Oklahoma 2025 Regular Session

Oklahoma Senate Bill SB904 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
2	2
3		-	SENATE FLOOR VERSION - SB904 SFLR Page 1
4		-	(Bold face denotes Committee Amendments) 1
	3	+	Req. No. 1816 Page 1 1
5	4		2
6	5		3
7	6		4
8	7		5
9	8		6
10	9		7
11	10		8
12	11		9
13	12		10
14	13		11
15	14		12
16	15		13
17	16		14
18	17		15
19	18		16
20	19		17
21	20		18
22	21		19
23	22		20
24	23		21
25	24		22
26	25		23
27	26		24
28	27
29		-	SENATE FLOOR VERSION
30		-	March 5, 2025
	28	+	STATE OF OKLAHOMA
31	29
	30	+	1st Session of the 60th Legislature (2025)
32	31
33	32		COMMITTEE SUBSTITUTE
34	33		FOR
35		-	SENATE BILL ~~NO.~~ 904 By: Rosino of the Senate
	34	+	SENATE BILL 904 By: Rosino of the Senate
36	35
37	36		and
38	37
39	38		Stinson of the House
40	39
41	40
42	41
	42	+	COMMITTEE SUBSTITUTE
43	43
	44	+	An Act relating to the state Medicaid program;
	45	+	amending 56 O.S. 2021, Section 1011.5, which relates
	46	+	to the nursing facility incentive reimbursement rate
	47	+	plan; modifying payment qualification criteria;
	48	+	directing certain allocation of funds; creating
	49	+	certain staff retention initiative; specifying
	50	+	conditions for payment; conforming language; removing
	51	+	obsolete language; modifying certain method of
	52	+	reporting; amending 63 O .S. 2021, Section 1-1925.2,
	53	+	which relates to reimbursements from the Nursing
	54	+	Facility Quality of Care Fund; expanding purpose of
	55	+	certain advisory commit tee; adding certain case -mix
	56	+	component to payment methodology; directing certain
	57	+	allocations and apportionment; updating statutory
	58	+	language; providing an effective date; and declaring
	59	+	an emergency.
44	60
45		-	[ state Medicaid program - reimbursement rate plan -
46		-	qualification criteria - allocation - staff retention
47		-	initiative - payment - reporting - advisory committee
48		-	- apportionment - effective date -
49		-	emergency ]
50	61
51	62
52	63
53	64
54	65
55	66		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
56	67		SECTION 1. AMENDATORY 56 O.S. 2021, Section 1011.5, is
57	68		amended to read as follows:
58	69		Section 1011.5. A. 1. The Oklahoma Health Care Authority
59	70		shall develop an incentive reimbursement rate plan for nursing
60		-	facilities focused on improving resident outcomes and resident
61		-	quality of life.
62		-	2. Under the current rate methodology, the Authority shall
63		-	reserve Five Dollars ($5.00) per patient day designated for the
64		-	quality assurance component that nursing facilities can earn for
65		-	improvement or performance achievement of resident-centered outcomes
66	71
67		-	SENATE FLOOR VERSION - SB904 SFLR Page 2
68		-	(Bold face denotes Committee Amendments) 1
	72	+	Req. No. 1816 Page 2 1
69	73		2
70	74		3
71	75		4
72	76		5
73	77		6
74	78		7
75	79		8
76	80		9
77	81		10
78	82		11
79	83		12
80	84		13
81	85		14
82	86		15
83	87		16
84	88		17
85	89		18
86	90		19
87	91		20
88	92		21
89	93		22
90	94		23
91	95		24
92	96
	97	+	facilities focused on improving resident outcomes and resident
	98	+	quality of life.
	99	+	2. Under the current rate methodology, the Authority shall
	100	+	reserve Five Dollars ($5.00) per patient day designated for the
	101	+	quality assurance component that nursing facilities can earn f or
	102	+	improvement or performance achievement of resident-centered outcomes
93	103		metrics the long-stay quality measures ratings specified in
94	104		paragraph 4 of this subsection . To fund the quality assurance
95	105		component, Two Dollars ($2.00) shall be deducted from each nursin g
96	106		facility’s per diem rate, and matched with Three Dollars ($3.00) per
97	107		day funded by the Authority. Payments to nursing facilities that
98	108		achieve specific metrics qualify under paragraph 4 of this
99	109		subsection shall be treated as an “add back” to their net
100	110		reimbursement per diem. Dollar values assigned to each metric
101	111		rating shall be determined so that an avera ge of the five-dollar-
102	112		quality five-dollar quality incentive is made to qualifying nursing
103	113		facilities.
104	114		3. Pay-for-performance payments may be earned qua rterly and
105	115		based on facility-specific performance achievement of four equally -
106	116		weighted, Long-Stay Quality Measures as defined by the facility’s
107	117		long-stay quality measures rating in the nursing home Five -Star
108	118		Quality Rating System of the Centers for Medicare and Medicaid
109	119		Services (CMS).
110		-	4. Contracted Medicaid long -term care providers may earn
111		-	payment by achieving either five percent (5%) relative improvement
112		-	each quarter from baseline or by achieving the National Average
113		-	Benchmark or better for each individual quality metric at least a
114		-	two-star long-stay quality measures rating. Program funds shall be
115		-	allocated as follows:
116	120
117		-	SENATE FLOOR VERSION - SB904 SFLR Page 3
118		-	(Bold face denotes Committee Amendments) 1
	121	+	Req. No. 1816 Page 3 1
119	122		2
120	123		3
121	124		4
122	125		5
123	126		6
124	127		7
125	128		8
126	129		9
127	130		10
128	131		11
129	132		12
130	133		13
131	134		14
132	135		15
133	136		16
134	137		17
135	138		18
136	139		19
137	140		20
138	141		21
139	142		22
140	143		23
141	144		24
142	145
	146	+	4. Contracted Medicaid long -term care providers may earn
	147	+	payment by achieving either five percent (5%) relative improvement
	148	+	each quarter from baseline or by achieving the National Average
	149	+	Benchmark or better for each individ ual quality metric at least a
	150	+	two-star long-stay quality measures rating. Program funds shall be
	151	+	allocated as follows:
143	152		a. facilities with a two -star rating shall receive forty
144	153		percent (40%) of the per -day amount reserved for the
145	154		quality assurance comp onent per Medicaid patient day,
146	155		b. facilities with a three -star rating shall receive
147	156		sixty percent (60%) of the per-day amount reserved for
148	157		the quality assurance component per Medicaid patient
149	158		day,
150	159		c. facilities with a four -star rating shall receive
151	160		eighty percent (80%) of the per -day amount reserved
152	161		for the quality assurance component per Medicaid
153	162		patient day, and
154	163		d. facilities with a five -star rating shall receive one
155	164		hundred percent (100%) of the per -day amount reserved
156	165		for the quality assurance componen t per Medicaid
157	166		patient day.
