authority to the
nursing facility from which it was collected.
J. 1. If any provision of this section or the applica tion
thereof shall be adjudged to be invalid by any cou rt of last resort,
such judgment shall not affect, impai r or invalidate the provisions
of the section, but shall be confined in its operation to the
provision thereof directly involved in the controver sy in which such
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judgment was rendered. The applicabil ity of such provision to other
persons or circumstances shall not be affected thereby.
2. This subsection shall not apply to any judgment that affects
the rate of the Nursing Facilities Quality of Car e Fee, its
applicability to all li censed nursing homes in the state, the usage
of the fee for the purposes pres cribed in this section, or the
ability of the Authority to obtain full federal participation to
match its expenditures of the proceeds of the fee .
K. The Authority shall promulga te rules for the impl ementation
and enforcement of the Nursing Facilities Qua lity of Care Fee
established by this section.
L. The Authority shall provide for administrative penalties in
the event nursing facilities fail t o:
1. Submit the Quality of Care Fee;
2. Submit the fee in a timely manner;
3. Submit reports as required by this section; or
4. Submit reports timely.
M. As used in this section:
1. "Nursing facility" means any home, establishment or
institution, or any portion thereof, licensed by the State
Department of Health as defined in Section 1 -1902 of Title 63 of th e
Oklahoma Statutes;
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2. "Medicaid" means the medical assistance program established
in Title XIX of the federal Social Security Act and administ ered in
this state by the Authorit y;
3. "Patient gross revenues" means gross revenues received in
compensation for services provided to residents of nursing
facilities including, but not limited to, client participation. The
term "patient gross revenues " shall not include amounts receive d by
nursing facilities as charitable contributions; and
4. "Additional costs paid to Medicaid-certified nursing
facilities under Oklahoma's Medicaid reimbursement methodology "
means both state and federal Medicaid expend itures including, but
not limited to, funds in excess o f the aggregate amounts that would
otherwise have been p aid to Medicaid-certified nursing facilities
under the Medicaid reimbursement methodology which have been updated
for inflationary, economic, and regulatory trends and which are i n
effect immediately prior to the inception of the Nursing Facilities
Quality of Care Fee.
N. 1. As per any approved feder al Medicaid waiver, the
assessment rate subject to the provision of subsection C of this
section is to remain the same as those rate s that were in effect
prior to January 1, 2012, for all state -licensed continuum of care
facilities.
2. Any facilities that made application to the State Department
of Health to become a licensed continuum of care facilit y no later
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than January 1, 2012, s hall be assessed at t he same rate as those
facilities assessed pursuant to pa ragraph 1 of this subsection;
provided, that any facility making the application shall receive the
license on or before September 1, 2012. Any f acility that fails to
receive such license from the Sta te Department of Health by
September 1, 2012, shall be a ssessed at the rate established by
subsection C of this section subsequent to September 1, 2012.
O. If any provision of this section, or the app lication
thereof, is determined by any controlling fede ral agency, or any
court of last resort , to prevent the state from obtaining federal
financial participation in the state's Medicaid program, such
provision shall be deemed null and void as of the date of the
nonavailability of such fed eral funding and thro ugh and during any
period of nonavailability. All othe r provisions of the bill this
section shall remain valid and enforceable.
SECTION 2. This act shall become effective November 1, 2024.
59-2-8495 TJ 11/30/23