Oklahoma 2024 Regular Session

Oklahoma Senate Bill SB1417 Compare Versions

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Version 2 (New)

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3		-	~~Req~~. No. ~~3783~~ Page 1 1
	3	+	ENGR. H. A. to ENGR. S. B. NO. 1417 Page 1 1
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28		-	STATE OF OKLAHOMA
29		-
30		-	2nd Session of the 59th Legislature (2024)
31		-
32		-	CONFERENCE COMMITTEE SUBSTITUTE
33		-	FOR ENGROSSED
34		-	SENATE BILL 1417 By: Thompson (Roger) of the
	28	+	ENGROSSED HOUSE AMENDME NT
	29	+	TO
	30	+	ENGROSSED SENATE BILL NO . 1417 By: Thompson (Roger) of the
35	31		Senate
36	32
37	33		and
38	34
39	35		McEntire of the House
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41	37
42		-
43		-
44		-	CONFERENCE COMMITTEE SUBSTITUTE
45		-
46		-	An Act relating to the state Medicaid program;
47		-	amending 56 O.S. 2021, Section 1011.5, which relates
48		-	to the nursing facility incentive reimbursement rate
49		-	plan; modifying payment qualification criteria;
50		-	directing certain allocation of funds; conforming
51		-	language; removing obsolete language; modifying
52		-	certain method of reporting; requiring the Oklahoma
53		-	Health Care Authority to include certain inform ation
54		-	in annual budget request; specifying calculation
55		-	method of certain costs; amending 63 O.S. 2021,
56		-	Section 1-1925.2, which relates to reimbursements
57		-	from the Nursing Facility Quality of Care Fund;
58		-	requiring transition to price -based payment
59		-	methodology under certain conditions; directing
60		-	certain allocation of funds; requiring the Oklahoma
61		-	Health Care Authority to implement ce rtain
62		-	scholarship program subject to available funding;
63		-	amending 63 O.S. 2021, Section 5023, which relates to
64		-	adjustment of per di em rate; directing certain rate
65		-	increase under specified conditions; updating
66		-	statutory language; providing for codification; and
67		-	providing an effective date .
	38	+	[ state Medicaid program - rate plan - quality
	39	+	measures - reporting - reimbursements - methodology -
	40	+	payments - scholarship program - effective date -
	41	+	emergency ]
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72		-	BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
73	46
74		-	Req. No. 3783 Page 2 1
	47	+
	48	+
	49	+
	50	+
	51	+
	52	+	AMENDMENT NO. 1. Page 1, line 10, strike the enacting clause
	53	+
	54	+	Passed the House of Representatives the 24th day of April, 2024.
	55	+
	56	+
	57	+
	58	+
	59	+
	60	+	Presiding Officer of the House of
	61	+	Representatives
	62	+
	63	+
	64	+	Passed the Senate the ____ day of _______ ___, 2024.
	65	+
	66	+
	67	+
	68	+
	69	+
	70	+	Presiding Officer of the Senate
	71	+
	72	+
	73	+	ENGR. S. B. NO. 1417 Page 1 1
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	98	+	ENGROSSED SENATE
	99	+	BILL NO. 1417 By: Thompson (Roger) of the
	100	+	Senate
	101	+
	102	+	and
	103	+
	104	+	McEntire of the House
	105	+
	106	+
	107	+
	108	+	[ state Medicaid program - rate plan - quality
	109	+	measures - reporting - reimbursements - methodology -
	110	+	payments - scholarship program - effective date -
	111	+	emergency ]
	112	+
	113	+
	114	+
	115	+
	116	+	BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
99	117		SECTION 1. AMENDATORY 56 O.S. 2021, Section 1011.5, is
100	118		amended to read as follows:
101	119		Section 1011.5. A. 1. The Oklahoma Health Care Authority
102	120		shall develop an incentive reimbursement rate plan for nursing
103	121		facilities focused on improving resident outcomes and resident
104	122		quality of life.
105	123		2. Under the current rate methodology, the Authority sha ll
106	124		reserve Five Dollars ($5.00) per patient day designated for the
107	125		quality assurance component that nursing facilities can earn for
108	126		improvement or performance achievement of resident -centered outcomes
109		-	metrics the long-stay quality measures ratings specified in
110		-	paragraph 4 of this subsection . To fund the quality assurance
111		-	component, Two Dollars ($2.00) shall be deducted from each nursing
112		-	facility’s per diem rate, and matched w ith Three Dollars ($3.00) per
113		-	day funded by the Authority. Payments to nursing facilities that
114		-	achieve specific metrics qualify under paragraph 4 of this
115		-	subsection shall be treated as an “add back” to their net
116		-	reimbursement per diem. Dollar values assigned to each metric
117		-	rating shall be determined so that an average of the five -dollar-
118		-	quality incentive is made to qualifying n ursing facilities.
119		-	3. Pay-for-performance payments may be earned quarterly and
120		-	based on facility-specific performance achievement of four equally-
121		-	weighted, Long-Stay Quality Measures as defined by the facility’s
122		-	long-stay quality measures rating in the Nursing Home Five-Star
	127	+	metrics. To fund the quality assurance component, Two Dollars
	128	+	($2.00) shall be deducted from each nursing facility ’s per diem
	129	+	rate, and matched with Three Dollars ($3.00) per day funded by the
	130	+	Authority. Payments to nursing facilities that achieve specific
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149		-	Quality Rating System of the Centers for Medicare and Medicaid
150		-	Services (CMS).
	157	+	metrics shall be treated as an “add back” to their net reimbursement
	158	+	per diem. Dollar values assigned to each metric shall be determined
	159	+	so that an average of the five -dollar-quality incentive is made to
	160	+	qualifying nursing facilities.
	161	+	3. Pay-for-performance payments may be earned quarterly and
	162	+	based on facility-specific performance achievement of four equally-
	163	+	weighted, equally weighted Long-Stay Quality Measures , as defined by
	164	+	the Centers for Medicare and Medicaid Services (CMS).
151	165		4. Contracted Medicaid long -term care providers may earn
152	166		payment by achieving either five percent (5%) relative improvement
153	167		each quarter from baseline or by achieving the National Average
154		-	Benchmark or better for each individual quality metric at least a
155		-	two-star long-stay quality measures rating. Program funds shall be
156		-	allocated as follows:
157		-	a. facilities with a two -star rating shall receive forty
158		-	percent (40%) of the per-day amount reserved for the
159		-	quality assurance component per Medicaid patient day,
160		-	b. facilities with a three -star rating shall receive
161		-	sixty percent (60%) of the per -day amount reserved for
162		-	the quality assurance component per Medicaid patien t
163		-	day,
164		-	c. facilities with a four -star rating shall receive
165		-	eighty percent (80%) of the per -day amount reserved
166		-	for the quality assurance component per Medicaid
167		-	patient day, and
168		-	d. facilities with a five -star rating shall receive one
169		-	hundred percent (100%) of t he per-day amount reserved
170		-	for the quality assurance component per Medicaid
171		-	patient day.
	168	+	Benchmark or better for each individual quality metric.
	169	+	5. Pursuant to federal Medicaid approval, any funds that remain
	170	+	as a result of provider s failing to meet the quality assurance
	171	+	metrics shall be pooled and redist ributed to those who achieve the
	172	+	quality assurance metrics each quarter. If federal approval is not
	173	+	received, any remaining funds shall be deposited in the Nursing
	174	+	Facility Quality of Care Fund authorized in Section 2002 of this
	175	+	title.
	176	+	6. The Authority shall establish an advisory group with
	177	+	consumer, provider and state agency representation to recommend
	178	+	quality measures other than those specified in paragraph 7 of this
	179	+	subsection to be included in the pay -for-performance program and to
	180	+	provide feedback on program performance and recommendations for
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198		-	5. Pursuant to federal Medicaid approval, any funds that remain
199		-	as a result of providers failing to meet the quality assurance
200		-	metrics after all the allocations u nder paragraph 4 of this
201		-	subsection have been made shall be pooled and redistributed to those
202		-	who achieve the quality assurance me trics each quarter qualify for
203		-	payments under paragraph 4 of this subsection . If federal approval
204		-	is not received, any remaining funds shall be deposited in the
205		-	Nursing Facility Quality of Care Fund authorized in Section 2002 of
206		-	this title.
