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STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
SENATE BILL 1417 By: Rosino
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 re imbursement rate
plan; modifying amount of certain reserve d funds;
removing certain limitations on deductions and
payments; adding certain outcomes metrics; modifying
terminology; clarifying language; providing for
establishment of certain benchmarks; modi fying
certain method of reporting; authorizing the Oklahoma
Health Care Authority to take certain actions
depending on certain factors; amending 63 O.S. 2021,
Section 1-1925.2, which relates to reimbursements
from the Nursing Facility Quality of Care Fund ;
modifying and adding components in certain payment
methodology; requiring certain adjust ments; removing
certain provisions relating to payment rates;
directing certain alloc ations; requiring development
of certain add-on rate; directing certain transition
of payment rate methodology; requiring the Authority
to implement certain scho larship program subject to
available funding; updating statutory language ;
providing an effective date; and declaring an
emergency.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 56 O.S. 2021, Section 1011.5, is
amended to read as follows:
Section 1011.5. A. 1. The Oklahoma Health Ca re Authority
shall develop an incentive reimbursement rate plan for nursing
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facilities focused on improving resident outcomes and resident
quality of life.
2. Under the current rate methodology, the The Authority shall
reserve funds above the average of Five Dollars ($5.00) per patient
day designated for incentive payment in the curr ently approved
Medicaid state plan for the quality assurance component that nursing
facilities can earn for improvement or perfor mance achievement 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 rate, and matched with Three Do llars ($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 die m. Dollar values assigned to each metric
shall be determined so that an average of the five -dollar-quality
incentive is made to qualifying nursin g facilities The Authority
shall determine the dollar amount for each resident-centered
outcomes metric under the incentive reimbursement rate plan .
3. Pay-for-performance payments to contracted nursing
facilities may be earned quarterly and shall be based on the
following outcomes metrics :
a. facility-specific performance achievement of four
equally-weighted equally weighted, Long-Stay Quality
Measures, as defined by the Centers for Medicare and
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Medicaid Services (CMS) and as provided by
subparagraph a of paragraph 6 of this subsection ,
b. completion of required h ours of a training component
as provided by subparagraph b of paragraph 6 of this
subsection,
c. achievement of staffing retention and direct care
component benchmarks as provided by subparagraph c of
paragraph 6 of this subsection , and
d. achievement of satisfaction survey benchmarks as
provided by subparagraph d of paragraph 6 of this
subsection.
4. Contracted Medicaid long -term care providers may earn
payment by achieving either five percent (5%) relative improvement
each quarter from baseline or by ach ieving the National Average
Benchmark or better fo r each individual quality metric.
5. Pursuant to federal Medicaid approval, an y funds that remain
as a result of providers failing to meet the quality assurance
benchmarks of the outcomes metrics established by this subsection
shall be pooled and redistri buted to those who achieve the quality
assurance metrics benchmarks each quarter. If federal approval is
not received, any remaining funds shall be deposited in the Nursing
Facility Quality of Care Fund au thorized in Section 2002 of th is
title.
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6. 5. The Authority shall establish an advi sory group with
consumer, provider and state agency representation to recommend
quality measures benchmarks for outcomes metrics, other than the
benchmarks specified in paragraph 6 of this subsection, to be
included in the pay-for-performance program and to provide feedback
on program performance and recommendations for improvement. The
quality measures Such benchmarks shall be reviewed annually and
shall be subject to chan ge every three (3) years throu gh the
agency’s promulgation of rules. The Authority shall insure ensure
adherence to the followin g criteria in determining the quality
measures benchmarks:
a. provides direct benefit to resident c are outcomes,
b. applies to long-stay residents, and
c. addresses a need for q uality improvement using
criteria including, but not limited to, the Centers
for Medicare and Medicaid Services (CMS) ranking for
Oklahoma.
