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SENATE FLOOR VERSION
March 5, 2025
COMMITTEE SUBSTITUTE
FOR
SENATE BILL NO. 904 By: Rosino of the Senate
and
Stinson of the House
[ state Medicaid program - reimbursement rate plan -
qualification criteria - allocation - staff retention
initiative - payment - reporting - advisory committee
- apportionment - effective date -
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 Care Authority
shall develop an incentive reimbursement rate plan for nursing
facilities focused on improving resident outcomes and resident
quality of life.
2. Under the current rate methodology, the Authority shall
reserve Five Dollars ($5.00) per patient day designated for the
quality assurance component that nursing facilities can earn for
improvement or performance achievement of resident-centered outcomes
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metrics the long-stay quality measures ra tings specified in
paragraph 4 of this subsection . 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 Dollars ($3.00) per
day funded by the Authority. Payments to nursing facilities that
achieve specific metrics qualify under paragraph 4 of this
subsection shall be treated as an “add back” to their net
reimbursement per diem. Dollar values assigned to each metric
rating shall be determined so that an average of the five-dollar-
quality five-dollar quality incentive is made to qualifying nursing
facilities.
3. Pay-for-performance payments may be earned quarterly and
based on facility-specific performance achievement of four equally -
weighted, Long-Stay Quality Measures as defined by the facility’s
long-stay quality measures rating in the nursing home Five -Star
Quality Rating System of the Centers for Medicare and Medicaid
Services (CMS).
4. Contracted Medicaid long -term care providers may earn
payment by achieving either five percent (5%) relative improvement
each quarter from baseline or by achieving the National Average
Benchmark or better for each individual quality metric at least a
two-star long-stay quality measures rating. Program funds shall be
allocated as follows:
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a. facilities with a two -star rating shall receive forty
percent (40%) of the per -day amount reserved for the
quality assurance component per Medicaid patient day,
b. facilities with a three -star rating shall receive
sixty percent (60%) of the p er-day amount reserved for
the quality assurance component per Medicaid patient
day,
c. facilities with a four -star rating shall receive
eighty percent (80%) of the per -day amount reserved
for the quality assurance component per Medicaid
patient day, and
d. facilities with a five -star rating shall receive one
hundred percent (100%) of the per -day amount reserved
for the quality assurance component per Medicaid
patient day.
5. As soon as practicable after receipt of any necessary
federal approval, and subje ct to appropriation of funds for a rate
increase to nursing facilities, facilities may earn up to Three
Dollars ($3.00) per Medicaid patient day by participating in an
optional staff retention initiative for Registered Nurses, Licensed
Practical Nurses, an d Certified Nurse Aides . Payments shall be
allocated at One Dollar and fifty cents ($1.50) per quality measure,
subject to the following conditions:
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a. a minimum of sixty percent (60%), or a percentage
determined by the Authority, of Registered Nurses and
Licensed Practical Nurses must be retained for not
less than twelve (12) months, with compliance measured
quarterly,
b. a minimum of fifty percent (50%), or a percentage
determined by the Authority, of Certified Nurse Aides
must be retained for not less t han twelve (12) months,
with compliance measured quarterly,
c. participating facilities must subm it an annual
retention plan to the Authority by June 30 of each
year, and
d. participating facilities shall receive incentive
payments under this paragraph dur ing the first year to
support retention efforts. Beginning in the second
year and thereafter, facilities must meet program
metrics as provided by this paragraph to remain
eligible for payments.
6. Pursuant to federal Medicaid approval, any funds that rem ain
as a result of providers failing to meet the quality assurance
metrics after all the allocati ons under this subsection have been
made shall be pooled and redistributed to those who achieve the
quality assurance metrics each quarter qualify for payments under
this subsection. If federal approval is not received, any remaining
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funds shall be deposited in the Nursing Facility Quality of Care
Fund authorized in Section 2002 of this title.