158	167		5. As soon as practicable after receipt of any necessary
159	168		federal approval, and subject to appropriation of funds for a rate
160	169		increase to nursing facilities, facilities may earn up to Three
161		-	Dollars ($3.00) per Medicaid patient day by participating in an
162		-	optional staff retention initiative for Registered Nurses, Licensed
163		-	Practical Nurses, an d Certified Nurse Aides . Payments shall be
164		-	allocated at One Dollar and fifty cents ($1.50) per quality measure,
165		-	subject to the following conditions:
166	170
167		-	SENATE FLOOR VERSION - SB904 SFLR Page 4
168		-	(Bold face denotes Committee Amendments) 1
	171	+	Req. No. 1816 Page 4 1
169	172		2
170	173		3
171	174		4
172	175		5
173	176		6
174	177		7
175	178		8
176	179		9
177	180		10
178	181		11
179	182		12
180	183		13
181	184		14
182	185		15
183	186		16
184	187		17
185	188		18
186	189		19
187	190		20
188	191		21
189	192		22
190	193		23
191	194		24
192	195
	196	+	Dollars ($3.00) per Medicaid patient day by participating in an
	197	+	optional staff retention initiative for Registered Nurses, Licensed
	198	+	Practical Nurses, and Certified Nurse Aides . Payments shall be
	199	+	allocated at One Dollar and fifty cents ($1.50) per quality measure,
	200	+	subject to the following condi tions:
193	201		a. a minimum of sixty percent (60%), or a percentage
194	202		determined by the Authority, of Registered Nurse s and
195	203		Licensed Practical Nurses must be retained for not
196	204		less than twelve (12) months, with compliance measured
197	205		quarterly,
198	206		b. a minimum of fifty percent (50%), or a percentage
199	207		determined by the Authority, of Certified Nurse Aides
200	208		must be retained for not less than twelve (12) months,
201	209		with compliance measured quarterly,
202	210		c. participating facilities must submit an annual
203	211		retention plan to the Authority b y June 30 of each
204	212		year, and
205	213		d. participating facilities shall receive incentive
206	214		payments under this paragrap h during the first year to
207	215		support retention efforts. Beginning in the second
208	216		year and thereafter, facilities must meet program
209	217		metrics as provided by this paragraph to remain
210	218		eligible for payments.
211		-	6. Pursuant to federal Medicaid approval, any funds that rem ain
212		-	as a result of providers failing to meet the quality assurance
213		-	metrics after all the allocati ons under this subsection have been
214		-	made shall be pooled and redistributed to those who achieve the
215		-	quality assurance metrics each quarter qualify for payments under
216		-	this subsection. If federal approval is not received, any remaining
217	219
218		-	SENATE FLOOR VERSION - SB904 SFLR Page 5
219		-	(Bold face denotes Committee Amendments) 1
	220	+	Req. No. 1816 Page 5 1
220	221		2
221	222		3
222	223		4
223	224		5
224	225		6
225	226		7
226	227		8
227	228		9
228	229		10
229	230		11
230	231		12
231	232		13
232	233		14
233	234		15
234	235		16
235	236		17
236	237		18
237	238		19
238	239		20
239	240		21
240	241		22
241	242		23
242	243		24
243	244
	245	+	6. Pursuant to federal Medicaid approval, any funds that remain
	246	+	as a result of providers failing to meet the quality assurance
	247	+	metrics after all the allocations under this subsection have been
	248	+	made shall be pooled and redistributed to those who achieve the
	249	+	quality assurance metrics each quarter qualify for payments under
	250	+	this subsection. If federal approval is not received, any remaining
244	251		funds shall be deposited in the Nursing Facility Quality of Care
245	252		Fund authorized in Section 2002 of this title.
246	253		6. The Authority shall establish an advisory group with
247	254		consumer, provider and state agency representation to recommend
248	255		quality measures to be included in the pay -for-performance program
249	256		and to provide feedback on program performance and recommendations
250	257		for improvement. The quality measures shall be reviewed annuall y
251	258		and shall be subject to change every three (3) years through the
252	259		agency’s promulgation of rules. The Authority shall insure
253	260		adherence to the followin g criteria in determining the quality
254	261		measures:
255	262		a. provides direct benefit to resident care outcomes,
256	263		b. applies to long-stay residents, and
257	264		c. addresses a need for quality improvement using the
258	265		Centers for Medicare and Medicaid Services (CMS)
259	266		ranking for Oklahoma.
260		-	7. The Authority shall begin the pay -for-performance program
261		-	focusing on improving the following C MS nursing home quality
262		-	measures:
263		-	a. percentage of long-stay, high-risk residents with
264		-	pressure ulcers,
265		-	b. percentage of long-stay residents who lose too much
266		-	weight,
267	267
268		-	SENATE FLOOR VERSION - SB904 SFLR Page 6
269		-	(Bold face denotes Committee Amendments) 1
	268	+	Req. No. 1816 Page 6 1
270	269		2
271	270		3
272	271		4
273	272		5
274	273		6
275	274		7
276	275		8
277	276		9
278	277		10
279	278		11
280	279		12
281	280		13
282	281		14
283	282		15
284	283		16
285	284		17
286	285		18
287	286		19
288	287		20
289	288		21
290	289		22
291	290		23
292	291		24
293	292
	293	+	7. The Authority shall begin the pay -for-performance program
	294	+	focusing on improving the follow ing CMS nursing home quality
	295	+	measures:
	296	+	a. percentage of long-stay, high-risk residents with
	297	+	pressure ulcers,
	298	+	b. percentage of long-stay residents who lo se too much
	299	+	weight,
294	300		c. percentage of long-stay residents with a urinary tract
295	301		infection, and
296	302		d. percentage of long-stay residents who got an
297	303		antipsychotic medication.
298	304		B. The Oklahoma Health Care Authority shall negotiate with the
299	305		Centers for Medicare and Medicaid Services to include the authority
300	306		to base provider reimbursement rates for nursing facilities o n the
301	307		criteria specified in subsection A of this section.
302	308		C. The Oklahoma Health Care Authority shall audit the program
303	309		to ensure transparency and inte grity.
304	310		D. The Oklahoma Health Care Authority shall provide
305	311		electronically submit an annual report of the incentive
306	312		reimbursement rate plan to the Governor, the Speaker of the House of
307	313		Representatives, and the President Pro Tempore of the Senate by
308	314		December 31 of each year. The report shall include, but not be
309	315		limited to, an analysis of the previous fiscal year including
310	316		incentive payments, ratings, and notable trends.
311		-	SECTION 2. AMENDATORY 63 O.S. 2021, Section 1 -1925.2, is
312		-	amended to read as follows:
313		-	Section 1-1925.2. A. The Oklahoma Health Care Authority shall
314		-	fully recalculate and reimburse nursing facilities and Intermediate
315		-	Care Facilities for Individuals with Intellectual D isabilities
316		-	intermediate care facilities for individuals with intellectual
317		-	disabilities (ICFs/IID) from the Nursing Facility Quality of Care
318	317
319		-	SENATE FLOOR VERSION - SB904 SFLR Page 7
320		-	(Bold face denotes Committee Amendments) 1
	318	+	Req. No. 1816 Page 7 1
321	319		2
322	320		3
323	321		4
324	322		5
325	323		6
326	324		7
327	325		8
328	326		9
329	327		10
330	328		11
331	329		12
332	330		13
333	331		14
334	332		15
335	333		16
336	334		17
337	335		18
338	336		19
339	337		20
340	338		21
341	339		22
342	340		23
343	341		24
344	342
	343	+	SECTION 2. AMENDATORY 63 O.S. 2021, Section 1 -1925.2, is
	344	+	amended to read as follows:
	345	+	Section 1-1925.2. A. The Oklahoma Health Care Authority shall
	346	+	fully recalculate and reimburse nursing facilities and Intermediate
	347	+	Care Facilities for Individuals with Intellectual Disabilities
	348	+	intermediate care facilities for i ndividuals with intellectual
	349	+	disabilities (ICFs/IID) from the Nursing Facility Quality of Care
345	350		Fund beginning October 1, 2000, the average actual, audited costs
346	351		reflected in previously submitted cost reports for the cost -
347	352		reporting period that began July 1, 199 8, and ended June 30, 1999,
348	353		inflated by the federally published inflationary factors for the two
349	354		(2) years appropriate to reflect present -day costs at the midpoint
350	355		of the July 1, 2000, through June 30, 2001, rate year.
