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HOUSE OF REPRESENTATIVES - FLOOR VERSION
STATE OF OKLAHOMA
1st Session of the 60th Legislature (2025)
ENGROSSED SENATE
BILL NO. 947 By: Rosino of the Senate
and
Gise of the House
An Act relating to long-term care; amending 56 O.S.
2021, Section 2002, which relates to the Nursing
Facilities Quality of Care Fee; updating statutory
language; amending 63 O.S. 2021, Section 1 -2216, as
amended by Section 17, Chapter 339, O.S.L. 2024 (63
O.S. Supp. 2024, Section 1 -2216), which relates to
the Oklahoma State Council on Aging and Adult
Protective Services; updating statutory language ; and
declaring an emergency.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 56 O.S. 2021, Section 2002, is
amended to read as follows:
Section 2002. A. For the purpose of providing quality care
enhancements, the Oklahoma Health Care Authority is authorized to
and shall assess a Nursing Facilities Quality of Care Fee pursuant
to this section upon each nursing facili ty licensed in this state.
Facilities operated by the Oklahoma Department of Veterans Affairs
shall be exempt from this fee. Quality of care enhancements
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include, but are not limited to, the purposes specified in this
section.
B. As a basis for determin ing the Nursing Facilities Quality of
Care Fee assessed upon each licensed nursing facility, the Authority
shall calculate a uniform per -patient day rate. The rate shall be
calculated by dividing six percent (6%) of the total annual patient
gross receipts of all licensed nursing facilities in this state by
the total number of patient days for all licensed nu rsing facilities
in this state. The result shall be the per -patient day rate.
Beginning July 15, 2004, the Nursing Facilities Quality of Care Fee
shall not be increased unless specifically authorized by the
Legislature.
C. Pursuant to any approved Medicaid waiver and pursuant to
subsection N of this section, the Nursing Facilities Quality of Care
Fee shall not exceed the amount or rate allowed by fede ral law for
nursing home licensed bed days.
D. The Nursing Facilities Quality of Care Fee owed by a
licensed nursing facility shall be calculated by the Authority by
adding the daily patient census of a licensed nursing facility, as
reported by the facili ty for each day of the month, and by
multiplying the ensuing figure by the per -patient day rate
determined pursuant to the provisions of subsection B of this
section.
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E. Each licensed nursing facility which is assessed the Nursing
Facilities Quality of Ca re Fee shall be required to file a report on
a monthly basis with the Authority detailing the daily patie nt
census and patient gross receipts at such time and in such manner as
required by the Authority.
F. 1. The Nursing Facilities Quality of Care Fee f or a
licensed nursing facility for the period beginning October 1, 2000,
shall be determined using the daily patient census and annual
patient gross receipts figures reported to the Authority for the
calendar year 1999 upon forms supplied by the Authority.
2. Annually the Nursing Facilities Quality of Care Fee shall be
determined by:
a. using the daily patie nt census and patient gross
receipts reports received by the Authority for the
most recent available twelve (12) months, and
b. annualizing those figur es.
Each year thereafter, the annualization of the Nursing
Facilities Quality of Care Fee specified in this paragraph shall be
subject to the limitation in subsection B of this section unless the
provision of subsection C of this section is met.
G. The payment of the Nursing Facilities Quality of Care Fee by
licensed nursing facilities shall be an allowable cost for Medicaid
reimbursement purposes.
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H. 1. There is hereby created in the State Treasury a
revolving fund to be designated the “Nursing Facility Quality of
Care Fund”.
2. The fund shall be a continuing fund, not subject to fiscal
year limitations, and shall consist of:
a. all monies received by the Authority pursuant to this
section and otherwise specified or authorized by law,
b. monies received by the Authority due to federal
financial participation pursuant to Title XIX of the
Social Security Act, and
c. interest attributable to investment of money in the
fund.