6. The Authority shall establish an advisory group with
consumer, provider and state agency representation to recommend
quality measures to be included in the pay -for-performance program
and to provide feedback on program performance and recommendations
for improvement. The quality measures shall be reviewed annually
and shall be subject to change every three (3) years through the
agency’s promulgation of rules. The Authority shall insure
adherence to the following criteria in determining the quality
measures:
a. provides direct benefit to resident care outcomes,
b. applies to long-stay residents, and
c. addresses a need for quality improvement using the
Centers for Medicare and Medicaid Services (CMS)
ranking for Oklahoma.
7. The Authority shall begin the pay -for-performance program
focusing on improving the following C MS nursing home quality
measures:
a. percentage of long-stay, high-risk residents with
pressure ulcers,
b. percentage of long-stay residents who lose too much
weight,
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c. percentage of long-stay residents with a urinary tract
infection, and
d. percentage of long-stay residents who got an
antipsychotic medication.
B. The Oklahoma Health Care Authority shall negotiate with the
Centers for Medicare and Medicaid Services to include the authority
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 inc entive
reimbursement rate plan to the Governor, the Speaker of the House of
Representatives, and the President Pro Tempore of the Senate by
December 31 of each year. The report shall include, but not be
limited to, an analysis of the previous fiscal year including
incentive payments, ratings, and notable trends.
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 Intermediate
Care Facilities for Individuals with Intellectual D isabilities
intermediate care facilities for individuals with intellectual
disabilities (ICFs/IID) from the Nursing Facility Quality of Care
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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 the 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 Indivi duals with Intellectual Disabilities
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
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 11:00 p.m., one direct -care staff to
every twelve 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.
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2. From September 1, 2001, through August 31, 2003, nursing
facilities subject to the Nursing Home Care Act and Intermediate
Care Facilities for Individuals with Intellectual Disabilities
intermediate 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
staffing 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 and Intermediate Care Facilities for
Individuals with Intellectua l Disabilities intermediate 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 staffing of nursing
facilities, the followi ng 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,
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b. from 3:00 p.m. to 11:00 p.m., one direct -care staff to
every eight residents, or major fraction the reof, and
c. from 11:00 p.m. to 7:00 a.m., one direct -care staff to
every fifteen residents, or m ajor fraction thereof.
4. Effective immediately, facilities shall 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 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
fifteen residents or major fraction thereof, and at
least two direct-care staff shall be on duty and awake
at all times.
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c. As used in this paragraph, “twenty-four-hour-based-
scheduling” “twenty-four-hour-based staff 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) two and nine-tenths (2.9) 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 fa cility 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 staffing 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 r equire a facility described in
subparagraph a of this paragraph to achieve and
maintain the shift-based, staff-to-resident ratios
provided in paragraph 3 of th is 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 sha ll
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 w ith the
twenty-four-hour-based staff-scheduling staffing
provisions of paragraph 5 of this subsec tion through
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reviews of monthly staffing reports, results of
complaint investigations and inspections.
b. If the Department identifies any quality -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 maintained
until full compliance is achieved,
(2) the second determination within a two -year period
shall require that shift -based, staff-to-resident
ratios be maintained for a minimum 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 apply fo r
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 promulgate rules
prescribing staffing requirements for Intermediate Care Facilities
for Individuals with Intellectual Disabilities intermediate care
facilities for individuals with intellectual dis abilities serving
six or fewer clients (ICFs/IID -6) and for Intermediate Care
Facilities for Individuals with Intellectual Disabilities
intermediate care facil ities for individuals with intellectual
disabilities serving 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 penalties and
sanctions imposed due to staffing noncompliance.
F. 1. When the state Medicaid program reimbursement rate
reflects the sum of Ni nety-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 s ubmitted for the most
current cost-reporting period and the 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 occupied bed, all nursing facilities
subject to the provisions of the Nursing Home Care Act and
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Intermediate Care Facilities for Individuals with Intellectual
Disabilities intermediate care facilities fo r individuals with
intellectual disabilities (ICFs/IID) with seventeen or more beds, in
addition to other state and federal requirements related to the
staffing of nursing facilities, shall maintain direct -care, flexible
staff-scheduling staffing levels ba sed on an overall three and two -
tenths (3.2) hours per day per occupied bed.