351	356		1. The recalculations provided f or in this subsection shall be
352	357		consistent for both nursing facilities and Intermediate Care
353	358		Facilities for Individuals with Intellectual Disabilities
354	359		intermediate care facilities for individuals with intellectual
355	360		disabilities (ICFs/IID).
356	361		2. The recalculated r eimbursement rate shall be implemented
357	362		September 1, 2000.
358	363		B. 1. From September 1, 2000, through August 31, 2001, all
359	364		nursing facilities subject to the Nursing Home Care Act, in addition
360	365		to other state and federal requirements related to the staffing of
361		-	nursing facilities, shall maintain the following minimum direct -
362		-	care-staff-to-resident ratios:
363		-	a. from 7:00 a.m. to 3:00 p.m., one direct -care staff to
364		-	every eight residents, or major fraction thereof,
365		-	b. from 3:00 p.m. to 11:00 p.m., one direct -care staff to
366		-	every twelve residents, or major fraction thereof, and
367		-	c. from 11:00 p.m. to 7:00 a.m., one direct -care staff to
368		-	every seventeen residents, or major fraction thereof.
369	366
370		-	SENATE FLOOR VERSION - SB904 SFLR Page 8
371		-	(Bold face denotes Committee Amendments) 1
	367	+	Req. No. 1816 Page 8 1
372	368		2
373	369		3
374	370		4
375	371		5
376	372		6
377	373		7
378	374		8
379	375		9
380	376		10
381	377		11
382	378		12
383	379		13
384	380		14
385	381		15
386	382		16
387	383		17
388	384		18
389	385		19
390	386		20
391	387		21
392	388		22
393	389		23
394	390		24
395	391
	392	+	nursing facilities, shall maintain the following minimum direct -
	393	+	care-staff-to-resident ratios:
	394	+	a. from 7:00 a.m. to 3:00 p.m., one direct -care staff to
	395	+	every eight residents, or major fraction thereof,
	396	+	b. from 3:00 p.m. to 11:00 p.m., one direct -care staff to
	397	+	every twelve residents, or major fraction thereof, and
	398	+	c. from 11:00 p.m. to 7:00 a.m., one direct -care staff to
	399	+	every seventeen residents, or major fraction thereof.
396	400		2. From September 1, 2001, through August 31, 2003, nursing
397	401		facilities subject to the Nursing Home Care Act and Intermediate
398	402		Care Facilities for Individuals with Intellectual Disabilities
399	403		intermediate care facilities for individuals with intellectual
400	404		disabilities (ICFs/IID) with seventeen or more beds shall maintain,
401	405		in addition to other s tate and federal requirements related to the
402	406		staffing of nursing facilities, the following minimum direct -care-
403	407		staff-to-resident ratios:
404	408		a. from 7:00 a.m. to 3:00 p.m., one direct -care staff to
405	409		every seven residents, or major fraction thereof,
406	410		b. from 3:00 p.m. to 11:00 p.m., one direct -care staff to
407	411		every ten residents, or major fraction thereof, and
408	412		c. from 11:00 p.m. to 7:00 a.m., one direct -care staff to
409	413		every seventeen residents, or major fraction thereof.
410	414		3. On and after October 1, 2019, nursing faci lities subject to
411	415		the Nursing Home Care Act and Intermediate Care Facilities for
412		-	Individuals with Intellectua l Disabilities intermediate care
413		-	facilities for individuals with intellectual disabilities (ICFs/IID)
414		-	with seventeen or more beds shall maintain, in addition to other
415		-	state and federal requirements related to the staffing of nursing
416		-	facilities, the followi ng minimum direct-care-staff-to-resident
417		-	ratios:
418		-	a. from 7:00 a.m. to 3:00 p.m., one direct -care staff to
419		-	every six residents, or major fraction thereof,
420	416
421		-	SENATE FLOOR VERSION - SB904 SFLR Page 9
422		-	(Bold face denotes Committee Amendments) 1
	417	+	Req. No. 1816 Page 9 1
423	418		2
424	419		3
425	420		4
426	421		5
427	422		6
428	423		7
429	424		8
430	425		9
431	426		10
432	427		11
433	428		12
434	429		13
435	430		14
436	431		15
437	432		16
438	433		17
439	434		18
440	435		19
441	436		20
442	437		21
443	438		22
444	439		23
445	440		24
446	441
	442	+	Individuals with Intellectual Disabilities intermediate care
	443	+	facilities for individuals with intellectual disabilities (ICFs/IID)
	444	+	with seventeen or more beds shall maintai n, in addition to other
	445	+	state and federal requirements related to the staffing of nursing
	446	+	facilities, the following minimum direct -care-staff-to-resident
	447	+	ratios:
	448	+	a. from 7:00 a.m. to 3:00 p.m., one direct -care staff to
	449	+	every six residents, or major fraction th ereof,
447	450		b. from 3:00 p.m. to 11:00 p.m., one direct -care staff to
448	451		every eight residents, or major fraction thereof, and
449	452		c. from 11:00 p.m. to 7:00 a.m., one direct -care staff to
450	453		every fifteen residents, or major fraction thereof.
451	454		4. Effective immediate ly, facilities shall have the option of
452	455		varying the starting times for the eight -hour shifts by one (1) hour
453	456		before or one (1) hour after the times designated in this section
454	457		without overlapping shifts.
455	458		5. a. On and after January 1, 2020, a facility may implem ent
456	459		twenty-four-hour-based staff scheduling; provided,
457	460		however, such facility shall continue to maintain a
458	461		direct-care service rate of at least two and nine
459	462		tenths nine-tenths (2.9) hours of direct -care service
460	463		per resident per day, the same to be calc ulated based
461	464		on average direct care staff maintained over a twenty -
462	465		four-hour period.
463		-	b. At no time shall direct -care staffing ratios in a
464		-	facility with twenty -four-hour-based staff-scheduling
465		-	privileges fall below one direct -care staff to every
466		-	fifteen residents or major fraction thereof, and at
467		-	least two direct-care staff shall be on duty and awake
468		-	at all times.