207		-	6. The Authority shall establish an advisory group with
208		-	consumer, provider and state agency representation to recommend
209		-	quality measures to be included in the pay-for-performance program
210		-	and to provide feedback on program performance and recommendations
211		-	for improvement. The quality measures shall be reviewed annually
212		-	and shall be subject to change every three (3) years through the
213		-	agency’s promulgation of rules. The Authority shall insure
214		-	adherence to the following criteria in determining the quality
215		-	measures:
	207	+	improvement. The quality measures shall be reviewed annually and
	208	+	shall be subject to change every three (3) years through the
	209	+	agency’s promulgation of rules as funding is available . The
	210	+	Authority shall insure ensure adherence to the following criteria in
	211	+	determining the quality measures:
216	212		a. provides direct benefit to resident care outcomes,
217	213		b. applies to long-stay residents, and
218	214		c. addresses a need for quality improvement using the
219	215		Centers for Medicare and Medi caid Services (CMS)
220	216		ranking for Oklahoma.
	217	+	7. The Authority shall begin the pay -for-performance program
	218	+	focusing on improving the following CMS nursing home long-stay
	219	+	quality measures:
	220	+	a. percentage of long-stay, percent of high-risk
	221	+	residents with pressur e ulcers,
	222	+	b. percentage of long-stay percent of residents who lose
	223	+	too much weight,
	224	+	c. percentage of long-stay percent of residents with a
	225	+	urinary tract infection, and
	226	+	d. percentage of long-stay percent of residents who got
	227	+	received an antipsychotic medica tion.
	228	+	B. The Oklahoma Health Care Authority shall negotiate with the
	229	+	Centers for Medicare and Medicaid Services to include the authority
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247		-	7. The Authority shall begin the pay -for-performance program
248		-	focusing on improving the following CMS nursing home quality
249		-	measures:
250		-	a. percentage of long-stay, high-risk residents with
251		-	pressure ulcers,
252		-	b. percentage of long-stay residents who lose too much
253		-	weight,
254		-	c. percentage of long-stay residents with a urinary tract
255		-	infection, and
256		-	d. percentage of long-stay residents who got an
257		-	antipsychotic medication.
258		-	B. The Oklahoma Health Care Authority shall negotiate with the
259		-	Centers for Medicare and Medicaid Services to include the authority
260	256		to base provider reimbursement rates for nur sing facilities on the
261	257		criteria specified in subsection A of this section.
262	258		C. The Oklahoma Health Care Authority shall audit the program
263	259		to ensure transparency and integrity.
264	260		D. The Oklahoma Health Care Authority shall provide
265	261		electronically submit an annual report of the incentive
266	262		reimbursement rate plan to the Governor, the Speaker of the House of
267	263		Representatives, and the President Pro Tempore of the Senate by
268	264		December 31 of each year. The report shall include, but not be
269	265		limited to, an analysis of the previous fiscal year including
270	266		incentive payments, ratings, and notable t rends.
	267	+	SECTION 2. AMENDATORY 63 O.S. 2021, Section 1 -1925.2, is
	268	+	amended to read as follows:
	269	+	Section 1-1925.2. A. The Oklahoma Health Care Authority shall
	270	+	fully recalculate and reimburse nursing facilities and Intermediate
	271	+	Care Facilities for Individuals with Intellectual Disabilities
	272	+	intermediate care facilities for individuals with intellectual
	273	+	disabilities (ICFs/IID) from the Nursing Facility Quality of C are
	274	+	Fund beginning October 1, 2000, the average actual, audited costs
	275	+	reflected in previously submitted cost reports for the cost -
	276	+	reporting period that began July 1, 1998, and ended June 30, 1999,
	277	+	inflated by the federally published inflationary factors fo r the two
	278	+	(2) years appropriate to reflect present -day costs at the midpoi nt
	279	+	of the July 1, 2000, through June 30, 2001, rate year.
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297		-	SECTION 2. NEW LAW A new section of law to be codified
298		-	in the Oklahoma Statutes as Section 1011.16 of Title 56, unless
299		-	there is created a duplication in numbering, reads as follows:
300		-	A. The Oklahoma Health Care Authority in its annual budget
301		-	request submitted pursuant to Section 34.36 of Title 62 of the
302		-	Oklahoma Statutes shall include a supplemental item reflecting the
303		-	new state and federal funding necessary to meet the additional costs
304		-	associated with reimbursing nursing facilities and intermediate care
305		-	facilities for individuals with intellectual disabilities at the
306		-	most recent audited cost.
307		-	B. Audited cost shall be calculated by using the latest cost
308		-	report submitted to the Oklahoma Health Care Authority.
309		-	SECTION 3. AMENDATORY 63 O.S. 2021, Section 1 -1925.2, is
310		-	amended to read as follows:
311		-	Section 1-1925.2. A. The Oklahoma Health Care Authority shall
312		-	fully recalculate and reimburse nursing facilities and Intermediate
	306	+	1. The recalculations provided for in this subsection shall be
	307	+	consistent for both nursing facilities and Intermediate Care
	308	+	Facilities for Individuals with Intellectual Disabilities
	309	+	intermediate care facilities for individuals with intellectual
	310	+	disabilities (ICFs/IID).
	311	+	2. The recalculated reimbursement rate shall be implemented
	312	+	September 1, 2000.
	313	+	B. 1. From September 1, 200 0, through August 31, 2001, all
	314	+	nursing facilities subject to the Nursing Home Care Act, in addition
	315	+	to other state and federal requirements related to the staffing of
	316	+	nursing facilities, shall maintain the following minimum direct -
	317	+	care-staff-to-resident ratios:
	318	+	a. from 7:00 a.m. to 3:00 p.m., one direct -care staff to
	319	+	every eight residents, or major fraction thereof,
	320	+	b. from 3:00 p.m. to 11:00 p.m., one direct -care staff to
	321	+	every twelve residents, or major fraction thereof, and
	322	+	c. from 11:00 p.m. to 7:00 a. m., one direct-care staff to
	323	+	every seventeen residents, or major fraction thereof.
	324	+	2. From September 1, 2001, through August 31, 2003, nursing
	325	+	facilities subject to the Nursing Home Care Act and Intermediate
313	326		Care Facilities for Individuals with Intellectu al Disabilities
314	327		intermediate care facilities for individuals with intellec tual
315		-	disabilities (ICFs/IID) from the Nursing Facility Quality of Care
316		-	Fund beginning October 1, 2000, the average actual, audited costs
317		-	reflected in previously submitted cost reports fo r the cost-
318		-	reporting period that began July 1, 1998, and ended June 30, 1999,
319		-	inflated by the federally published inflationary fac tors for the two
	328	+	disabilities (ICFs/IID) with seventeen or more beds shall maintain,
	329	+	in addition to other state and federal requirements related to the
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346		-	(2) years appropriate to reflect present -day costs at the midpoint
347		-	of the July 1, 2000, through June 30, 2001, ra te year.
348		-	1. The recalculations provided for in this subsection shall be
349		-	consistent for both nursing facilities and Intermediate Care
350		-	Facilities for Individuals with Intellectual Disabilities
351		-	intermediate care facilities for individuals with intellectu al
352		-	disabilities (ICFs/IID).
353		-	2. The recalculated reimbursement rate shall be implemented
354		-	September 1, 2000.
355		-	B. 1. From September 1, 2000, through August 31, 2001, all
356		-	nursing facilities subject to the Nursing Home Care Act, in addition
357		-	to other state and fed eral requirements related to the staffing of
358		-	nursing facilities, shall maintain the following minimum direct -
359		-	care-staff-to-resident ratios:
	356	+	staffing of nursing facilities, the follow ing minimum direct-care-
	357	+	staff-to-resident ratios:
360	358		a. from 7:00 a.m. to 3:0 0 p.m., one direct-care staff to
361		-	every ~~eight~~ residents, or major fraction thereof,
	359	+	every seven residents, or major fraction thereof,
362	360		b. from 3:00 p.m. to 11:00 p.m., one direct -care staff to
363		-	every ~~twelve~~ residents, or major fraction ~~thereof~~, and
	361	+	every ten residents, or major fraction th ereof, and
364	362		c. from 11:00 p.m. to 7:00 a.m., one direct -care staff to
365	363		every seventeen residents, or major fraction thereof.
366		-	2. From September 1, 2001, through Augu st 31, 2003, nursing
367		-	facilities subject to the Nursing Home Care Act and Intermediate
368		-	Care Facilities for Individuals with Intellectual Disabilities
369		-	intermediate care facilities for individuals with intellectual
	364	+	3. On and after October 1, 2019, nursing facilities subject to
	365	+	the Nursing Home Care Act and Intermediate Care Facilities for
	366	+	Individuals with Intellectual Disabilities intermediate care
	367	+	facilities for individuals with intellectual disabilities (ICFs/IID)
	368	+	with seventeen or more beds shall maintain, in addition to other
	369	+	state and federal requirements related to the staffing of nursing
	370	+	facilities, the following minimum direct -care-staff-to-resident
	371	+	ratios:
	372	+	a. from 7:00 a.m. to 3:00 p.m., one direct -care staff to
	373	+	every six residents, or major fraction thereof,
	374	+	b. from 3:00 p.m. to 11:00 p.m., one direct -care staff to
	375	+	every eight residents, or major fraction thereof, and
	376	+	c. from 11:00 p.m. to 7:00 a.m., one direc t-care staff to
	377	+	every fifteen residents, or major fraction thereof.