7. 6. The Authority shall begin administer the pay-for-
performance program focusing on improvin g the following CMS nursing
home quality measures utilizing the following benchmarks for
outcomes metrics:
a. achievement of either five percent (5%) relative
improvement each quarter from baseline or by achieving
the national average benchmark or better for each of
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the following equally weighted CMS Long-Stay Quality
Measures:
a. percentage of long-stay, high-risk residents with
pressure ulcers
(1) percentage of long-stay, high-risk residents with
falls,
b. (2) percentage of long-stay residents who lose
too much weight,
c. (3) percentage of long-stay residents with a
urinary tract infection, and
d. (4) percentage of long-stay residents who got
an antipsychotic medication ,
b. completion of training hours required by the Authority
through distance learning or in -person training on:
(1) fall prevention,
(2) mental health care,
(3) techniques to manage care,
(4) pressure ulcer care, or
(5) any other subject approved by the Authority,
c. achievement of the following staffing retention and
direct care hour benchmarks:
(1) retention of not less than fifty percent (50%) of
registered nurses for twelve (12) months ,
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(2) retention of not less than sixty percent (60%) of
certified nurse aides for twelve (12) months , and
(3) provision of direct care hours every three (3)
months in accordance with a benchmark established
by the Authority, and
d. achievement of benchmarks established by the Authority
for satisfaction surveys of:
(1) residents and families of residents, and
(2) staff of the facility.
B. The Oklahoma Health Care Authority shall negotiate with the
Centers for Medicare and Medicaid Services to include the au thority
to base provider reimbursement rates for nursing facilities on the
criteria specified in subsection A of this section.
C. The Oklahoma Health Care Authority shall audit the program
to ensure transparency and integrity.
D. The Oklahoma Health Care Authority shall provide
electronically submit an annual report of the incentive
reimbursement rate plan to the Governor, the S peaker of the House of
Representatives, and the Pr esident Pro Tempore of the Senate by
December 31 of each year. The report shal l include, but not be
limited to, an analysis of the previous fiscal year including
incentive payments, ratings, and notable trends.
E. The Oklahoma Health Care Authority may change, add, or
exclude any outcomes metric from the incentive reimbursement rate
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plan based on availability of funding, changes to metrics made by
the Centers for Medicare and Medicaid Services, and quality needs of
nursing facilities in this state as determined by the Authority.
SECTION 2. AMENDATORY 63 O.S. 2021, Section 1-1925.2, is
amended to read as follows:
Section 1-1925.2. A. The Oklahoma Health Care Authority shall
fully recalculate and reimburse nursing facilities and I ntermediate
Care Facilities for Individuals with Intellectual Disabilities
(ICFs/IID) from the Nursing Facility Quality of Care Fund beginning
October 1, 2000, the average actual, audited costs reflected in
previously submitted cost reports for the cost -reporting period that
began July 1, 1998, and ended June 30, 1999, inflated by th e
federally published inflationary factors for the two (2 ) years
appropriate to reflect present-day costs at the midpoint of the July
1, 2000, through June 30, 2001, rate year.
1. The recalculations provided for in this subsection shall be
consistent for both nursing facilities and Intermediate Care
Facilities for Individuals with Intellectual Disabilities
(ICFs/IID).
2. The recalculated reimbursement rate shall be implemented
September 1, 2000.
B. 1. From September 1, 2000, through August 31, 2001, all
nursing facilities subject to the Nursing Home Care Act, in addition
to other state and federal requirements related to the staffing of
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nursing facilities, shall maintain the following minimum direct -
care-staff-to-resident ratios:
a. from 7:00 a.m. to 3:00 p.m., one direct -care staff to
every eight residents, or major fraction thereof,
b. from 3:00 p.m. to 11:0 0 p.m., one direct-care staff to
every twelve residents, or major fra ction thereof, and
c. from 11:00 p.m. to 7:00 a.m., one direct -care staff to
every seventeen residents, or major fraction thereof.
2. From September 1, 2001, through August 31, 2003, nursing
facilities subject to the Nursing Home Care Act and Intermediat e
Care Facilities for Individuals with Intellectual Disabilities
(ICFs/IID) with seventeen or more beds shall maintain, in addition
to other state and federal requirements related to the s taffing of
nursing facilities, the following minimum direct -care-staff-to-
resident ratios:
a. from 7:00 a.m. to 3:00 p.m., one direct -care staff to
every seven residents, or major fraction thereof,
b. from 3:00 p.m. to 11:00 p.m., one direct-care staff to
every ten residents, or major fraction thereof, and
c. from 11:00 p.m. to 7:00 a.m., one direct -care staff to
every seventeen residents, or major fraction thereof.
3. On and after October 1, 2019, nursing facilities subject to
the Nursing Home Care Act an d Intermediate Care Facilities for
Individuals with Intellectual Disa bilities (ICFs/IID) with seventeen
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or more beds shall maintain, in addition to other state and federal
requirements related to the staff ing of nursing facilities, the
following minimum direct -care-staff-to-resident ratios:
a. from 7:00 a.m. to 3:00 p.m., one direct-care staff to
every six residents, or major fraction thereof,
b. from 3:00 p.m. to 11:00 p.m., one direct -care staff to
every eight residents, or major fraction thereof, and
c. from 11:00 p.m. to 7:00 a.m., one direct-care staff to
every fifteen residents, or major fraction thereof.