469	466
470		-	SENATE FLOOR VERSION - SB904 SFLR Page 10
471		-	(Bold face denotes Committee Amendments) 1
	467	+	Req. No. 1816 Page 10 1
472	468		2
473	469		3
474	470		4
475	471		5
476	472		6
477	473		7
478	474		8
479	475		9
480	476		10
481	477		11
482	478		12
483	479		13
484	480		14
485	481		15
486	482		16
487	483		17
488	484		18
489	485		19
490	486		20
491	487		21
492	488		22
493	489		23
494	490		24
495	491
	492	+	b. At no time shall dir ect-care staffing ratios in a
	493	+	facility with twenty -four-hour-based staff-scheduling
	494	+	privileges fall below one direct -care staff to every
	495	+	fifteen residents or major fraction thereof, and at
	496	+	least two direct-care staff shall be on duty and awake
	497	+	at all times.
496	498		c. As used in this paragraph, “twenty-four-hour-based-
497	499		scheduling” “twenty-four-hour-based staff scheduling ”
498	500		means maintaining:
499	501		(1) a direct-care-staff-to-resident ratio based on
500	502		overall hours of direct -care service per resident
501	503		per day rate of not less t han two and ninety one-
502	504		hundredths (2.90) two and nine-tenths (2.9) hours
503	505		per day,
504	506		(2) a direct-care-staff-to-resident ratio of at least
505	507		one direct-care staff person on duty to every
506	508		fifteen residents or major fraction thereof at
507	509		all times, and
508	510		(3) at least two direct-care staff persons on duty
509	511		and awake at all times.
510	512		6. a. On and after January 1, 2004, the State Department of
511	513		Health shall require a fa cility to maintain the shift -
512	514		based, staff-to-resident ratios provided in paragraph
513	515		3 of this subsection if t he facility has been
514		-	determined by the Department to be deficient with
515		-	regard to:
516		-	(1) the provisions of paragraph 3 of this subsection,
517		-	(2) fraudulent reporting of staffing on the Quality
518		-	of Care Report, or
519	516
520		-	SENATE FLOOR VERSION - SB904 SFLR Page 11
521		-	(Bold face denotes Committee Amendments) 1
	517	+	Req. No. 1816 Page 11 1
522	518		2
523	519		3
524	520		4
525	521		5
526	522		6
527	523		7
528	524		8
529	525		9
530	526		10
531	527		11
532	528		12
533	529		13
534	530		14
535	531		15
536	532		16
537	533		17
538	534		18
539	535		19
540	536		20
541	537		21
542	538		22
543	539		23
544	540		24
545	541
	542	+	determined by the Department to be deficient with
	543	+	regard to:
	544	+	(1) the provisions of paragraph 3 of this subsection,
	545	+	(2) fraudulent reporting of staffing on the Quality
	546	+	of Care Report, or
546	547		(3) a complaint or survey investigation that has
547	548		determined substandard quality of care as a
548	549		result of insufficient staffing.
549	550		b. The Department shall require a facility described in
550	551		subparagraph a of this paragraph to achieve and
551	552		maintain the shift-based, staff-to-resident ratios
552	553		provided in paragraph 3 of this subsection for a
553	554		minimum of three (3) months before being considered
554	555		eligible to implement twenty -four-hour-based staff
555	556		scheduling as defined in subparagraph c of paragraph 5
556	557		of this subsection.
557	558		c. Upon a subsequent determination by the Department that
558	559		the facility has achieved and maintained for at least
559	560		three (3) months the shift -based, staff-to-resident
560	561		ratios described in paragraph 3 of th is subsection,
561	562		and has corrected any deficiency described in
562	563		subparagraph a of this paragraph, the Departmen t shall
563	564		notify the facility of its eligibility to implement
564	565		twenty-four-hour-based staff-scheduling privileges.
565		-	7. a. For facilities that utilize twenty -four-hour-based
566		-	staff-scheduling privileges, the Department shall
567		-	monitor and evaluate facility compliance w ith the
568		-	twenty-four-hour-based staff-scheduling staffing
569		-	provisions of paragraph 5 of this subsec tion through
570	566
571		-	SENATE FLOOR VERSION - SB904 SFLR Page 12
572		-	(Bold face denotes Committee Amendments) 1
	567	+	Req. No. 1816 Page 12 1
573	568		2
574	569		3
575	570		4
576	571		5
577	572		6
578	573		7
579	574		8
580	575		9
581	576		10
582	577		11
583	578		12
584	579		13
585	580		14
586	581		15
587	582		16
588	583		17
589	584		18
590	585		19
591	586		20
592	587		21
593	588		22
594	589		23
595	590		24
596	591
	592	+	7. a. For facilities that utilize twenty -four-hour-based
	593	+	staff-scheduling privileges, the Department shall
	594	+	monitor and evaluate facility compliance with the
	595	+	twenty-four-hour-based staff-scheduling staffing
	596	+	provisions of paragraph 5 of this subsection through
597	597		reviews of monthly staffing repor ts, results of
598	598		complaint investigations and inspections.
599	599		b. If the Department identifies any quality -of-care
600	600		problems related to insufficient staffing in such
601	601		facility, the Department shall issue a directed plan
602	602		of correction to the facility found to be out of
603	603		compliance with the provisions of this subsection.
604	604		c. In a directed plan of correction, the Department shall
605	605		require a facility described in subparagraph b of this
606	606		paragraph to maintain shift -based, staff-to-resident
607	607		ratios for the following periods o f time:
608	608		(1) the first determination shall require that shift -
609	609		based, staff-to-resident ratios be maintained
610	610		until full compliance is achieved,
611	611		(2) the second determination within a two -year period
612	612		shall require that shift -based, staff-to-resident
613	613		ratios be maintained for a minimum period of
614	614		twelve (12) months, and
615		-	(3) the third determination within a two -year period
616		-	shall require that shift -based, staff-to-resident
617		-	ratios be maintained. The facility may apply fo r
618		-	permission to use twenty -four-hour staffing
619		-	methodology after two (2) years.
620	615
621		-	SENATE FLOOR VERSION - SB904 SFLR Page 13
622		-	(Bold face denotes Committee Amendments) 1
	616	+	Req. No. 1816 Page 13 1
623	617		2
624	618		3
625	619		4
626	620		5
627	621		6
628	622		7
629	623		8
630	624		9
631	625		10
632	626		11
633	627		12
634	628		13
635	629		14
636	630		15
637	631		16
638	632		17
639	633		18
640	634		19
641	635		20
642	636		21
643	637		22
644	638		23
645	639		24
646	640
	641	+	(3) the third determination within a two -year period
	642	+	shall require that shift -based, staff-to-resident
	643	+	ratios be maintained. The facility may apply for
	644	+	permission to use twenty -four-hour staffing
	645	+	methodology after two (2) years.
647	646		C. Effective September 1, 2002, facilities shall post the names
648	647		and titles of direct-care staff on duty each day in a conspicuous
649	648		place, including the name and title of the supervising nurse.
650	649		D. The State Commissioner of Heal th shall promulgate rules
651	650		prescribing staffing requirements for Intermediate Care Facilities
652	651		for Individuals with Intellectual Disabilities intermediate care
653	652		facilities for individuals with intellectual disabilities serving
654	653		six or fewer clients (ICFs/I ID-6) and for Intermediate Care
655	654		Facilities for Individuals with Intellectual Disabilities
656	655		intermediate care facilities for individuals with intellectual
657	656		disabilities serving sixteen or fewer clients (ICFs/IID -16).