	378	+	4. Effective immediately, facilities shall have the option of
	379	+	varying the starting times for the eight -hour shifts by one (1) hour
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396		-	~~disabilities~~ (~~ICFs/IID~~) ~~with seventeen o r more beds shall maintain,~~
397		-	~~in addition to other state and federal requirements related to the~~
398		-	~~staffing of nursing facilities~~, ~~the following minimum direct -care-~~
399		-	staff~~-to-resident ratios:~~
400		-	~~a. from 7:00 a.m.~~ to ~~3:00 p.m., one direct -care staff to~~
401		-	~~every seven residents,~~ ~~or major fraction thereof,~~
402		-	b. ~~from 3:00 p.m. to 11:00 p.m., one~~ direct -care ~~staff to~~
403		-	~~every ten residents~~, ~~or major fraction thereof,~~ ~~and~~
404		-	~~c. from 11:00 p.m. to 7:00 a.m., one~~ direct -care staff to
405		-	~~every seventeen residents, or major fraction there of~~.
406		-	3. ~~On and after October 1,~~ ~~2019, nursing facilities subject to~~
407		-	~~the Nursing Home Care Act and Intermediate Care Facilities for~~
408		-	~~Individuals with Intellectual Disabilities intermediate~~ care
409		-	~~facilities for individuals with intellectual disabilities (ICFs/IID)~~
410		-	~~with seventeen or more beds~~ shall ~~maintain, in addition to other~~
411		-	~~state and federal requirements related to the staffing of nursing~~
412		-	~~facilities~~, ~~the following minimum direct -care-staff-to-resident~~
413		-	~~ratios:~~
414		-	~~a. from 7:00 a.m. to 3:00 p.m., one direct -care staff to~~
415		-	~~every six residents,~~ ~~or major fraction thereof,~~
416		-	~~b. from 3:00 p.m. to 11:00 p.m., one~~ direct -care ~~staff to~~
417		-	~~every eight residents,~~ ~~or major fraction thereof,~~ and
418		-	c. ~~from 11:00 p~~.~~m. to 7:00 a.m., one direct -care staff to~~
419		-	~~every fifteen residents~~, ~~or major fraction thereof.~~
	406	+	before or one (1) hour after the times designated in thi s section
	407	+	without overlapping shifts.
	408	+	5. a. On and after January 1, 2020, a facility may implement
	409	+	twenty-four-hour-based staff scheduling; provided,
	410	+	however, such facility shall con tinue to maintain a
	411	+	direct-care service rate of at least two and nine
	412	+	tenths nine-tenths (2.9) hours of direct -care service
	413	+	per resident per day, the same to be calculated based
	414	+	on average direct care staff maintained over a twenty -
	415	+	four-hour period.
	416	+	b. At no time shall direct -care staffing ratios in a
	417	+	facility with twenty -four-hour-based staff-scheduling
	418	+	privileges fall below one direct -care staff to every
	419	+	fifteen residents or major fraction thereof, and at
	420	+	least two direct-care staff shall be on duty and a wake
	421	+	at all times.
	422	+	c. As used in this paragraph, “twenty-four-hour-based-
	423	+	scheduling” “twenty-four-hour-based staff scheduling ”
	424	+	means maintaining:
	425	+	(1) a direct-care-staff-to-resident ratio based on
	426	+	overall hours of direct -care service per resident
	427	+	per day rate of not less than two and ninety one-
	428	+	hundredths (2.90) two and nine-tenths (2.9) hours
	429	+	per day,
420	430
421		-	~~Req~~. No. ~~3783~~ Page 9 1
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446		-	~~4. Effective immediately, facilities shall have the option~~ of
447		-	~~varying the starting times for the eight -hour shifts by~~ one ~~(1) hour~~
448		-	~~before~~ or ~~one (1) hour after the times designated in this section~~
449		-	~~without overlapping shifts.~~
450		-	~~5. a.~~ On ~~and after January 1, 2020, a facility may implement~~
451		-	~~twenty-four-hour-based staff scheduling;~~ ~~provided,~~
452		-	~~however~~, ~~such facility sh all continue to maintain a~~
453		-	~~direct-care service rate of at least two and nine~~
454		-	~~tenths nine-tenths (2.9) hours of direct -care service~~
455		-	~~per resident per day,~~ the ~~same to be calculated based~~
456		-	~~on average direct care staff maintained over a twenty -~~
457		-	~~four-hour period.~~
458		-	~~b. At no time shall direct -care~~ ~~staffing ratios in a~~
459		-	~~facility with twenty -four-hour-based staff-scheduling~~
460		-	~~privileges fall below one direct-~~care ~~staff to every~~
461		-	~~fifteen residents~~ or ~~major fraction thereof,~~ ~~and at~~
462		-	~~least two direct-~~care ~~staff shall be on dut y and awake~~
463		-	~~at all times~~.
464		-	c. ~~As used~~ in ~~this paragraph, “twenty-four-hour-based-~~
465		-	~~scheduling” “twenty-four-hour-based staff scheduli ng”~~
466		-	~~means maintaining:~~
467		-	~~(1)~~ a ~~direct-care-staff-to-resident ratio based on~~
468		-	~~overall hours~~ of ~~direct -care~~ ~~service per resident~~
469		-	~~per day rate of not less than two and ninety one-~~
	456	+	(2) a direct-care-staff-to-resident ratio of at least
	457	+	one direct-care staff person on duty to every
	458	+	fifteen residents or major fraction thereof at
	459	+	all times, and
	460	+	(3) at least two direct-care staff persons on duty
	461	+	and awake at all times.
	462	+	6. a. On and after January 1, 2004, the State Department of
	463	+	Health shall require a facility to maintain the shift -
	464	+	based, staff-to-resident ratios provided in paragraph
	465	+	3 of this subsection if the facility has been
	466	+	determined by the Department to be d eficient with
	467	+	regard to:
	468	+	(1) the provisions of paragraph 3 of this subsection,
	469	+	(2) fraudulent reporting of staffing on the Quality
	470	+	of Care Report, or
	471	+	(3) a complaint or survey invest igation that has
	472	+	determined substandard quality of care as a
	473	+	result of insufficient staffing.
	474	+	b. The Department shall require a facility described in
	475	+	subparagraph a of this paragraph to achieve and
	476	+	maintain the shift-based, staff-to-resident ratios
	477	+	provided in paragraph 3 of this subsection for a
	478	+	minimum of three (3) months befo re being considered
	479	+	eligible to implement twenty -four-hour-based staff
470	480
471		-	~~Req~~. No. ~~3783~~ Page 10 1
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496		-	~~hundredths (2.90) two and nine-tenths~~ ~~(2.9) hours~~
497		-	~~per day,~~
498		-	~~(2)~~ a ~~direct-care-staff-to-resident ratio of at least~~
499		-	~~one direct-care~~ ~~staff person on duty to every~~
500		-	~~fifteen residents or major fraction thereof at~~
501		-	~~all times~~, ~~and~~
502		-	~~(3) at least two direct-care~~ ~~staff persons on duty~~
503		-	~~and awake at all times.~~
504		-	~~6. a. On and after January 1, 2004,~~ the ~~Sta te Department~~ of
505		-	~~Health shall require a facility to maintain the shift -~~
506		-	based~~, staff-to-resident ratios provided in paragraph~~
507		-	~~3 of this subsection if~~ the ~~facility has been~~
508		-	~~determined by~~ the ~~Department to be deficient with~~
509		-	~~regard to:~~
510		-	~~(1) the~~ provisions of paragraph 3 of this subsection,
511		-	~~(2) fraudulent reporting~~ of staffing ~~on the Quality~~
512		-	~~of Care Report,~~ or
513		-	~~(3) a complaint or survey investigation that has~~
514		-	~~determined substandard quality of care as a~~
515		-	~~result of insufficient staffing.~~
516		-	b. The ~~Department shall requi re a~~ facility ~~described in~~
517		-	~~subparagraph a~~ of this ~~paragraph to achieve and~~
518		-	~~maintain~~ the ~~shift-based, staff-to-resident ratios~~
519		-	~~provided~~ in ~~paragraph 3~~ of ~~this subsection for a~~
	506	+	scheduling as defined in subparagraph c of paragraph 5
	507	+	of this subsection.