2. When the state M edicaid 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
Care Authority to increase the direct -care flexible staff-scheduling
staffing level from three and t wo-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 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 nursing 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.
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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
Care Authority to increase the direct -care, flexible staff-
scheduling staffing level from three and eight -tenths (3.8) hours
per day per occupied bed t o four and one-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 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 nur sing facilities, shall
maintain 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 no ncompliant facilities denoting 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 Individuals with Intellectual
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Disabilities intermediate care faciliti es for individuals with
intellectual disabilities (ICFs/IID) having seventeen or more beds
is reduced below actual audited costs, the requirements for staffing
ratio levels shall be adjusted to the appropriate levels provided in
paragraphs 1 through 4 of this subsection.
G. For purposes of this subsection section:
1. “Direct-care staff” means any nursing or therapy staff who
provides direct, hands -on care to residents in a nursing facility;
2. Prior to September 1, 2003, activity and social services
staff who are not providing 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 persons 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 counted in the direct -care-
staff-to-resident ratio regardless of the administ rator’s licensure
or certification status.
H. 1. The Oklahoma Health Care Authority shall requi re all
nursing facilities subject to the provisions of the Nursing Home
Care Act and Intermediate Care Facilities for Individuals with
Intellectual Disabilitie s intermediate 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.
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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 section. 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:
a. administrative penalties shall not accrue until the
Authority notifies the facility in writing that 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 penalties shall not be assessed for
computational errors made in preparing the report.
5. Monies collected from administrative penalties shall be
deposited in the Nursing Facili ty Quality of Care Fund established
in Section 2002 of Title 56 of the Oklahoma Statutes and utilized
for the purposes specified in the Oklahoma Healthcare Initiative Act
such section.
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 s hall be developed by the
Oklahoma Health Care Authority in consultation with the State
Department of Health.
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2. a. The Oklahoma Nursing Facility Funding Adviso ry
Committee is hereby created and shall consist of the
following:
(1) four members selected by the Oklahoma Association
of Health Care Providers Care Providers Oklahoma
or its successor organization ,
(2) three members selected by the Oklahoma
Association of Homes and Services for the Aging
LeadingAge Oklahoma or its successor
organization, and
(3) two members selected by the State Council on
Aging State Council on Aging and Adult Protective
Services.
The Chair chair shall be elected by the committee. No
state employees may be appointed to serve.
b. The purpose of the advisory committee will shall be
to:
(1) develop a new methodology for calculating state
Medicaid program reimbursements to nursing
facilities by implementing facility -specific
rates based on expenditures relating to direct
care staffing, and
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(2) recommend changes to the incentive reimbur sement
rate plan created under Section 1011.5 of Title
56 of the Oklahoma Statutes .
No nursing home will shall receive less than the
current rate at the time of implementation of
facility-specific rates pursuant to division 1 of this
subparagraph.
c. The advisory committee shall be staffed and advised by
the Oklahoma Health Care Authority.
d. The new methodology will shall be submitted for
approval to the Board of the Oklahoma Health Care
Authority Board by January 15, 2005, and shall be
finalized by July 1, 2005. The new methodology will
shall apply only to new funds that become available
for Medicaid nursing facility reimbursement after the
methodology of this paragraph has been finalized.
Existing funds paid to nursing homes will shall not be
subject to the methodology of this paragraph. The
methodology as outlined in this paragraph will shall
only be applied to any new funding for nursing
facilities appropriated above and beyond the funding
amounts effective on January 15, 2005.
e. The new methodology shall divide the payment into two
components:
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(1) direct care which includes allowable costs for
registered nurses Registered Nurses, licensed
practical nurses Licensed Practical Nurses ,
certified medication aides Certified Medication
Aides and certified nurse aides 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, and
(2) other costs.