658	657		E. Facilities shall have the right to appeal and to the
659	658		informal dispute resolution process with regard to penalties and
660	659		sanctions imposed due to staffing noncompliance.
661	660		F. 1. When the state Medicaid program reimbursement rate
662	661		reflects the sum of Ninety -four Dollars and eleven cents ($94.11),
663	662		plus the increases in actual audited costs over and above the actual
664	663		audited costs reflected in the cost repo rts submitted for the most
665	664		current cost-reporting period and the costs estimated by the
666		-	Oklahoma Health Care Authority to increase the direct -care, flexible
667		-	staff-scheduling staffing level from two and eighty -six one-
668		-	hundredths (2.86) hours per day per occupied bed to three and two -
669		-	tenths (3.2) hours per day per occupied bed, all nursing facilities
670		-	subject to the provisions of the Nursing Home Care Act and
671	665
672		-	SENATE FLOOR VERSION - SB904 SFLR Page 14
673		-	(Bold face denotes Committee Amendments) 1
	666	+	Req. No. 1816 Page 14 1
674	667		2
675	668		3
676	669		4
677	670		5
678	671		6
679	672		7
680	673		8
681	674		9
682	675		10
683	676		11
684	677		12
685	678		13
686	679		14
687	680		15
688	681		16
689	682		17
690	683		18
691	684		19
692	685		20
693	686		21
694	687		22
695	688		23
696	689		24
697	690
	691	+	Oklahoma Health Care Authority to increase the direct -care, flexible
	692	+	staff-scheduling staffing level from two and eighty -six one-
	693	+	hundredths (2.86) hours per day per occupied bed to three and two -
	694	+	tenths (3.2) hours per day per occupied bed, all nursing facilities
	695	+	subject to the provisions of the Nursing Home Care Ac t and
698	696		Intermediate Care Facilities for Individuals with Intellectual
699	697		Disabilities intermediate care faciliti es for individuals with
700	698		intellectual disabilities (ICFs/IID) with seventeen or more beds, in
701	699		addition to other state and federal requirements related to the
702	700		staffing of nursing facilities, shall maintain direct -care, flexible
703	701		staff-scheduling staffing levels based on an overall three and two -
704	702		tenths (3.2) hours per day per occupied bed.
705	703		2. When the state Medicaid program reimbursement rate reflects
706	704		the sum of Ninety-four Dollars and eleven cents ($94.11), plus the
707	705		increases in actual audited costs over and above the actual audited
708	706		costs reflected in the cost reports submitted for the most current
709	707		cost-reporting period and the costs estimated by the Oklahom a Health
710	708		Care Authority to increase the direct -care flexible staff-scheduling
711	709		staffing level from three and two -tenths (3.2) hours per day per
712	710		occupied bed to three and eight -tenths (3.8) hours per day per
713	711		occupied bed, all nursing facilities subject t o the provisions of
714	712		the Nursing Home Care Act and Intermediate Care Facilities for
715	713		Individuals with Intellec tual Disabilities intermediate care
716	714		facilities for individuals with intellectual disabilities (ICFs/IID)
717		-	with seventeen or more beds, in addition to other state and federal
718		-	requirements related to the staffing of nursing facilities, shall
719		-	maintain direct-care, flexible staff-scheduling staffing levels
720		-	based on an overall three and eight -tenths (3.8) hours per day per
721		-	occupied bed.
722	715
723		-	SENATE FLOOR VERSION - SB904 SFLR Page 15
724		-	(Bold face denotes Committee Amendments) 1
	716	+	Req. No. 1816 Page 15 1
725	717		2
726	718		3
727	719		4
728	720		5
729	721		6
730	722		7
731	723		8
732	724		9
733	725		10
734	726		11
735	727		12
736	728		13
737	729		14
738	730		15
739	731		16
740	732		17
741	733		18
742	734		19
743	735		20
744	736		21
745	737		22
746	738		23
747	739		24
748	740
	741	+	with seventeen or more beds, in addition to oth er state and federal
	742	+	requirements related to the staffing of nursing facilities, shall
	743	+	maintain direct-care, flexible staff -scheduling staffing levels
	744	+	based on an overall three and eight -tenths (3.8) hours per day per
	745	+	occupied bed.
749	746		3. When the state M edicaid program reimbursement rate reflects
750	747		the sum of Ninety-four Dollars and eleven cents ($94.11), plus t he
751	748		increases in actual audited costs over and above the actual audited
752	749		costs reflected in the cost reports submitted for the most current
753	750		cost-reporting period and the costs estimated by the Oklahoma Health
754	751		Care Authority to increase the direct -care, flexible staff -
755	752		scheduling staffing level from three and eight -tenths (3.8) hours
756	753		per day per occupied bed to four and one -tenth (4.1) hours per day
757	754		per occupied bed, all nursing facilities subject to the provisions
758	755		of the Nursing Home Care Act and Intermediate Care Facilities for
759	756		Individuals with Intellectual Disabilities intermediate care
760	757		facilities for individuals with intellectual disabilities (ICFs/IID)
761	758		with seventeen or more beds, in addition to other state and federal
762	759		requirements related to the staffing of nursing facilities, shall
763	760		maintain direct-care, flexible staff -scheduling staffing levels
764	761		based on an overall four and one -tenth (4.1) hours per d ay per
765	762		occupied bed.
766	763		4. The Commissioner shall promulgate rules for shift -based,
767	764		staff-to-resident ratios for noncompliant facilities denoting the
768		-	incremental increases reflected in direct -care, flexible staff -
769		-	scheduling staffing levels.
770		-	5. In the event that the state Medicaid program reimbursement
771		-	rate for facilities subject to the Nursing Home Care Act , and
772		-	Intermediate Care Facilities for Individuals with Intellectual
773	765
774		-	SENATE FLOOR VERSION - SB904 SFLR Page 16
775		-	(Bold face denotes Committee Amendments) 1
	766	+	Req. No. 1816 Page 16 1
776	767		2
777	768		3
778	769		4
779	770		5
780	771		6
781	772		7
782	773		8
783	774		9
784	775		10
785	776		11
786	777		12
787	778		13
788	779		14
789	780		15
790	781		16
791	782		17
792	783		18
793	784		19
794	785		20
795	786		21
796	787		22
797	788		23
798	789		24
799	790
	791	+	incremental increases reflected in direct -care, flexible staff -
	792	+	scheduling staffing levels.
	793	+	5. In the event that the state Medicaid program reimbursement
	794	+	rate for facilities subject to the Nursing Home Care Act , and
	795	+	Intermediate Care Facilities for Individuals with Intellectual
800	796		Disabilities intermediate care facilities for individuals with
801	797		intellectual disabilit ies (ICFs/IID) having seventeen or more beds
802	798		is reduced below actual audited costs, the requirements for sta ffing
803	799		ratio levels shall be adjusted to the appropriate levels provided in
804	800		paragraphs 1 through 4 of this subsection.