4. Effective immediately, facilities sha ll have the option of
varying the starting times for the eight-hour shifts by one (1) hour
before or one (1) hour after the times designated in this section
without overlapping shifts.
5. a. On and after January 1, 2020, a facility may implement
twenty-four-hour-based staff scheduling; provided,
however, such facility shall continue to maintain a
direct-care service rate of at least two and nine
tenths (2.9) hours of direct -care service per resident
per day, the same to be calculated based on average
direct care staff maintained over a twenty-four-hour
period.
b. At no time shall direct-care staffing ratios in a
facility with twenty -four-hour-based staff-scheduling
privileges fall below one direct-care staff to every
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fifteen residents or major fraction thereof, and at
least two direct-care staff shall be on duty and awake
at all times.
c. As used in this paragraph , “twenty-four-hour-based-
scheduling” means maintaining:
(1) a direct-care-staff-to-resident ratio based on
overall hours of direct -care service per resident
per day rate of not less than two and ninety one -
hundredths (2.90) hours per day,
(2) a direct-care-staff-to-resident ratio of at least
one direct-care staff person on duty to every
fifteen residents or major fraction thereof at
all times, and
(3) at least two direct-care staff persons on duty
and awake at all times.
6. a. On and after January 1, 2004, the State Department of
Health shall require a facility to maintain the shift-
based, staff-to-resident ratios provided in paragraph
3 of this subsection if the facility has been
determined by the Department to be deficient with
regard to:
(1) the provisions of paragraph 3 of this subsection,
(2) fraudulent reporting of st affing on the Quality
of Care Report, or
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(3) a complaint or survey investigation that has
determined substandard quality of care as a
result of insufficient staffing.
b. The Department shall require a facility described in
subparagraph a of this paragraph t o achieve and
maintain the shift-based, staff-to-resident ratios
provided in paragraph 3 of this subsection for a
minimum of three (3) months before being considered
eligible to implement twenty -four-hour-based staff
scheduling as defined in subparagraph c of paragraph 5
of this subsection.
c. Upon a subsequent determination by the Department that
the facility has achieved and maintained for at least
three (3) months the shift -based, staff-to-resident
ratios described in paragraph 3 of this subsection,
and has corrected any deficiency described in
subparagraph a of this paragraph, the Department shall
notify the facility of its eligibility to implement
twenty-four-hour-based staff-scheduling privileges.
7. a. For facilities that utilize twenty -four-hour-based
staff-scheduling privileges, the Department shall
monitor and evaluate facility compliance with the
twenty-four-hour-based staff-scheduling staffing
provisions of paragraph 5 of this su bsection through
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reviews of monthly staffing reports, results of
complaint investigations and inspections.
b. If the Department identifies any quali ty-of-care
problems related to insufficient staffing in such
facility, the Department shall issue a directed plan
of correction to the facility found to be out of
compliance with the provisions of this subsection.
c. In a directed plan of correction, the Department shall
require a facility described in subparagraph b of this
paragraph to maintain shift -based, staff-to-resident
ratios for the following periods of time:
(1) the first determination shall require that shift -
based, staff-to-resident ratios be ma intained
until full compliance is achieved,
(2) the second determination wit hin a two-year period
shall require that shift -based, staff-to-resident
ratios be maintained for a m inimum period of
twelve (12) months, and
(3) the third determination within a two -year period
shall require that shift -based, staff-to-resident
ratios be maintained. The facility may appl y for
permission to use twenty-four-hour staffing
methodology after two (2) years.
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C. Effective September 1, 2002, facilities shall post the names
and titles of direct-care staff on duty each day in a conspicuous
place, including the name and title of the supervising nurse.
D. The State Commissioner of Health shall promu lgate rules
prescribing staffing requirements for Intermediate Care Facilities
for Individuals with Intellectual Disabilities serving six or fewer
clients (ICFs/IID-6) and for Intermediate Care Facilities for
Individuals with Intellectual Disabilities servi ng sixteen or fewer
clients (ICFs/IID-16).
E. Facilities shall have the right to appeal and to the
informal dispute resolution process with regard to pena lties and
sanctions imposed due to staffing noncompliance.