f. The Oklahoma Health Care Authority, in calculating the
base year prospective direct care rate component,
shall use the following criteria:
(1) to construct an array of facility per diem
allowable expenditures o n 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 care or the
limit,
(3) as soon as practicable after receipt of any
necessary federal approval, and subject to
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appropriation of funds for a rate increase to
nursing facilities, the Authority shall
incorporate a case-mix component into the payment
rate methodology for nursing facilities. The
inclusion of the case -mix component shall occur
upon the availability and analysis of the
necessary data by the Authority. Appropriated
funds shall be allocated as follows:
(a) fifty percent (50%) of funds shall be
designated for the case -mix component, and
(b) the remaining fifty percent (50%) of funds
shall be allocated to the base rate
component,
(4) other rate components shall be determined by the
Oklahoma Nursing Facility Funding Advisory
Committee or the Authority in accordance with
federal regulations and requirements,
(4) (5) prior to July 1, 2020, the Authority shall
seek federal approval to calculate the upper
payment limit under the authority of CMS the
Centers for Medicare and Medicaid S ervices (CMS)
utilizing the Medicare equivalent payment rate,
and
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(5) (6) if Medicaid payment rat es to providers are
adjusted, nursing home rates and Intermediate
Care Facilities for Individuals with Intellectual
Disabilities intermediate care facilities f or
individuals with intellectual disabilities
(ICFs/IID) rates shall not be adjusted less
favorably than the average percentage -rate
reduction or increase applicable to the majority
of other provider groups.
g. (1) Effective October 1, 2019, if sufficient funding
is appropriated for a rate increase, a new
average rate for nursing facilities shall be
established. The rate shall be equal to the
statewide average cost as derived from audited
cost reports for SFY 2018, ending 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 existing base rate amount
shall continue to be distributed as a part
of the base rate in accordance with the
existing Medicaid State Plan, and
(b) to the extent the new rate exceeds the rate
effective before the effective date of this
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act October 1, 2019, fifty percent (50%) of
the resulting increase on October 1, 2019,
shall be allocated toward an increase of t he
existing base reimbursement rate and
distributed accordingly. The remaining
fifty percent (50%) of the increase shall be
allocated in accordance with the currently
approved 70/30 reimbursement rate
methodology as outlined in the existing
Medicaid State Plan.
(2) Any subsequent rate increases, as determined
based on the provisions set forth in this
subparagraph, shall be allocated in accordance
with the currently approved 70/30 reimbursement
rate methodology. When the case-mix component is
included in the rate methodology, fifty percent
(50%) of the amount allocated to direct care
shall be apportioned to the case -mix component.
The rate shall not exceed the upper payment limit
established by the Medicare rate equivalent
established by the federal CMS.
h. Effective October 1, 2019, in coordination with the
rate adjustments identified in the precedin g section,
a portion of the funds shall be utilized as follows:
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(1) effective October 1, 2019, the Oklahoma Health
Care Authority shall increase the personal n eeds
allowance for residents of nursing homes and
Intermediate Care Facilities for Individuals with
Intellectual Disabilities intermediate care
facilities for individuals with intellectual
disabilities (ICFs/IID) from Fifty Dollars
($50.00) per month to Se venty-five Dollars
($75.00) per month per resident. The increase
shall be funded by Medicaid nur sing 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 facility 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 statewide
toll-free, Senior-Info Line Senior Info-line for senior citizen
services to include assistance with or information on long -term care
services in this state.
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4. The Oklahoma Health Care Authority shall develop a nursing
facility cost-reporting system that reflects the most current costs
experienced by nursing and specialized facilities. The Oklahoma
Health Care Authority shall utilize the most current cost report
data to estimate costs in determining daily per diem rates.
5. The Oklahoma Health Care Authority shall pro vide access to
the detailed Medicaid payment audit adjustments and implement an
appeal process for disputed payment audit adjustments to the
provider. Additionally, the Oklahoma Health Care Authority shall
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 inclusion 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 Services for a waiver of
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the uniform requirement on health -care-related taxes as permitted by
Section 433.72 of 42 C.F.R., Section 433.72.
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.
SECTION 3. This act shall become effective July 1, 2025.
SECTION 4. It being immediately necessary for the preservation
of the public peace, health 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.
COMMITTEE REPORT BY: COMMITTEE ON APPROPRIATIONS
March 5, 2025 - DO PASS AS AMENDED BY CS