3. All monies accruing to the credit of the fund are hereby
appropriated and shall be budgeted and expended by the Authority
for:
a. reimbursement of the additional costs paid to
Medicaid-certified nursing facilities for purposes
specified by Sections 1 -1925.2 and 5022.2 of Title 63
of the Oklahoma Statutes,
b. reimbursement of the Medic aid rate increases for
intermediate care facilities for individuals with
intellectual disabilities (ICFs/ IID),
c. nonemergency transportation services for Medicaid -
eligible nursing home clients,
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d. eyeglass and denture services for Medicaid -eligible
nursing home clients,
e. fifteen ombudsmen employed by the Department of Human
Services Office of the Attorney General ,
f. ten additional nursing facility inspectors employed by
the State Department of Health,
g. pharmacy and other Medicaid services to qualified
Medicare beneficiaries whose incomes are at or below
one hundred percent (100%) of the federal poverty
level; provided however, pharmacy benefits authorized
for such qualified Medicare beneficiaries shall be
suspended if the federal government subsequentl y
extends pharmacy benefits to this population,
h. costs incurred by the Authority in the administration
of the provisions of this section and any programs
created pursuant to this section,
i. durable medical equipment and supplies services for
Medicaid-eligible elderly adults, and
j. personal needs allowance increases for residents of
nursing homes and Inter mediate Care Facilities for
Individuals with Intellectual Disabilities (ICFs/IID)
from Thirty Dollars ($30.00) to Fifty Dollars ($50.00)
per month per resident.
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4. Expenditures from the fund shall be made upon warrants
issued by the State Treasurer against claims filed as prescribed by
law with the Director of the Office of Management and Enterprise
Services for approval and payment.
5. The fund and the programs specified in this section funded
by revenues collected from the Nursing Facilities Quality of Care
Fee pursuant to this section are exempt from budgetary cuts,
reductions, or eliminations.
6. The Medicaid rate increases for intermediate care fa cilities
for individuals with intellectual disabilities (ICFs/IID) shall not
exceed the net Medicaid rate increase for nursing facilities
including, but not limited to, the Medicaid rate increase for which
Medicaid-certified nursing facilities are eligible due to the
Nursing Facilities Quality of Care Fee less the portion of that
increase attributable to trea ting the Nursing Facilities Quality of
Care Fee as an allowable cost.
7. The reimbursement rate for nursing facilities shall be made
in accordance with Oklahoma’s Medicaid reimbursement rate
methodology and the provisions of this section.
8. No nursing facility shall be guaranteed, expressly or
otherwise, that any additional costs reimbursed to the facility will
equal or exceed the amount of the Nursin g Facilities Quality of Care
Fee paid by the nursing facility.
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I. 1. In the event that federal financia l participation
pursuant to Title XIX of the Social Security Act is not available to
the Oklahoma Medicaid program, for purposes of matching expenditur es
from the Nursing Facility Quality of Care Fund at the approved
federal medical assistance percentage for the applicable fiscal
year, the Nursing Facilities Quality of Care Fee shall be null and
void as of the date of the nonavailability of such federal funding,
through and during any period of nonavailability.
2. In the event of an invalidation of this se ction by any court
of last resort under circumstances not covered in subsection J of
this section, the Nursing Facilities Quality of Care Fee shall be
null and void as of the effective date of that invalidation.
3. In the event that the Nursing Facilities Quality of Care Fee
is determined to be null and void for any of the reasons enumerated
in this subsection, any Nursing Facilities Quality of Care Fee
assessed and collected for any periods after such invalidation shall
be returned in full within sixty (6 0) days by the Authority to the
nursing facility from which it was collected.
J. 1. If any provision of this section or the application
thereof shall be adjudged to be invalid by any court of last resort,
such judgment shall not affect, impair or invalidate the provisions
of the section, but shall be confined in its operation to the
provision thereof directly involved in the controversy in which such
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judgment was rendered. The applicability of such provision to other
persons or circumstances shall not be affected thereby.
2. This subsection shall not apply to any judgment that affects
the rate of the Nursing Facilities Quality of Care Fee, its
applicability to all licensed nursing homes in the state, the usage
of the fee for the purposes prescribed in this section, or the
ability of the Authority to obtain full federal participation to
match its expenditures of the proceeds of the fee.
K. The Authority shall promulgate rules for the implementation
and enforcement of the Nursing Facilities Quality of Care Fee
established by this section.