805	801		G. For purposes of this subsection section:
806	802		1. “Direct-care staff” means any nursing or therapy staff who
807	803		provides direct, hands -on care to residents in a nursing facility;
808	804		2. Prior to September 1, 2003, activity and social services
809	805		staff who are not providing direct, hands -on care to residents may
810	806		be included in the direct -care-staff-to-resident ratio in any shift.
811	807		On and after Septembe r 1, 2003, such persons shall not be included
812	808		in the direct-care-staff-to-resident ratio, regardless of their
813	809		licensure or certification status; and
814	810		3. The administrator shall not be counted in the direct -care-
815	811		staff-to-resident ratio regardless of the administrator ’s licensure
816	812		or certification status.
817	813		H. 1. The Oklahoma Health Care Authority shall require all
818	814		nursing facilities subject to the provi sions of the Nursing Home
819		-	Care Act and Intermediate Care Facilities for Individuals with
820		-	Intellectual Disabilitie s intermediate care facilities for
821		-	individuals with intellectual disabilities (ICFs/IID) with seventeen
822		-	or more beds to submit a monthly report on staffing ratios on a form
823		-	that the Authority shall develop.
824	815
825		-	SENATE FLOOR VERSION - SB904 SFLR Page 17
826		-	(Bold face denotes Committee Amendments) 1
	816	+	Req. No. 1816 Page 17 1
827	817		2
828	818		3
829	819		4
830	820		5
831	821		6
832	822		7
833	823		8
834	824		9
835	825		10
836	826		11
837	827		12
838	828		13
839	829		14
840	830		15
841	831		16
842	832		17
843	833		18
844	834		19
845	835		20
846	836		21
847	837		22
848	838		23
849	839		24
850	840
	841	+	Care Act and Intermediate Care Facilities for Individuals with
	842	+	Intellectual Disabilities intermediate care facilities for
	843	+	individuals with intellectual disabilities (ICFs/IID) with seventeen
	844	+	or more beds to submit a monthly report on staffing ratios on a form
	845	+	that the Authority shall develop.
851	846		2. The report shall document the extent to which such
852	847		facilities are meeting or are failing to meet the minimum direct -
853	848		care-staff-to-resident ratios specified by this section. Such
854	849		report shall be available to the public upon request.
855	850		3. The Authority may assess administrative penalties for the
856	851		failure of any facility to submit the report as required by the
857	852		Authority. Provided, however:
858	853		a. administrative penalties shall not accrue until the
859	854		Authority notifies the facility in writing that the
860	855		report was not timely submitted as required, and
861	856		b. a minimum of a one-day penalty shall be assessed in
862	857		all instances.
863	858		4. Administrative penalties shall not be assessed for
864	859		computational errors made in preparing the report.
865	860		5. Monies collected from administrative penalties shall be
866	861		deposited in the Nursing F acility Quality of Care Fund established
867	862		in Section 2002 of Title 56 of the Oklahoma Statutes and utilized
868	863		for the purposes specified in the Oklahoma Healthcare Initiative Act
869	864		such section.
870		-	I. 1. All entities regulated by this state that provide long -
871		-	term care services shall utilize a single assessment tool to
872		-	determine client services needs. The tool s hall be developed by the
873		-	Oklahoma Health Care Authority in consultation with the State
874		-	Department of Health.
875	865
876		-	SENATE FLOOR VERSION - SB904 SFLR Page 18
877		-	(Bold face denotes Committee Amendments) 1
	866	+	Req. No. 1816 Page 18 1
878	867		2
879	868		3
880	869		4
881	870		5
882	871		6
883	872		7
884	873		8
885	874		9
886	875		10
887	876		11
888	877		12
889	878		13
890	879		14
891	880		15
892	881		16
893	882		17
894	883		18
895	884		19
896	885		20
897	886		21
898	887		22
899	888		23
900	889		24
901	890
	891	+	I. 1. All entities regulated by this state that provide long -
	892	+	term care services shall utilize a single assessment tool to
	893	+	determine client services needs. The tool shall be developed by the
	894	+	Oklahoma Health Care Authority in consultation with the State
	895	+	Department of Health.
902	896		2. a. The Oklahoma Nursing Facility Funding A dvisory
903	897		Committee is hereby created and shall consist of the
904	898		following:
905	899		(1) four members selected by the Oklahoma Association
906	900		of Health Care Providers Care Providers Oklahoma
907	901		or its successor organization ,
908	902		(2) three members selected by the Oklahoma
909	903		Association of Homes and Services for the Aging
910	904		LeadingAge Oklahoma or its successor
911	905		organization, and
912	906		(3) two members selected by the State Council on
913	907		Aging State Council on Aging and Adult Protective
914	908		Services.
915	909		The Chair chair shall be elected by the committee. No
916	910		state employees may be appointed to serve.
917	911		b. The purpose of the advisory committee will shall be
918	912		to:
919	913		(1) develop a new methodology for calculating state
920	914		Medicaid program reimbursements to nursing
921		-	facilities by implementing facility -specific
922		-	rates based on expenditures relating to direct
923		-	care staffing, and
924	915
925		-	SENATE FLOOR VERSION - SB904 SFLR Page 19
926		-	(Bold face denotes Committee Amendments) 1
	916	+	Req. No. 1816 Page 19 1
927	917		2
928	918		3
929	919		4
930	920		5
931	921		6
932	922		7
933	923		8
934	924		9
935	925		10
936	926		11
937	927		12
938	928		13
939	929		14
940	930		15
941	931		16
942	932		17
943	933		18
944	934		19
945	935		20
946	936		21
947	937		22
948	938		23
949	939		24
950	940
	941	+	facilities by implementing facility -specific
	942	+	rates based on expenditures relating to direct
	943	+	care staffing, and
951	944		(2) recommend changes to the incentive reimbursement
952	945		rate plan created under Section 1011.5 of Title
953	946		56 of the Oklahoma Statutes .
954	947		No nursing home will shall receive less than the
955	948		current rate at the time of implementation of
956	949		facility-specific rates pursuant to division 1 of this
957	950		subparagraph.
958	951		c. The advisory committee shall be staffed and advised by
959	952		the Oklahoma Health Care Authority.
960	953		d. The new methodology will shall be submitted for
961	954		approval to the Board of the Oklahoma Health Care
962	955		Authority Board by January 15, 2005, and shall be
963	956		finalized by July 1, 2005. The new methodology will
964	957		shall apply only to new funds that become available
965	958		for Medicaid nursing facility reimbursement after the
966	959		methodology of this paragraph has been finalized.
967	960		Existing funds paid to nursing homes will shall not be
968	961		subject to the methodology of this paragraph. The
969	962		methodology as outlined in this paragraph will shall
970	963		only be applied to any new funding for nursing
971		-	facilities appropriated above and beyond the funding
972		-	amounts effective on January 15, 2005.
973		-	e. The new methodology shall divide the payment into two
974		-	components:
975	964
976		-	SENATE FLOOR VERSION - SB904 SFLR Page 20
977		-	(Bold face denotes Committee Amendments) 1
	965	+	Req. No. 1816 Page 20 1
978	966		2
979	967		3
980	968		4
981	969		5
982	970		6
983	971		7
984	972		8
985	973		9
986	974		10
987	975		11
988	976		12
989	977		13
990	978		14
991	979		15
992	980		16
993	981		17
994	982		18
995	983		19
996	984		20
997	985		21
998	986		22
999	987		23
1000	988		24
1001	989
	990	+	facilities appropriated above and beyond the funding
	991	+	amounts effective on January 15, 2005.