	508	+	c. Upon a subsequent determination b y the Department that
	509	+	the facility has achieved and maintained for at leas t
	510	+	three (3) months the shift -based, staff-to-resident
	511	+	ratios described in paragraph 3 of this subsection,
	512	+	and has corrected any deficiency described in
	513	+	subparagraph a of this paragra ph, the Department shall
	514	+	notify the facility of its eligibility to impleme nt
	515	+	twenty-four-hour-based staff-scheduling privileges.
	516	+	7. a. For facilities that utilize twenty -four-hour-based
	517	+	staff-scheduling privileges, the Department shall
	518	+	monitor and evaluate facility compliance with the
	519	+	twenty-four-hour-based staff-scheduling staffing
	520	+	provisions of paragraph 5 of this subsection through
	521	+	reviews of monthly staffing reports, results of
	522	+	complaint investigations and inspections.
	523	+	b. If the Department identifies an y quality-of-care
	524	+	problems related to insufficient staffing in such
	525	+	facility, the Department shall issue a directed plan
	526	+	of correction to the facility found to be out of
	527	+	compliance with the provisions of this subsection.
	528	+	c. In a directed plan of correction , the Department shall
	529	+	require a facility described in subparagraph b of t his
520	530
521		-	~~Req~~. No. ~~3783~~ Page 11 1
	531	+	ENGR. S. B. NO. 1417 Page 10 1
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546		-	minimum of three (3) months before being considered
547		-	eligible to implement twe nty-four-hour-based staff
548		-	scheduling as defined in subparagraph c of paragraph 5
549		-	of this subsection.
550		-	c. Upon a subsequent determin ation by the Department that
551		-	the facility has achieved and maintained for at least
552		-	three (3) months the shift -based, staff-to-resident
553		-	ratios described in paragraph 3 of this subsection,
554		-	and has corrected any deficiency described in
555		-	subparagraph a of this paragraph, the Department shall
556		-	notify the facility of its eligibility to implement
557		-	twenty-four-hour-based staff-scheduling privileges.
558		-	7. a. For facilities that utilize twenty -four-hour-based
559		-	staff-scheduling privileges, the Department shall
560		-	monitor and evaluate facility compliance with the
561		-	twenty-four-hour-based staff-scheduling staffing
562		-	provisions of paragraph 5 of this subsection through
563		-	reviews of monthly staffing reports, results of
564		-	complaint investigations and inspections.
565		-	b. If the Department identifies any quality -of-care
566		-	problems related to insufficient staffing in such
567		-	facility, the Department shall issue a directed pla n
568		-	of correction to the facility found to be out of
569		-	compliance with the provisions of this subsection.
	556	+	paragraph to maintain shift -based, staff-to-resident
	557	+	ratios for the following periods of time:
	558	+	(1) the first determination shall require that shift -
	559	+	based, staff-to-resident ratios be maintained
	560	+	until full compliance is achieved,
	561	+	(2) the second determination within a two-year period
	562	+	shall require that shift -based, staff-to-resident
	563	+	ratios be maintained for a minimum period of
	564	+	twelve (12) months, and
	565	+	(3) the third determination with in a two-year period
	566	+	shall require that shift -based, staff-to-resident
	567	+	ratios be maintained. The facility may apply for
	568	+	permission to use twenty -four-hour staffing
	569	+	methodology after two (2) years.
	570	+	C. Effective September 1, 2002, facilities shall post the names
	571	+	and titles of direct -care staff on duty each day in a conspicuous
	572	+	place, including the name and title of the supervising nurse.
	573	+	D. The State Commissioner of Health shall promulgate rules
	574	+	prescribing staffing requirements for Intermediate Care Facil ities
	575	+	for Individuals with Intellectual Disabilities intermediate care
	576	+	facilities for individuals with intellectual disabilities serving
	577	+	six or fewer clients (ICFs/IID -6) and for Intermediate Care
	578	+	Facilities for Individuals with Intellectual Disabilities
570	579
571		-	~~Req~~. No. ~~3783~~ Page 12 1
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595	604
596		-	~~c. In a directed plan of cor rection, the Department shall~~
597		-	~~require a facility described in subparagraph b of this~~
598		-	~~paragraph~~ to ~~maintain shift -based, staff-to-resident~~
599		-	~~ratios for the following periods of time:~~
600		-	~~(1) the first determination shall require that shift -~~
601		-	~~based, staff-to-resident ratios be maintained~~
602		-	~~until full compliance is achieved~~,
603		-	~~(2)~~ the ~~second determination within a two -year~~ ~~period~~
604		-	~~shall require that shift-based, staff-to-resident~~
605		-	~~ratios be maintained for a minimum~~ period of
606		-	~~twelve (12) months~~, ~~and~~
607		-	~~(3) the third determinati on within a~~ two~~-year period~~
608		-	~~shall require that shift -based, staff-to-resident~~
609		-	~~ratios be maintained.~~ ~~The facility may apply for~~
610		-	~~permission~~ to ~~use twenty -four-hour staffing~~
611		-	~~methodology after two (2) years.~~
612		-	~~C. Effective September 1, 2002,~~ facilities ~~shall post the names~~
613		-	~~and titles of direct -care~~ ~~staff on duty each day~~ in ~~a conspicuous~~
614		-	~~place, including~~ the ~~name and title of the sup ervising nurse.~~
615		-	~~D. The State Commissioner~~ of ~~Health~~ shall ~~promulgate rules~~
616		-	~~prescribing~~ staffing ~~requirements for Intermediate Care Facilities~~
617		-	~~for Individuals with Intellectual Disabilities intermediate care~~
618		-	~~facilities for individuals with intellectual disabil ities serving~~
619		-	~~six or fewer clients (ICFs/IID -6)~~ and ~~for Intermediate Care~~
	605	+	intermediate care facilities for individuals with intellectual
	606	+	disabilities serving sixteen or fewer clients (ICFs/IID -16).
	607	+	E. Facilities shall have the right to appeal and to the
	608	+	informal dispute resolution process with regard to penalties and
	609	+	sanctions imposed due to staffing noncompliance.
	610	+	F. 1. When the state Medicaid prog ram reimbursement rate
	611	+	reflects the sum of Ninety -four Dollars and eleven cents ($94.11),
	612	+	plus the increases in actual audited costs over and above the actual
	613	+	audited costs reflected in the cost reports submitted for the most
	614	+	current cost-reporting period and the costs estimated by the
	615	+	Oklahoma Health Care Authority to increase the direct -care, flexible
	616	+	staff-scheduling staffing level from two and eighty -six one-
	617	+	hundredths (2.86) hour s per day per occupied bed to three and two -
	618	+	tenths (3.2) hours per day per occupied bed, all nursing facilities
	619	+	subject to the provisions of the Nursing Home Care Act and
	620	+	Intermediate Care Facilities for Individuals with Intellectual
	621	+	Disabilities intermediate care facilities for individuals with
	622	+	intellectual disabilities (ICFs/IID) with seventeen or more beds, in
	623	+	addition to other state and federal requirements related to the
	624	+	staffing of nursing facilities, shall maintain direct -care, flexible
	625	+	staff-scheduling staffing levels based on an overall three and two -
	626	+	tenths (3.2) hours p er day per occupied bed.
	627	+	2. When the state Medicaid program reimbursement rate reflects
	628	+	the sum of Ninety-four Dollars and eleven cents ($94.11), plus the
620	629
621		-	~~Req~~. No. ~~3783~~ Page 13 1
	630	+	ENGR. S. B. NO. 1417 Page 12 1
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646		-	Facilities for Individuals with Intellectual Disabilities
647		-	intermediate care facilities for individuals with intellectual
648		-	disabilities serving sixteen or fewer clients (ICFs/IID -16).
649		-	E. Facilities shall have the right to appeal and to the
650		-	informal dispute resolution process with regard to penalties and
651		-	sanctions imposed due to staffing noncompliance.
652		-	F. 1. When the state Medicaid program reimbursement rate
653		-	reflects the sum of Ninety -four Dollars and eleven cents ($94.11),
654		-	plus the increases in actual audited costs over and above the actual
655		-	audited costs reflected in the cost reports submitted for the most
656		-	current cost-reporting period and the costs estimated by the
657		-	Oklahoma Health Care Authority to increase the direct -care, flexible
658		-	staff-scheduling staffing level from two and eighty -six one-
659		-	hundredths (2.86) hours per day per occupied bed to three and two -
660		-	tenths (3.2) hours per day per occupied bed, all nursing facilities
661		-	subject to the provisions of the Nursing Home Care Act and
662		-	Intermediate Care Facilities for Individuals with Intellectual
663		-	Disabilities intermediate care facilities for individuals with
664		-	intellectual disabilities (ICFs/IID) with seventeen or more beds, in
665		-	addition to other state and federal requirements related to the
666		-	staffing of nursing facilities, shall maintain direct -care, flexible
667		-	staff-scheduling staffing levels based on an overall three and two -
668		-	tenths (3.2) hours per day per occupied bed.