L. The Authority shall provide for administrative penalties in
the event nursing facilities fail to:
1. Submit the Quality of Care Fee;
2. Submit the fee in a timely manner;
3. Submit reports as required by this section; or
4. Submit reports timely.
M. As used in this section:
1. “Nursing facility” means any home, establishment or
institution, or any portion there of, licensed by the State
Department of Health as defined in Section 1 -1902 of Title 63 of the
Oklahoma Statutes;
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2. “Medicaid” means the medical assistance program established
in Title XIX of the federal Social Security Act and administered in
this state by the Authority;
3. “Patient gross revenues ” means gross revenues received in
compensation for services provided to residents of nursing
facilities including, but not limited to, client participation. The
term “patient gross revenues ” shall not include amounts received by
nursing facilities as charitable contributions; and
4. “Additional costs paid to Me dicaid-certified nursing
facilities under Oklahoma ’s Medicaid reimbursement methodology ”
means both state and federal Medicaid expenditures including, but
not limited to, funds in excess of the aggregate amounts that would
otherwise have been paid to Medicaid -certified nursing facilities
under the Medicaid reimbursement methodology which have been updated
for inflationary, economic, and regulatory trends and which are in
effect immediately prior to the inception of the Nursing Facilities
Quality of Care Fee.
N. 1. As per any approved federal Medicaid waiver, the
assessment rate subject to the provision of subsection C of this
section is to remain the sa me as those rates that were in effect
prior to January 1, 2012, for all state -licensed continuum of care
facilities.
2. Any facilities that made application to the State Department
of Health to become a licensed continuum of care facility no later
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than January 1, 2012, shall be assessed at the same rate as those
facilities assessed pursuant to paragraph 1 of this subsection;
provided, that any facility making the application shall receive the
license on or before September 1, 2012. Any facility that fails to
receive such license from the State Department of Health by
September 1, 2012, shall be assessed at the rate established by
subsection C of this section subsequent to September 1, 2012.
O. If any provision of this section, or the application
thereof, is determined by any controlling federal agency, or any
court of last resort to prevent the state from ob taining federal
financial participation in the state ’s Medicaid program, such
provision shall be deemed null and void as of the date of the
nonavailability of such federal funding and through and during any
period of nonavailability. All other provisions of the bill shall
remain valid and enforceable.
SECTION 2. AMENDATORY 63 O.S. 2021, Section 1 -2216, as
amended by Section 17, Chapter 339, O.S.L. 2024 (63 O.S. Supp. 2024,
Section 1-2216), is amended to read as follows:
Section 1-2216. A. The Attorney General shall promulgate rules
regarding:
1. The powers and official duties of the State Long -Term Care
Ombudsman consistent w ith applicable federal law and rules or as
provided by the Long -Term Care Ombudsman Act;
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2. Minimum qualifications for persons to serve as
representatives of the Office of the State Long -Term Care Ombudsman;
3. Initial and continuing training requirement s for ombudsman
staff and volunteers which shall provide for a minimum of eighteen
(18) hours of continui ng education relevant to the care of the aging
and disabled;
4. The minimum number of visits that must be made by an
ombudsman to the assigned facilit ies;
5. The proper documentation and reporting of visits made to
facilities by the ombudsman;
6. Procedures to ensure that officers, employees, or other
representatives of the Office are not subject to a conflict of
interest which would impair their abil ity to carry out their
official duties in an impartial manner; and
7. The disclosure by the State Long -Term Care Ombudsman or area
or local Ombudsman entities of files maintained by the State Long -
Term Care Ombudsman Program. Such rules shall:
a. provide that such files and records may be disclosed
only at the discretion of the State Long -Term Care
Ombudsman or the person designated by the State Long -
Term Care Ombudsman to disclose the files and records,
and
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b. prohibit the disclosure of the identity of a ny
complainant or resident with respect to whom the
Office maintains such files or records unless:
(1) the complainant or resident, or the legal
representative of the complainant or resident,
consents to the disclosure and the consent is
given in writing,
(2) (a) the complainant or resident gives consent
orally, and
(b) the consent is documented contemporaneously
in a writing made by a State Long -Term Care
Ombudsman representative of the Office in
accordance with such rules as the Attorney
General shall promulgate, or
(3) the disclosure is required by court order.
B. The Oklahoma State Council on Aging and Ad ult Protective
Services, established by the Attorney General Department of Human
Services to review, monitor, and evaluate programs targeted to older
persons, shall serve in an advisory capacity to the State Long -Term
Care Ombudsman through establishment of a committee with equal
provider and consumer representation.
SECTION 3. It being immediately necessary for the preservation
of the public peace, health or safety, an emergency is hereby
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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 HEALTH AND HUMAN SERVICES, dated
04/16/2025 – DO PASS.