F. 1. When the state Medicaid program r eimbursement rate
reflects the sum of Ninety -four Dollars and eleven cents ($94.11),
plus the increases in actual audited costs over and above the actual
audited costs reflected in the cos t reports submitted for the most
current cost-reporting period and th e costs estimated by the
Oklahoma Health Care Authority to increase the direct -care, flexible
staff-scheduling staffing level from two and eighty -six one-
hundredths (2.86) hours per day per occupied bed to three and two -
tenths (3.2) hours per day per occu pied bed, all nursing facilities
subject to the provisions of the Nursing Home Care Act and
Intermediate Care Facilities for Individuals with Intellectual
Disabilities (ICFs/IID) with seve nteen or more beds, in addition to
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other state and federal requiremen ts related to the staffing of
nursing facilities, shall maintain direct -care, flexible staff-
scheduling staffing levels based on an overall three and two -tenths
(3.2) hours per day per occupied bed.
2. When the state Medicaid program reimbursement rate r eflects
the sum of Ninety-four Dollars and eleven cents ($94.11), plus the
increases in actual audited costs over and above the actual audited
costs reflected in the cost reports submitted for the most current
cost-reporting period and the costs estimated b y the Oklahoma Health
Care Authority to increase the direct -care flexible staff-scheduling
staffing level from three and two -tenths (3.2) hours per day per
occupied bed to three and eight -tenths (3.8) hours per day per
occupied bed, all nursing facilities subject to the provisions of
the Nursing Home Care Act and Intermediate Care Facilities for
Individuals with Intellectual Disabilities (ICFs/IID) with seventeen
or more beds, in addition to other state and federal requirements
related to the staffing of nu rsing facilities, shall maintain
direct-care, flexible staff -scheduling staffing levels based on an
overall three and eight-tenths (3.8) hours per day per occupied bed.
3. When the state Medicaid program reimbursement rate reflects
the sum of Ninety-four Dollars and eleven cents ($94.11), plus the
increases in actual audited costs over and above the actual audited
costs reflected in the cost reports submitted for the most current
cost-reporting period and the costs estimated by the Oklahoma Health
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Care Authority to increase the direct -care, flexible staff -
scheduling staffing level fr om three and eight-tenths (3.8) hours
per day per occupied bed to four and o ne-tenth (4.1) hours per day
per occupied bed, all nursing facilities subject to the provisions
of the Nursing Home Care Act and Intermediate Care Facilities for
Individuals with Intellectual Disabilities (ICFs/IID) with seventeen
or more beds, in addition to other state and federal requ irements
related to the staffing of nursing facilities, shall maintai n
direct-care, flexible staff -scheduling staffing levels based on an
overall four and one-tenth (4.1) hours per day per occupied bed.
4. The Commissioner shall promulgate rules for shift -based,
staff-to-resident ratios for noncompliant facilities denotin g the
incremental increases reflected in direct -care, flexible staff -
scheduling staffing levels.
5. In the event that the state Medicaid program reimbursement
rate for facilities subject to the Nursing Home Care Act, and
Intermediate Care Facilities for In dividuals with Intellectual
Disabilities (ICFs/IID) having seventeen or more be ds is reduced
below actual audited costs, the requirements for staffing rati o
levels shall be adjusted to the appropriate levels provided in
paragraphs 1 through 4 of this subs ection.
G. For purposes of this subsection:
1. “Direct-care staff” means any nursing or therapy staff who
provides direct, hands -on care to residents in a nursing facility;
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2. Prior to September 1, 2003, activity and social services
staff who are not pro viding direct, hands -on care to residents may
be included in the direct -care-staff-to-resident ratio in any shift.
On and after September 1, 2003, such pe rsons shall not be included
in the direct-care-staff-to-resident ratio, regardless of their
licensure or certification status; and
3. The administrator shall not be co unted in the direct-care-
staff-to-resident ratio regardless of the administrator ’s licensure
or certification status.
H. 1. The Oklahoma Health Care Authority shall require all
nursing facilities subject to the provisions of the Nursing Home
Care Act and Intermediat e Care Facilities for Individuals with
Intellectual Disabilities (ICFs/IID) with seventeen or more beds to
submit a monthly report on staffing ratios on a form that the
Authority shall develop.
2. The report shall document the extent to which such
facilities are meeting or are failing to meet the minimum direct -
care-staff-to-resident ratios specified by this se ction. Such
report shall be available to the public upon request.
3. The Authority may assess administrative penalties for the
failure of any facility to submit the report as required by the
Authority. Provided, however:
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a. administrative penalties shall not accrue until the
Authority notifies the facility in writing th at the
report was not timely submitted as required, and
b. a minimum of a one-day penalty shall be assessed in
all instances.