	655	+	increases in actual audite d costs over and above the actual audited
	656	+	costs reflected in the cost repo rts submitted for the most current
	657	+	cost-reporting period and the costs estimated by the Oklahoma Health
	658	+	Care Authority to increase the direct -care flexible staff-scheduling
	659	+	staffing level from three and two -tenths (3.2) hours per day per
	660	+	occupied bed to three and eight-tenths (3.8) hours per day per
	661	+	occupied bed, all nursing facilities subject to the provisions of
	662	+	the Nursing Home Care Act and Intermediate Care Facilities for
	663	+	Individuals with Intellectual Disabilities intermediate care
	664	+	facilities for indivi duals with intellectual disabilities (ICFs/IID)
	665	+	with seventeen or more beds, in addition to other state and federal
	666	+	requirements related to the staffing of nursing facilities, shall
	667	+	maintain direct-care, flexible staff -scheduling staffing levels
	668	+	based on an overall three and eight -tenths (3.8) hours per day per
	669	+	occupied bed.
	670	+	3. When the state Medicaid program reimbursement rate reflects
	671	+	the sum of Ninety-four Dollars and eleven cents ($94.11), plus the
	672	+	increases in actual audited costs over and above the a ctual audited
	673	+	costs reflected in the cost reports submitted for the most current
	674	+	cost-reporting period and the costs estimated by the Oklahoma Health
	675	+	Care Authority to increase the d irect-care, flexible staff -
	676	+	scheduling staffing level from three and eight -tenths (3.8) hours
	677	+	per day per occupied bed to four and one -tenth (4.1) hours per day
	678	+	per occupied bed, all nursing facilities subject to the provisions
669	679
670		-	~~Req~~. No. ~~3783~~ Page 14 1
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694	704
695		-	2. When the state Medic aid program reimbursement rate reflects
696		-	the sum of Ninety-four Dollars and eleven cents ($94.11), plus the
697		-	increases in actual audited costs over and above the actual audited
698		-	costs reflected in the cost reports submitted for the most current
699		-	cost-reporting period and the costs estimated by the Oklahoma Health
700		-	Care Authority to increase the direct -care flexible staff-scheduling
701		-	staffing level from three and two -tenths (3.2) hours per day per
702		-	occupied bed to three and eight -tenths (3.8) hours per day per
703		-	occupied bed, all nursing facilities subject to the provisions of
704		-	the Nursing Home Care Act and Intermediate Care Facilities for
	705	+	of the Nursing Home Care Act and Intermediate Care Facilities for
705	706		Individuals with Intellectual Disabil ities intermediate care
706	707		facilities for individuals with intellectual disabilities (ICFs/IID)
707	708		with seventeen or more beds, in addition to other state and federal
708	709		requirements related to the staffing of nursing facilities, shall
709	710		maintain direct-care, flexible staff-scheduling staffing levels
710		-	based on an overall ~~three~~ and ~~eight -tenths~~ (3.8) hours per day per
	711	+	based on an overall four and one -tenth (4.1) hours per day per
711	712		occupied bed.
712		-	3. When the state Medicaid program reimbursement rate reflects
713		-	the sum of Ninety-four Dollars and eleven cents ($94.11), plus the
714		-	increases in actual audited costs over and above the actual audited
715		-	costs reflected in the cost rep orts submitted for the most current
716		-	cost-reporting period and the costs estimated by the Oklahoma Health
717		-	Care Authority to increas e the direct-care, flexible staff -
718		-	scheduling staffing level from three and eight -tenths (3.8) hours
	713	+	4. The Commissioner shall promulgate rules for shift -based,
	714	+	staff-to-resident ratios for noncompliant facilities denoting the
	715	+	incremental increases reflected in direct-care, flexible staff -
	716	+	scheduling staffing levels.
	717	+	5. In the event that the state Medicaid program reimbursement
	718	+	rate for facilities subject to the Nursing Ho me Care Act, and
	719	+	Intermediate Care Facilities for Individuals with Intelle ctual
	720	+	Disabilities intermediate care facilities for individuals with
	721	+	intellectual disabilities (ICFs/IID) having seventeen or more beds
	722	+	is reduced below actual audited costs, the req uirements for staffing
	723	+	ratio levels shall be adjusted to the appropriate l evels provided in
	724	+	paragraphs 1 through 4 of this subsection.
	725	+	G. For purposes of this subsection section:
	726	+	1. “Direct-care staff” means any nursing or therapy staff who
	727	+	provides direct, hands-on care to residents in a nursing facility;
719	728
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744	753
745		-	~~per day per occupied bed~~ to ~~fo ur~~ and ~~one-tenth (4.1) hours per day~~
746		-	~~per occupied bed~~, ~~all nursing facilities subject~~ to ~~the provisions~~
747		-	of the ~~Nursing Home Care Act and Intermediate Care Facilities for~~
748		-	~~Individuals with Intellectual Disabilities intermediate care~~
749		-	~~facilities for indivi duals with intellectual disabilities (ICFs/IID)~~
750		-	~~with seventeen~~ or ~~more beds, in addition to other state~~ and ~~federal~~
751		-	~~requirements related to~~ the ~~staffing of nursing facilities,~~ shall
752		-	~~maintain direct-care, flexible staff -scheduling~~ ~~staffing levels~~
753		-	~~based on an overall four and one-tenth (4.1) hours per day per~~
754		-	~~occupied bed~~.
755		-	4. The ~~Commissioner shall promulgate rules for shift -based,~~
756		-	~~staff-to-resident ratios~~ for ~~noncompliant facilities denoting the~~
757		-	~~incremental increases reflected in direct -care, flexible staff -~~
758		-	~~scheduling staffing levels.~~
759		-	~~5. In the event that the state Medicaid program reimbursement~~
760		-	~~rate for facilities subject to~~ the ~~Nur sing Home Care Act, and~~
761		-	~~Intermediate Care Facilities for Individuals with Intellectual~~
762		-	~~Disabilities intermediate care~~ facilities f or ~~individuals with~~
763		-	~~intellectual disabilities (ICFs/IID) having seventeen or more beds~~
764		-	~~is reduced below actual audited costs,~~ the ~~requirements for staffing~~
765		-	~~ratio levels shall be adjusted to~~ the ~~appropriate levels provided in~~
766		-	~~paragraphs 1 through 4~~ of ~~t his subsection.~~
767		-	G. ~~For purposes of this subsection section~~:
	754	+	2. Prior to Septemb er 1, 2003, activity and social services
	755	+	staff who are not providing direct, hands -on care to residents may
	756	+	be included in the direct -care-staff-to-resident ratio in any shift.
	757	+	On and after September 1, 2003, such persons shall not be included
	758	+	in the direct-care-staff-to-resident ratio, regardless of their
	759	+	licensure or certification status; and
	760	+	3. The administrator shall not be counted in the direct -care-
	761	+	staff-to-resident ratio regardless of the administrator ’s licensure
	762	+	or certification status.
	763	+	H. 1. The Oklahoma Health Care Authority shall require all
	764	+	nursing facilities subject to the provisions of the Nursing Home
	765	+	Care Act and Intermediate Care Facilities for Individuals with
	766	+	Intellectual Disabilities intermediate care facilities for
	767	+	individuals with intellectual disabilities (ICFs/IID) with seventeen
	768	+	or more beds to submit a monthly report on staffing ratios on a form
	769	+	that the Authority shall develop.
	770	+	2. The report shall docume nt the extent to which such
	771	+	facilities are meeting or are failing to meet the minimum direct-
	772	+	care-staff-to-resident ratios specified by this section. Such
	773	+	report shall be available to the public upon request.
	774	+	3. The Authority may assess administrative pe nalties for the
	775	+	failure of any facility to submit the report as required b y the
	776	+	Authority. Provided, however:
768	777
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793	802
794		-	1. ~~“Direct-care staff”~~ ~~means any nursing or therapy staff who~~
795		-	~~provides direct,~~ ~~hands-on care to residents~~ in ~~a nursing facility;~~
796		-	~~2. Prior to September 1~~, ~~2003, activity~~ and ~~social services~~
797		-	~~staff who are not providing direct,~~ ~~hands -on~~ ~~care to residents may~~
798		-	~~be included in the direct -care-staff-to-resident ratio in any shift~~.