	992	+	e. The new methodology shall divide the payment into two
	993	+	components:
1002	994		(1) direct care which includes allowable costs for
1003	995		registered nurses Registered Nurses, licensed
1004	996		practical nurses Licensed Practical Nurses ,
1005	997		certified medication aides Certified Medication
1006	998		Aides and certified nurse aides Certified Nurse
1007	999		Aides. The direct care component of the rate
1008	1000		shall be a facility-specific rate, directly
1009	1001		related to each facility ’s actual expenditures on
1010	1002		direct care, and
1011	1003		(2) other costs.
1012	1004		f. The Oklahoma Health Care Authority, in calculating the
1013	1005		base year prospective direct care rate compone nt,
1014	1006		shall use the following criteria:
1015	1007		(1) to construct an array of facility per diem
1016	1008		allowable expenditures on direct care, the
1017	1009		Authority shall use the most recent data
1018	1010		available. The limit o n this array shall be no
1019	1011		less than the ninetieth percentile,
1020	1012		(2) each facility’s direct care base-year component
1021	1013		of the rate shall be the lesser of the facility ’s
1022		-	allowable expenditures on direct care or the
1023		-	limit,
1024		-	(3) as soon as practicable after receipt of any
1025		-	necessary federal approval, and subject to
1026	1014
1027		-	SENATE FLOOR VERSION - SB904 SFLR Page 21
1028		-	(Bold face denotes Committee Amendments) 1
	1015	+	Req. No. 1816 Page 21 1
1029	1016		2
1030	1017		3
1031	1018		4
1032	1019		5
1033	1020		6
1034	1021		7
1035	1022		8
1036	1023		9
1037	1024		10
1038	1025		11
1039	1026		12
1040	1027		13
1041	1028		14
1042	1029		15
1043	1030		16
1044	1031		17
1045	1032		18
1046	1033		19
1047	1034		20
1048	1035		21
1049	1036		22
1050	1037		23
1051	1038		24
1052	1039
	1040	+	allowable expenditures on direct care or the
	1041	+	limit,
	1042	+	(3) as soon as practicable after receipt of any
	1043	+	necessary federal approval, and subject to
1053	1044		appropriation of funds for a rate increase to
1054	1045		nursing facilities, the Authority shall
1055	1046		incorporate a case-mix component into the payment
1056	1047		rate methodology for nursing facilities. The
1057	1048		inclusion of the case -mix component shall occur
1058	1049		upon the availability and analysis of th e
1059	1050		necessary data by the Authority. Appropriated
1060	1051		funds shall be allocated as follows:
1061	1052		(a) fifty percent (50%) of funds shall be
1062	1053		designated for the case -mix component, and
1063	1054		(b) the remaining fifty percent (50%) of funds
1064	1055		shall be allocated to the base rate
1065	1056		component,
1066	1057		(4) other rate components shall be determined by the
1067	1058		Oklahoma Nursing Facility Funding Advisory
1068	1059		Committee or the Authority in accordance with
1069	1060		federal regulations and requirements,
1070	1061		(4) (5) prior to July 1, 2020, the Authority shall
1071	1062		seek federal approval to calculate the upper
1072	1063		payment limit under the authority of CMS the
1073		-	Centers for Medicare and Medicaid S ervices (CMS)
1074		-	utilizing the Medicare equivalent payment rate,
1075		-	and
1076	1064
1077		-	SENATE FLOOR VERSION - SB904 SFLR Page 22
1078		-	(Bold face denotes Committee Amendments) 1
	1065	+	Req. No. 1816 Page 22 1
1079	1066		2
1080	1067		3
1081	1068		4
1082	1069		5
1083	1070		6
1084	1071		7
1085	1072		8
1086	1073		9
1087	1074		10
1088	1075		11
1089	1076		12
1090	1077		13
1091	1078		14
1092	1079		15
1093	1080		16
1094	1081		17
1095	1082		18
1096	1083		19
1097	1084		20
1098	1085		21
1099	1086		22
1100	1087		23
1101	1088		24
1102	1089
	1090	+	Centers for Medicare and Medicaid Services (CMS)
	1091	+	utilizing the Medicare equivalent payment rate,
	1092	+	and
1103	1093		(5) (6) if Medicaid payment rates to providers are
1104	1094		adjusted, nursing home rates a nd Intermediate
1105	1095		Care Facilities for Individuals with Intellectual
1106	1096		Disabilities intermediate care facilit ies for
1107	1097		individuals with intellectual disabilities
1108	1098		(ICFs/IID) rates shall not be adjuste d less
1109	1099		favorably than the average percentage -rate
1110	1100		reduction or increase applicable to the majority
1111	1101		of other provider groups.
1112	1102		g. (1) Effective October 1, 2019, if sufficient funding
1113	1103		is appropriated for a rate increase, a new
1114	1104		average rate for nursing facilities shall be
1115	1105		established. The rate shall be equal to the
1116	1106		statewide average cost as derived from audited
1117	1107		cost reports for SFY 2018, ending June 30, 2018,
1118	1108		after adjustment for inflation. After such new
1119	1109		average rate has been established, the facility
1120	1110		specific reimbursement rate shall be as follows:
1121	1111		(a) amounts up to the existing base rate amount
1122	1112		shall continue to be distributed as a part
1123		-	of the base rate in accordance with the
1124		-	existing Medicaid State Plan, and
1125		-	(b) to the extent the new rate exceeds the rate
1126		-	effective before the effective date of this
1127	1113
1128		-	SENATE FLOOR VERSION - SB904 SFLR Page 23
1129		-	(Bold face denotes Committee Amendments) 1
	1114	+	Req. No. 1816 Page 23 1
1130	1115		2
1131	1116		3
1132	1117		4
1133	1118		5
1134	1119		6
1135	1120		7
1136	1121		8
1137	1122		9
1138	1123		10
1139	1124		11
1140	1125		12
1141	1126		13
1142	1127		14
1143	1128		15
1144	1129		16
1145	1130		17
1146	1131		18
1147	1132		19
1148	1133		20
1149	1134		21
1150	1135		22
1151	1136		23
1152	1137		24
1153	1138
	1139	+	of the base rate in accordance with the
	1140	+	existing Medicaid State Plan, and
	1141	+	(b) to the extent the new rate exceeds the rate
	1142	+	effective before the effective date of this
1154	1143		act October 1, 2019, fifty percent (50%) of
1155	1144		the resulting increase on October 1, 2019,
1156	1145		shall be allocated toward an increase of the
1157	1146		existing base reimbursement rate and
1158	1147		distributed accordingly. The remaining
1159	1148		fifty percent (50%) of the increase shall be
1160	1149		allocated in accordanc e with the currently
1161	1150		approved 70/30 reimbursement rate
1162	1151		methodology as outlined in the existing
1163	1152		Medicaid State Plan.