4. Administrative pena lties shall not be assessed for
computational errors made in preparing the report.
5. Monies collected from administrative penalties shall be
deposited in the Nursing Facility Quality of Care Fund and utilized
for the purposes specified in the Oklahoma Healthcar e Initiative
Act.
I. 1. All entities regulated by this state that provide long -
term care services shall utilize a single assessment tool to
determine client services needs. The tool shall be developed by the
Oklahoma Health Care Authority in cons ultation with the State
Department of Health.
2. a. The Oklahoma Nursing Facility Funding Advisory
Committee is hereby created and shall consist of the
following:
(1) four members selecte d by the Oklahoma Association
of Health Care Providers,
(2) three members selected by the Oklahoma
Association of Homes and Services for the Aging,
and
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(3) two members selected by the State Council on
Aging.
The Chair shall be elected by the committee. No state
employees may be appointed to serve.
b. The purpose of the adv isory committee will be to
develop a new methodology for calculating state
Medicaid program reimbursements t o nursing facilities
by implementing facility -specific rates based on
expenditures relating to direct care staffing. No
nursing home will receive less tha n the current rate
at the time of implementation of facility -specific
rates pursuant to this subpara graph.
c. The advisory committee shall be staffed and advised by
the Oklahoma Health Care Authority.
d. The new methodology will be submitted for app roval to
the Board of the Oklahoma Heal th Care Authority by
January 15, 2005, and shall be finalized by July 1,
2005. The new methodology will apply only to new
funds that become availab le for Medicaid nursing
facility reimbursement after the methodology of this
paragraph has been finalized. Existing funds paid to
nursing homes will not be subject to the meth odology
of this paragraph. The methodology as outlined in
this paragraph will only be applied to any new funding
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for nursing facilities appropriated above and beyond
the funding amounts e ffective on January 15, 2005.
e. The new methodology shall divide the payment into two
components:
(1) direct care which the nursing rate component,
which shall consist of direct care and a nurse
aide wage and promotion scale if utilized.
(a) Direct care includes allowable costs for
registered nurses, licensed practical
nurses, certified medication aides and
certified nurse aides. The direct care
component of the rate shall be a facility -
specific rate, directly related to each
facility’s actual expenditures on direct
care.
(b) Effective July 1, 2025, the Authority shall
design and implement an optional nurse aide
wage and promotion scale for nursing
facilities. This program shall provide
qualifying facilities with a subsidy
payment, and
(2) other costs.
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f. The Oklahoma Health Care Authority, in calculating the
base year prospective direct care rat e component,
shall use the following criteria:
(1) to construct an array of facility per diem
allowable expenditures on direct care, the
Authority shall use the most recent data
available. The limit on this array shall be no
less than the ninetieth percentile,
(2) each facility’s direct care base-year component
of the rate shall be the lesser of the facility ’s
allowable expenditures on direct car e or the
limit,
(3) effective July 1, 2025, the direct care payment
amount of each facil ity shall be adjusted to
reflect the resident case mix of each facility
using a percentage of funds in the direct care
pool as determined by the Authority ,
(4) other rate components shall be determined by t he
Oklahoma Nursing Facility Funding Advisory
Committee of the Authority in accordance with
federal regulations and requirements,
(4) (5) prior to July 1, 2020, the Authority shall
seek federal approval to calculate th e upper
payment limit under the authority of CMS
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utilizing the Medicare equivalent payme nt rate,
and
(5) (6) if Medicaid payment rates to providers are
adjusted, nursing home ra tes and Intermediate
Care Facilities for Individuals with Intellectual
Disabilities (ICFs/IID) rates shall not be
adjusted less favorably than the average
percentage-rate reduction or incr ease applicable
to the majority of other provider groups .
g. (1) Effective October 1, 2019, if sufficient funding
is appropriated for a rate increa se, a new
average rate for nursing facilities shall be
established. The rate shall be e qual to the
statewide average cost as derived from audited
cost reports for SFY 2018, end ing June 30, 2018,
after adjustment for inflation. After such new
average rate has been established, the facility
specific reimbursement rate shall be as follows:
(a) amounts up to the ex isting base rate amount
shall continue to be distributed a s a part
of the base rate in accordance with the
existing State Plan, and
(b) to the extent the new rate excee ds the rate
effective before the effective date of this
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act, fifty percent (50%) of the resulting
increase on October 1, 2019, shall be
allocated toward an increase of the existing
base reimbursement rate and distributed
accordingly. The remaining fifty percent
(50%) of the increase shall be allocated in
accordance with the currently approve d 70/30
reimbursement rate meth odology as outlined
in the existing State Plan.