799		-	~~On and after September 1, 2003, such persons~~ shall not be ~~included~~
800		-	in the ~~direct-care-staff-to-resident ratio, regardless o f their~~
801		-	~~licensure or certification status;~~ ~~and~~
802		-	~~3. The administrator shall not be counted~~ in the ~~direct -~~care-
803		-	~~staff-to-resident ratio regardless~~ of the ~~administrator ’s~~ ~~licensure~~
804		-	~~or certification status.~~
805		-	H. ~~1. The Oklahoma Health Care Authority shall require a ll~~
806		-	~~nursing facilities subject to the provisions of the Nursing Home~~
807		-	~~Care Act and Intermediate~~ Care ~~Facilities for Individuals with~~
808		-	~~Intellectual Disabilities intermediate care facilities for~~
809		-	~~individuals~~ with ~~intellectual disabilities (ICFs/IID) with seventeen~~
810		-	~~or more beds to submit a monthly report on staffing ratios on a form~~
811		-	~~that~~ the ~~Authority shall develop.~~
812		-	2. The ~~report shall document the extent to which such~~
813		-	~~facilities are meeting or are failing to meet the minimum direct -~~
814		-	~~care-staff-to-resident ratios specified~~ by ~~this section.~~ ~~Such~~
815		-	~~report shall be available to the public upon request.~~
	803	+	a. administrative penalties shall not accrue until the
	804	+	Authority notifies the facility in writing that the
	805	+	report was not timely submitted as req uired, and
	806	+	b. a minimum of a one-day penalty shall be assessed in
	807	+	all instances.
	808	+	4. Administrative penalties shall not be assessed for
	809	+	computational errors made in preparing the report.
	810	+	5. Monies collected from administrative penalties shall be
	811	+	deposited in the Nursing Facility Quality of Care Fund established
	812	+	in Section 2002 of Title 56 of the Oklahoma Statutes and utilized
	813	+	for the purposes specified in the Oklahoma Healthcare Initiative Act
	814	+	such section.
	815	+	I. 1. All entities regulated by this state that provide long-
	816	+	term care services shall utilize a single assessment tool to
	817	+	determine client services needs. The tool shall be developed by the
	818	+	Oklahoma Health Care Authority in consultation with the State
	819	+	Department of Health.
	820	+	2. a. The Oklahoma Nursing F acility Funding Advisory
	821	+	Committee is hereby created and shall consist of the
	822	+	following:
	823	+	(1) four members selected by the Oklahoma Association
	824	+	of Health Care Providers Oklahoma,
816	825
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819	828		3
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841	850
842		-	3. The Authority may assess administrative penalties for the
843		-	failure of any facility to submit the report as required by the
844		-	Authority. Provided, however:
845		-	a. administrative penalties shall not accrue until the
846		-	Authority notifies the facility in writing that the
847		-	report was not timely submitted as required, and
848		-	b. a minimum of a one-day penalty shall be assessed in
849		-	all instances.
850		-	4. Administrative penalties shall not be assessed for
851		-	computational errors made in preparing the report.
852		-	5. Monies collected from administrative penalties shall be
853		-	deposited in the Nursing Facility Quality of Care Fund established
854		-	in Section 2002 of Title 56 of the Oklahoma Statutes and utilized
855		-	for the purposes specified in the Oklahoma Healthcare Initiative Act
856		-	such section.
857		-	I. 1. All entities regulated by this sta te that provide long -
858		-	term care services shall utilize a single assessment tool to
859		-	determine client services needs. The tool shall be developed by the
860		-	Oklahoma Health Care Authority in consultation with the State
861		-	Department of Health.
862		-	2. a. The Oklahoma Nursing Facility Funding Advisory
863		-	Committee is hereby created and shall consist of the
864		-	following:
	851	+	(2) three members selected by the Oklahoma
	852	+	Association of Homes and Services f or the Aging,
	853	+	and
	854	+	(3) two members selected by the Oklahoma State
	855	+	Council on Aging and Adult Protective Services.
	856	+	The Chair chair shall be elected by the committee. No
	857	+	state employees may be appointed to serve.
	858	+	b. The purpose of the advisory committee will be to
	859	+	develop a new methodology for calculating state
	860	+	Medicaid program reimbursements to nursing facilities
	861	+	by implementing facility -specific rates based on
	862	+	expenditures relating to direct care staffing. No
	863	+	nursing home will receive less than the current rate
	864	+	at the time of implementation of facility -specific
	865	+	rates pursuant to this subparagraph.
	866	+	c. The advisory committee shall be staffed and advised by
	867	+	the Oklahoma Health Care Authority.
	868	+	d. The new methodology will be submitted for approval to
	869	+	the Board of the Oklahoma Health Care Authority Board
	870	+	by January 15, 2005, and shall be finalized by July 1,
	871	+	2005. The new methodology will apply only to new
	872	+	funds that become available for Medicaid nursing
	873	+	facility reimbursement after the methodology of this
	874	+	paragraph has been finalized. Existing funds paid to
865	875
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868	878		3
869	879		4
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873	883		8
874	884		9
875	885		10
876	886		11
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881	891		16
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884	894		19
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886	896		21
887	897		22
888	898		23
889	899		24
890	900
891		-	(1) four members selected by the Oklahoma Association
892		-	of Health Care Providers,
893		-	(2) three members selected by the Oklahoma
894		-	Association of Homes and Services for the Aging,
895		-	and
896		-	(3) two members selected by the State Council on
897		-	Aging.
898		-	The Chair shall be elected by the committee. No state
899		-	employees may be appointed to serve.
900		-	b. The purpose of the advisory committee will be to
901		-	develop a new methodology for calculating state
902		-	Medicaid program reimbursements to nursing facilities
903		-	by implementing facility -specific rates based on
904		-	expenditures relating to direct care staffing. No
905		-	nursing home will receive less than the current rate
906		-	at the time of implementation of facility -specific
907		-	rates pursuant to this subparagraph.
908		-	c. The advisory committee shall be staffed and advised by
909		-	the Oklahoma Health Care Authority.
910		-	d. The new methodology will be submitted for approval to
911		-	the Board of the Oklahoma Health Care Authority by
912		-	January 15, 2005, and shall be finalized by July 1,
913		-	2005. The new methodology will apply only to new
914		-	funds that become available for Med icaid nursing
	901	+	nursing homes will not be subject to the methodology
	902	+	of this paragraph. The methodology as outlined in
	903	+	this paragraph will only be applied to any new funding
	904	+	for nursing facilities appropriated above and bey ond
	905	+	the funding amounts effective on January 15, 2005.
	906	+	e. The new methodology shall divide the payment into two
	907	+	components:
	908	+	(1) direct care which includes allowable costs for
	909	+	registered nurses, licensed practical nurses,
	910	+	certified medication aides and cert ified nurse
	911	+	aides. The direct care component of the rate
	912	+	shall be a facility-specific rate, directly
	913	+	related to each facility ’s actual expenditures on
	914	+	direct care, and
	915	+	(2) other costs.
	916	+	f. The Oklahoma Health Care Authority, in calculating the
	917	+	base year prospective direct care rate component,
	918	+	shall use the following criteria:
	919	+	(1) to construct an array of facility per diem
	920	+	allowable expenditures on direct care, the
	921	+	Authority shall use the most recent data
	922	+	available. The limit on this array shall be no
	923	+	less than the ninetieth percentile,
915	924
916		-	~~Req~~. No. ~~3783~~ Page 19 1
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940	949
941		-	facility reimbursement after the methodology of this
942		-	paragraph has been finalized. Existing funds paid to
943		-	nursing homes will not be subject to the methodology
944		-	of this paragraph. The methodology as outlined in
945		-	this paragraph will only be app lied to any new funding
946		-	for nursing facilities appropriated above and beyond
947		-	the funding amounts effective on Januar y 15, 2005.
948		-	e. The new methodology shall divide the payment into two
949		-	components:
950		-	(1) direct care which includes allowable costs for
951		-	registered nurses, licensed practical nurses,
952		-	certified medication aides and certified nurse
953		-	aides. The direct care component of the rate
954		-	shall be a facility-specific rate, directly
955		-	related to each facility ’s actual expenditures on
956		-	direct care, and
957		-	(2) other costs.