1164	1153		(2) Any subsequent rate increases, as determined
1165	1154		based on the provisions set forth in this
1166	1155		subparagraph, shall be allocated in accordance
1167	1156		with the currently approved 70/30 reimbursement
1168	1157		rate methodology. When the case-mix component is
1169	1158		included in the rate methodology, fifty percent
1170	1159		(50%) of the amount allocated to direct care
1171	1160		shall be apportioned to the case -mix component.
1172	1161		The rate shall not exceed the upper payment limit
1173		-	established by the Medicare rate equivalent
1174		-	established by the federal CMS.
1175		-	h. Effective October 1, 2019, in coordination with the
1176		-	rate adjustments identified in the precedin g section,
1177		-	a portion of the funds shall be utilized as follows:
1178	1162
1179		-	SENATE FLOOR VERSION - SB904 SFLR Page 24
1180		-	(Bold face denotes Committee Amendments) 1
	1163	+	Req. No. 1816 Page 24 1
1181	1164		2
1182	1165		3
1183	1166		4
1184	1167		5
1185	1168		6
1186	1169		7
1187	1170		8
1188	1171		9
1189	1172		10
1190	1173		11
1191	1174		12
1192	1175		13
1193	1176		14
1194	1177		15
1195	1178		16
1196	1179		17
1197	1180		18
1198	1181		19
1199	1182		20
1200	1183		21
1201	1184		22
1202	1185		23
1203	1186		24
1204	1187
	1188	+	established by the Medicare rate equivalent
	1189	+	established by the federal CMS.
	1190	+	h. Effective October 1, 2019, in coordination with the
	1191	+	rate adjustments identified in the preceding section,
	1192	+	a portion of the funds shall be utilize d as follows:
1205	1193		(1) effective October 1, 2019, the Oklahoma Health
1206	1194		Care Authority shall increase the perso nal needs
1207	1195		allowance for residents of nursing homes and
1208	1196		Intermediate Care Facilities for Individuals with
1209	1197		Intellectual Disabilities intermediate care
1210	1198		facilities for individuals with intellectual
1211	1199		disabilities (ICFs/IID) from Fifty Dollars
1212	1200		($50.00) per month to Seventy -five Dollars
1213	1201		($75.00) per month per resident. The increase
1214	1202		shall be funded by Medicaid nursing home
1215	1203		providers, by way of a reduction of eigh ty-two
1216	1204		cents ($0.82) per day deducted from the base
1217	1205		rate. Any additional cost shall be funded by the
1218	1206		Nursing Facility Quality of Care Fund, and
1219	1207		(2) effective January 1, 2020, all clinical emp loyees
1220	1208		working in a licensed nursing facility shall be
1221	1209		required to receive at least four (4) hours
1222	1210		annually of Alzheimer ’s or dementia training, to
1223	1211		be provided and paid for by the facilities.
1224		-	3. The Department of Human Services shall expand its statewide
1225		-	toll-free, Senior-Info Line Senior Info-line for senior citizen
1226		-	services to include assistance with or information on long -term care
1227		-	services in this state.
1228	1212
1229		-	SENATE FLOOR VERSION - SB904 SFLR Page 25
1230		-	(Bold face denotes Committee Amendments) 1
	1213	+	Req. No. 1816 Page 25 1
1231	1214		2
1232	1215		3
1233	1216		4
1234	1217		5
1235	1218		6
1236	1219		7
1237	1220		8
1238	1221		9
1239	1222		10
1240	1223		11
1241	1224		12
1242	1225		13
1243	1226		14
1244	1227		15
1245	1228		16
1246	1229		17
1247	1230		18
1248	1231		19
1249	1232		20
1250	1233		21
1251	1234		22
1252	1235		23
1253	1236		24
1254	1237
	1238	+	3. The Department of Human Services shall expand its statewide
	1239	+	toll-free, Senior-Info Line Senior Info-line for senior citizen
	1240	+	services to include assistance with or information on long -term care
	1241	+	services in this state.
1255	1242		4. The Oklahoma Health Care Authority shall develop a nursing
1256	1243		facility cost-reporting system that reflects the most current costs
1257	1244		experienced by nursing and speci alized facilities. The Oklahoma
1258	1245		Health Care Authority shall utilize the most current cost report
1259	1246		data to estimate costs in determining daily per diem rates.
1260	1247		5. The Oklahoma Health Care Authority shall provide access to
1261	1248		the detailed Medicaid payment audit adjustments and implement an
1262	1249		appeal process for disputed payment audit adjustments to the
1263	1250		provider. Additionally, the Oklahoma Health Care Authority shall
1264	1251		make sufficient revisions to the nu rsing facility cost reporting
1265	1252		forms and electronic data input sy stem so as to clarify what
1266	1253		expenses are allowable and appropriate for inclusion in cost
1267	1254		calculations.
1268	1255		J. 1. When the state Medicaid program reimbursement rate
1269	1256		reflects the sum of Ninety -four Dollars and eleven cents ($94.11),
1270	1257		plus the increases in actual audited costs, over and above the
1271	1258		actual audited costs reflected in the cost reports submitted for the
1272	1259		most current cost-reporting period, and the direct -care, flexible
1273	1260		staff-scheduling staffing level has been prospectively funded at
1274	1261		four and one-tenth (4.1) hours per day per occupied bed, the
1275		-	Authority may apportion funds for the implementation of the
1276		-	provisions of this section.
1277		-	2. The Authority shall make application to the United States
1278		-	Centers for Medicare and Medicaid Service Services for a waiver of
1279	1262
1280		-	SENATE FLOOR VERSION - SB904 SFLR Page 26
1281		-	(Bold face denotes Committee Amendments) 1
	1263	+	Req. No. 1816 Page 26 1
1282	1264		2
1283	1265		3
1284	1266		4
1285	1267		5
1286	1268		6
1287	1269		7
1288	1270		8
1289	1271		9
1290	1272		10
1291	1273		11
1292	1274		12
1293	1275		13
1294	1276		14
1295	1277		15
1296	1278		16
1297	1279		17
1298	1280		18
1299	1281		19
1300	1282		20
1301	1283		21
1302	1284		22
1303	1285		23
1304	1286		24
1305	1287
	1288	+	Authority may apportion funds for the implementation of the
	1289	+	provisions of this section.
	1290	+	2. The Authority shall make application to the United States
	1291	+	Centers for Medicare and Medicaid Service Services for a waiver of
1306	1292		the uniform requirement on health -care-related taxes as permitted by
1307	1293		Section 433.72 of 42 C.F.R., Section 433.72.
1308	1294		3. Upon approval of the waiver, the Authority shall develop a
1309	1295		program to implement the provisions of the waiver as it relates to
1310	1296		all nursing facilities.
1311	1297		SECTION 3. This act shall become effective July 1, 2025.
1312	1298		SECTION 4. It being immediately necessary for the preservation
1313	1299		of the public peace, health or safety, an emergency is hereby
1314	1300		declared to exist, by reaso n whereof this act shall take effect and
1315	1301		be in full force from and after its passage and approval.
1316		-	~~COMMITTEE REPORT BY: COMMITTEE ON APPROPRIATIONS~~
1317		-	~~March~~ 5, 2025 ~~- DO PASS AS AMENDED BY CS~~
	1302	+
	1303	+	60-1-1816 DC 3/5/2025 6:27:14 PM