(2) Any subsequent rate increases, as determined
based on the provisions set forth in thi s
subparagraph,
(7) effective July 1, 2025, the base rate of each
facility shall be adjusted by a percentage
determined by the Authority based on the
facility’s performance in the CMS Five -Star
Quality Rating System or similar program if the
CMS Five-Star Quality Rating System is
discontinued,
(8) subsequently, for any ne w funds, seventy percent
(70%) shall be allocated in accordance with the
currently approved 70/30 reimbursement rate
methodology to the direct care component of the
nursing rate and thirty percent (30%) shall be
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allocated for other costs under the nursing rate.
The rate shall not exceed the upper paym ent limit
established by the Medicare rate equivalent
established by the federal CMS ,
(9) upon the effective date of this act, subject to
the availability of f unds, the Authority shall
develop an add-on rate for nursing facilities
serving residents who have received a
tracheostomy. The Authority shall establish
eligibility requirements for the add -on rate, and
(10) the Authority shall transition the payment rate
methodology of nursing facilities to a price -
based methodology when data for such a
methodology becomes available and has been
analyzed by the Authority .
h. g. Effective October 1, 2019, in coordination with the
rate adjustments identified in the precedi ng section,
a portion of the funds s hall be utilized as follows:
(1) effective October 1, 2019, the Oklahoma Health
Care Authority shall increase the personal needs
allowance for residents of nursing homes a nd
Intermediate Care Facilities for Individuals with
Intellectual Disabilities (ICFs/IID) from Fif ty
Dollars ($50.00) per month to Seventy-five
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Dollars ($75.00) per month per resident. The
increase shall be funded by Medicaid nursing home
providers, by way of a reduction of eighty -two
cents ($0.82) per day deducted from the base
rate. Any additional cost shall be funded by the
Nursing Facility Quality of Care Fund, and
(2) effective January 1, 2020, all clinical employees
working in a licensed nursing fac ility shall be
required to receive at least four (4) hours
annually of Alzheimer ’s or dementia training, to
be provided and paid for by the facilities.
3. The Department of Human Services shall expand its st atewide
toll-free, Senior-Info Line for senior citizen services to include
assistance with or inf ormation on long-term care services in this
state.
4. The Oklahoma Health Care Authority shall develop a nursing
facility cost-reporting system that reflects the most current costs
experienced by nursing and specializ ed facilities. The Oklahoma
Health Care Authority shall utilize the m ost current cost report
data to estimate costs in determining daily per diem rates.
5. The Oklahoma Health Care Authority shal l provide access to
the detailed Medicaid payment audit adjustments and implement an
appeal process for disputed payment audit adjust ments to the
provider. Additionally, the Oklahoma Health Care Authority shall
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make sufficient revisions to the nursing facility cost reporting
forms and electronic data input system so as to clarify what
expenses are allowable and appropriate for incl usion in cost
calculations.
J. 1. When the state Medicaid program reimbursement rate
reflects the sum of Ninety -four Dollars and eleven cents ($94.11),
plus the increases in actual audited costs, over and above the
actual audited costs reflected in the cost reports submitted for the
most current cost-reporting period, and the direct -care, flexible
staff-scheduling staffing level has been prospectively funded at
four and one-tenth (4.1) hours per day per occupied bed, the
Authority may apportion funds for the implementation of the
provisions of this section.
2. The Authority shall make application to the United States
Centers for Medicare and Medicaid Service for a waiver of the
uniform requirement on health -care-related taxes as permitted by
Section 433.72 of 42 C.F.R.
3. Upon approval of the waiver, the Authority shall develop a
program to implement the provisions of the waiver as it relates to
all nursing facilities.
K. Subject to the availability of funds, the Authority shall
design and implement a sc holarship program for nurse aides who work
in Medicaid-certified nursing facilities or Intermediate Care
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Facilities for Individuals with Intellectual Disabilities
(ICFs/IID).
SECTION 3. This act shall become effective July 1, 2024.
SECTION 4. It being immediately necessary for the preservation
of the public peace, hea lth or safety, an emergency is hereby
declared to exist, by reason whereof this act shall take effect and
be in full force from and after its passage and approval.
59-2-2722 DC 12/15/2023 3:47:15 PM