958		-	f. The Oklahoma Health Care Authority, in calculating the
959		-	base year prospective direct care rate component,
960		-	shall use the following criteria:
961		-	(1) to construct an array of facility per diem
962		-	allowable expenditures on direct care, the
963		-	Authority shall use t he most recent data
	950	+	(2) each facility’s direct care base-year component
	951	+	of the rate shall be the lesser of the facility ’s
	952	+	allowable expenditures on direct care or the
	953	+	limit,
	954	+	(3) the Authority shall transition the payment rate
	955	+	methodology of nursing facilities to a price -
	956	+	based methodology when data for such a
	957	+	methodology becomes available and has been
	958	+	analyzed by the Authority. Under the price -based
	959	+	methodology, the direct care payment amount of
	960	+	each facility shall be adjusted to reflect the
	961	+	resident case mix of each facility using a
	962	+	percentage of funds in the direct c are pool as
	963	+	determined by the Authority ,
	964	+	(4) other rate components shall be determined by the
	965	+	Oklahoma Nursing Facility Funding Advisory
	966	+	Committee or the Authority in accordance with
	967	+	federal regulations and requirements,
	968	+	(4) (5) prior to July 1, 2020, the Authority shall
	969	+	seek federal approval to calculate the upper
	970	+	payment limit under the authority of CMS the
	971	+	Centers for Medicare and Medicaid Services (CMS)
	972	+	utilizing the Medicare equi valent payment rate,
	973	+	and
964	974
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976	986		12
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979	989		15
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989	999
990		-	~~available. The limit on this array shall be no~~
991		-	~~less than the ninetieth percentile~~,
992		-	~~(2) each facility’s direct~~ care ~~base-year component~~
993		-	~~of the rate shall be the lesser of the facility ’s~~
994		-	~~allowable expenditures on direct care or the~~
995		-	~~limit,~~
996		-	~~(3) subject to availability of funds,~~ the ~~Authority~~
997		-	~~shall transition~~ the ~~payment rate methodology of~~
998		-	~~nursing facilities to a price-based methodology~~
999		-	~~when data for such a methodology becomes~~
1000		-	~~available and has been analyzed by the Authority.~~
1001		-	~~Under the price-based~~ ~~methodology, fifty percent~~
1002		-	~~(50%) of funds~~ shall be ~~allocated~~ to ~~a case mix~~
1003		-	~~component and the remaining fifty percent (50%)~~
1004		-	~~of funds shall be allocated to the base rate~~
1005		-	~~component,~~
1006		-	~~(4) other~~ rate ~~components shall be determined by~~ the
1007		-	~~Oklahoma Nursing Facility Funding Advisory~~
1008		-	~~Committee or~~ the ~~Authority in accordance with~~
1009		-	~~federal regulations and requirements,~~
1010		-	~~(4) (5) prior to July 1, 2020,~~ the ~~Authority shall~~
1011		-	~~seek federal approval to calculate the upper~~
1012		-	~~payment limit under~~ the ~~authority of CMS~~ the
1013		-	~~Centers for Medicare and Medicaid Services (CMS)~~
	1000	+	(5) (6) if Medicaid payment rates to providers ar e
	1001	+	adjusted, nursing home rates and Intermediate
	1002	+	Care Facilities for Individuals with Intellectual
	1003	+	Disabilities intermediate care facilities for
	1004	+	individuals with intellectual disabili ties
	1005	+	(ICFs/IID) rates shall not be adjusted less
	1006	+	favorably than the averag e percentage-rate
	1007	+	reduction or increase applicable to the majority
	1008	+	of other provider groups.
	1009	+	g. (1) Effective October 1, 2019, if sufficient funding
	1010	+	is appropriated for a rate increa se, a new
	1011	+	average rate for nursing facilities shall be
	1012	+	established. The rate shall be equal to the
	1013	+	statewide average cost as derived from audited
	1014	+	cost reports for SFY 2018, ending June 30, 2018,
	1015	+	after adjustment for inflation. After such new
	1016	+	average rate has been established, the facility
	1017	+	specific reimbursement rate shall be a s follows:
	1018	+	(a) amounts up to the existing base rate amount
	1019	+	shall continue to be distributed as a part
	1020	+	of the base rate in accordance with the
	1021	+	existing State Plan, and
	1022	+	(b) to the extent the new rate exceeds the rate
	1023	+	effective before the effective date of th is
1014	1024
1015		-	~~Req~~. No. ~~3783~~ Page 21 1
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1037	1047		23
1038	1048		24
1039	1049
1040		-	~~utilizing the Medicare equivalent payment rate~~,
1041		-	~~and~~
1042		-	~~(5) (6) if Medicaid payment rates to providers are~~
1043		-	~~adjusted, nursing home rates~~ and ~~Intermediate~~
1044		-	~~Care Facilities for Individuals with Intellectual~~
1045		-	~~Disabilities intermediate care facilities for~~
1046		-	~~individuals~~ with ~~intellectual disabilities~~
1047		-	~~(ICFs~~/~~IID) rates shall not be adjusted less~~
1048		-	~~favorably than~~ the ~~average percentage -rate~~
1049		-	~~reduction or increase applicable to the majority~~
1050		-	~~of other provider groups.~~
1051		-	~~g. (1) Effective October 1,~~ ~~2019, if sufficient funding~~
1052		-	~~is appropriated for a rate increase~~, ~~a new~~
1053		-	~~average rate for nursing facilities shall b e~~
1054		-	~~established~~. The rate shall ~~be equal to~~ the
1055		-	~~statewide average cost as derived from audited~~
1056		-	~~cost reports for SFY 2018,~~ ~~ending Ju ne 30, 2018,~~
1057		-	~~after adjustment for inflation~~. ~~After such new~~
1058		-	~~average~~ rate ~~has been established,~~ the ~~facility~~
1059		-	~~specific reimbursement rate~~ shall be as follows:
1060		-	(a) ~~amounts up to~~ the ~~existing base rate amount~~
1061		-	shall ~~continue to be distributed as a part~~
1062		-	of ~~the base rate in accordance with the~~
1063		-	~~existing State Plan,~~ ~~and~~
	1050	+	act October 1, 2019, fifty percent (50%) of
	1051	+	the resulting increase on October 1, 2019,
	1052	+	shall be allocated toward an increase of the
	1053	+	existing base reimbursement rate and
	1054	+	distributed accordingly. The remaining
	1055	+	fifty percent (50%) of the increase shall be
	1056	+	allocated in accordance with the currently
	1057	+	approved 70/30 reimbursement rate
	1058	+	methodology as outlined in the existing
	1059	+	State Plan.
	1060	+	(2) Any subsequent rate increases, as determined
	1061	+	based on the provisions set forth in this
	1062	+	subparagraph, shall be allocated in accordance
	1063	+	with the currently approved 70/30 reimbursement
	1064	+	rate methodology. The rate shall not exceed the
	1065	+	upper payment limit established by the Medicare
	1066	+	rate equivalent establish ed by the federal CMS.
	1067	+	h. Effective October 1, 2019, in coordination with the
	1068	+	rate adjustments identified in the preceding section,
	1069	+	a portion of the funds shall be utilized as follows:
	1070	+	(1) effective October 1, 2019, the Oklahoma Health
	1071	+	Care Authority shall increase the personal needs
	1072	+	allowance for residents of nursing homes and
	1073	+	Intermediate Care Facilities for Individuals with
1064	1074
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1072	1082		8
1073	1083		9
1074	1084		10
1075	1085		11
1076	1086		12
1077	1087		13
1078	1088		14
1079	1089		15
1080	1090		16
1081	1091		17
1082	1092		18
1083	1093		19
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1089	1099
1090		-	~~(b) to the extent the new rate exceeds the rate~~
1091		-	~~effective before the effective date of this~~
1092		-	~~act October 1, 2019,~~ fifty ~~percent (50%) of~~
1093		-	~~the resulting increase on October 1,~~ ~~2019,~~
1094		-	~~shall be allocated toward an~~ increase ~~of the~~
1095		-	~~existing base reimbursement rate and~~
1096		-	~~distributed accordingly.~~ ~~The remaining~~
1097		-	~~fifty percent~~ (~~50%~~) of the ~~increase shall be~~
1098		-	~~allocated in accordance with~~ the ~~currently~~
1099		-	~~approved 70/30 reimbursement rate~~
1100		-	~~methodology as outlined in the existing~~
1101		-	~~State Plan.~~
1102		-	(2) ~~Any subsequent rate increases, as determined~~
1103		-	~~based on the provisions set forth in this~~
1104		-	~~subparagraph, shall~~ be ~~allocated in accordance~~
1105		-	~~with~~ the ~~currently approved 70/30 reimbursement~~
1106		-	~~rate methodology.~~ ~~The rate shall not exceed the~~
1107		-	~~upper payment limit established by the Medicare~~
1108		-	~~rate equivalent established by the federal CMS~~.
1109		-	h. ~~Effective October 1, 2019, in coordination with~~ the
1110		-	~~rate adjustments identified in~~ the ~~preceding section,~~
1111		-	~~a portion of~~ the ~~funds shall be utilized as follows :~~
1112		-	~~(1) effective October 1,~~ ~~2019,~~ the ~~Oklahoma Health~~
1113		-	~~Care Authority shall increase the personal needs~~
	1100	+	Intellectual Disabilities intermediate care
	1101	+	facilities for individuals with intellectual
	1102	+	disabilities (ICFs/IID) from Fifty Dollars
	1103	+	($50.00) per month to Seventy -five Dollars
	1104	+	($75.00) per month per resident . The increase
	1105	+	shall be funded by Medicaid nursing home
	1106	+	providers, by way of a reduction of eighty -two
	1107	+	cents ($0.82) per day deducted from the base
	1108	+	rate. Any additional cost shall be funded by the
	1109	+	Nursing Facility Quality of Care Fund, and
	1110	+	(2) effective January 1, 2020, all clinical employees
	1111	+	working in a licensed nursing facility shall be
	1112	+	required to receive at least four (4) hours
	1113	+	annually of Alzheimer ’s or dementia training, to
	1114	+	be provided and paid for by the facilities.
	1115	+	3. The Department of Human Ser vices shall expand its statewide
	1116	+	toll-free, Senior-Info Line Senior Info-line for senior citizen
	1117	+	services to include assistance with or information on long -term care
	1118	+	services in this state.
	1119	+	4. The Oklahoma Health Care Authority shall develop a nursing
	1120	+	facility cost-reporting system that reflects the most current costs
	1121	+	experienced by nursing and specialized facilities. The Oklahoma
	1122	+	Health Care Authority shall utilize the most current cost report
	1123	+	data to estimate costs in determining daily per diem rates.
1114	1124
1115		-	~~Req~~. No. ~~3783~~ Page 23 1
	1125	+	ENGR. S. B. NO. 1417 Page 22 1
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1140		-	~~allowance for residents of nursing homes and~~
1141		-	~~Intermediate Care Facilities for Individuals with~~
1142		-	~~Intellectual Disabilities intermediate care~~
1143		-	~~facilities for individuals with intellectual~~
1144		-	~~disabilities (ICFs/IID) from Fifty Dollars~~
1145		-	~~($50.00) per month~~ to ~~Seventy -five~~ ~~Dollars~~
1146		-	~~($75.00) per month per resident.~~ ~~The increase~~
1147		-	~~shall be funded by Medicaid nursing home~~
1148		-	~~providers, by way of a reduction of eighty -two~~
1149		-	cents ($0.82) ~~per day deducted from the base~~
1150		-	~~rate. Any additional cost shall be funded by~~ the
1151		-	~~Nursing Facility Quality of Care Fun d,~~ ~~and~~
1152		-	~~(2) effective January 1~~, ~~2020~~, ~~all clinical employees~~
1153		-	~~working in a licensed nursing facility shall be~~
1154		-	~~required to receive a t least four~~ (4) hours
1155		-	~~annually~~ of ~~Alzheimer ’s or dementia training, to~~
1156		-	~~be provided and paid for by the facilities~~.
1157		-	3. The ~~Department of Human Services~~ shall ~~expand its statewide~~
1158		-	~~toll-free, Senior-Info Line Senior Info-line~~ for ~~senior citizen~~
1159		-	~~services to include assistance with or information~~ on ~~long -term care~~
1160		-	~~services in this state~~.
1161		-	4. The ~~Oklahoma Health Care~~ Authority shall develop a ~~nursing~~
1162		-	~~facility cost-reporting~~ ~~system that reflects~~ the ~~most current costs~~
1163		-	~~experienced by~~ nursing ~~and specialized facil ities~~. ~~The Oklahoma~~
	1150	+	5. The Oklahoma Health Care Authority shall provide access to
	1151	+	the detailed Medicaid payment audit adjustments and implement an
	1152	+	appeal process for disputed payment audit adjustments t o the
	1153	+	provider. Additionally, the Oklahoma Health Care Authority shall
	1154	+	make sufficient revisions to the nursing facility cost reporting
	1155	+	forms and electronic data input system so as to clarify what
	1156	+	expenses are allowable and appropriate for inclusion in co st
	1157	+	calculations.
	1158	+	J. 1. When the state Medicaid program reimbursement rat e
	1159	+	reflects the sum of Ninety-four Dollars and eleven cents ($94.11),
	1160	+	plus the increases in actual audited costs, over and above the
	1161	+	actual audited costs reflected in the cost reports submitted for the
	1162	+	most current cost-reporting period, and the direct -care, flexible
	1163	+	staff-scheduling staffing level has been prospectively funded at
	1164	+	four and one-tenth (4.1) hours per day per occupied bed, the
	1165	+	Authority may apportion funds for the impleme ntation of the
	1166	+	provisions of this section.
	1167	+	2. The Authority shall make ap plication to the United States
	1168	+	Centers for Medicare and Medicaid Service for a waiver of the
	1169	+	uniform requirement on health -care-related taxes as permitted by
	1170	+	Section 433.72 of 42 C.F.R., Section 433.72.
	1171	+	3. Upon approval of the waiver, the Authority shall develop a
	1172	+	program to implement the provisions of the waiver as it relates to
	1173	+	all nursing facilities.
1164	1174
1165		-	~~Req~~. No. ~~3783~~ Page 24 1
	1175	+	ENGR. S. B. NO. 1417 Page 23 1
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1190		-	Health Care Authority shall utilize the most current cost report
1191		-	data to estimate costs in dete rmining daily per diem rates.
1192		-	5. The Oklahoma Health Care Authority shall provide access to
1193		-	the detailed Medicaid payment audit adjustments and implement an
1194		-	appeal process for disputed payment audit adjustments to the
1195		-	provider. Additionally, the Oklahoma Health Ca re Authority shall
1196		-	make sufficient revisions to the nursing facility cost reporting
1197		-	forms and electronic data input system so as t o clarify what
1198		-	expenses are allowable and appropriate for inclusion in cost
1199		-	calculations.
1200		-	J. 1. When the state Med icaid program reimbursement rate
1201		-	reflects the sum of Ninety -four Dollars and eleven cents ($94.11),
1202		-	plus the increases in actual audited cos ts, over and above the
1203		-	actual audited costs reflected in the cost reports submitted for the
1204		-	most current cost-reporting period, and the direct-care, flexible
1205		-	staff-scheduling staffing level has been prospectively funded at
1206		-	four and one-tenth (4.1) hours pe r day per occupied bed, the
1207		-	Authority may apportion funds for the implementation of the
1208		-	provisions of this section.
1209		-	2. The Authority shall make application to the United States
1210		-	Centers for Medicare and Medicaid Service for a waiver of the
1211		-	uniform requirement on health-care-related taxes as permitted by
1212		-	Section 433.72 of 42 C.F.R., Section 433.72.
1213		-
1214		-	Req. No. 3783 Page 25 1
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1238		-
1239		-	3. Upon approval of the waiver, the Authority shall develop a
1240		-	program to implement the provisions of the waiver as it relates to
1241		-	all nursing facilities.
1242	1200		K. Subject to the availability of funds, the Authority shall
1243	1201		design and implement a scholarship program for nurse aides who work
1244	1202		in Medicaid-certified nursing facilities or intermediate care
1245	1203		facilities for individuals with intellectual disabilities (ICFs/IID)
1246	1204		and who are attending a program of practical nursing approved by the
1247	1205		Oklahoma Board of Nursing.
1248		-	SECTION 4. AMENDATORY 63 O.S. 2021, Section 5023, is
1249		-	amended to read as follows:
1250		-	Section 5023. A. Effective January 1, 2000, and every January
1251		-	thereafter until subsection B of this section becomes effective , the
1252		-	Oklahoma Health Care Authority will adj ust the nursing facility per
1253		-	diem rate in an amount equal to the total amount of the savings to
1254		-	the Medicaid program as a result of the auto matic cost-of-living
1255		-	adjustment on Social Security benefits received by nursing home
1256		-	recipients, as published in the Federal R egister.
1257		-	B. Effective January 1, 2026, and every January 1 thereafter,
1258		-	subject to receipt of any necessary federal approval, the Authority
1259		-	shall increase each nursing facility ’s per diem rate in an amount
1260		-	equal to the automatic cost -of-living adjustments on Social Security
1261		-	benefits received by residents of the facility, as published in the
	1206	+	SECTION 3. This act shall become effe ctive July 1, 2024.
	1207	+	SECTION 4. It being immediately necessary for the preservation
	1208	+	of the public peace, health or safety, an emergency is hereby
	1209	+	declared to exist, b y reason whereof this act shall take effect and
	1210	+	be in full force from and after its passage and approval.
	1211	+	Passed the Senate the 11th day of March, 2024.
1262	1212
1263		-	Req. No. 3783 Page 26 1
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1287	1213
1288		-	Federal Register. The Authority shall seek any federal approval
1289		-	necessary to implement this subsection.
1290		-	SECTION 5. This act shall become effective July 1, 2025.
1291	1214
1292		-	59-2-3783 DC 5/29/2024 5:26:51 PM
	1215	+	Presiding Officer of the Senate
	1216	+
	1217	+
	1218	+	Passed the House of Representatives the ____ day of __________,
	1219	+	2024.
	1220	+
	1221	+
	1222	+
	1223	+	Presiding Officer of the House
	1224	+	of Representatives
	1225	+
	1226	+