2020 -- H 7168 | |
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LC003051 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2020 | |
____________ | |
A N A C T | |
RELATING TO HUMAN SERVICES -- NURSING HOME MEDICAL ASSISTANCE | |
PAYMENTS | |
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Introduced By: Representatives Place, Newberry, and Quattrocchi | |
Date Introduced: January 16, 2020 | |
Referred To: House Finance | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Section 40-8-19 of the General Laws in Chapter 40-8 entitled "Medical |
2 | Assistance" is hereby amended to read as follows: |
3 | 40-8-19. Rates of payment to nursing facilities. |
4 | (a) Rate reform. |
5 | (1) The rates to be paid by the state to nursing facilities licensed pursuant to chapter 17 of |
6 | title 23, and certified to participate in Title XIX of the Social Security Act for services rendered to |
7 | Medicaid-eligible residents, shall be reasonable and adequate to meet the costs that must be |
8 | incurred by efficiently and economically operated facilities in accordance with 42 U.S.C. § |
9 | 1396a(a)(13). The executive office of health and human services ("executive office") shall |
10 | promulgate or modify the principles of reimbursement for nursing facilities in effect as of July 1, |
11 | 2011, to be consistent with the provisions of this section and Title XIX, 42 U.S.C. § 1396 et seq., |
12 | of the Social Security Act. |
13 | (2) The executive office shall review the current methodology for providing Medicaid |
14 | payments to nursing facilities, including other long-term-care services providers, and is |
15 | authorized to modify the principles of reimbursement to replace the current cost-based |
16 | methodology rates with rates based on a price-based methodology to be paid to all facilities with |
17 | recognition of the acuity of patients and the relative Medicaid occupancy, and to include the |
18 | following elements to be developed by the executive office: |
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1 | (i) A direct-care rate adjusted for resident acuity; |
2 | (ii) An indirect-care rate comprised of a base per diem for all facilities; |
3 | (iii) A rearray of costs for all facilities every three (3) years beginning October, 2015, that |
4 | may or may not result in automatic per diem revisions; |
5 | (iv) Application of a fair-rental value system; |
6 | (v) Application of a pass-through system; and |
7 | (vi) Adjustment of rates by the change in a recognized national nursing home inflation |
8 | index to be applied on October 1 of each year, beginning October 1, 2012. This adjustment will |
9 | not occur on October 1, 2013, October 1, 2014, or October 1, 2015, but will occur on April 1, |
10 | 2015. The adjustment of rates will also not occur on October 1, 2017, October 1, 2018, and |
11 | October 1, 2019. Effective July 1, 2018, rates paid to nursing facilities from the rates approved by |
12 | the Centers for Medicare and Medicaid Services and in effect on October 1, 2017, both fee-for- |
13 | service and managed care, will be increased by one and one-half percent (1.5%) and further |
14 | increased by one percent (1%) on October 1, 2018, and further increased by one percent (1%) on |
15 | October 1, 2019. The inflation index shall be applied without regard for the transition factors in |
16 | subsections (b)(1) and (b)(2). For purposes of October 1, 2016, adjustment only, any rate increase |
17 | that results from application of the inflation index to subsections (a)(2)(i) and (a)(2)(ii) shall be |
18 | dedicated to increase compensation for direct-care workers in the following manner: Not less than |
19 | 85% of this aggregate amount shall be expended to fund an increase in wages, benefits, or related |
20 | employer costs of direct-care staff of nursing homes. For purposes of this section, direct-care staff |
21 | shall include registered nurses (RNs), licensed practical nurses (LPNs), certified nursing |
22 | assistants (CNAs), certified medical technicians, housekeeping staff, laundry staff, dietary staff, |
23 | or other similar employees providing direct-care services; provided, however, that this definition |
24 | of direct-care staff shall not include: (i) RNs and LPNs who are classified as "exempt employees" |
25 | under the Federal Fair Labor Standards Act (29 U.S.C. § 201 et seq.); or (ii) CNAs, certified |
26 | medical technicians, RNs, or LPNs who are contracted, or subcontracted, through a third-party |
27 | vendor or staffing agency. By July 31, 2017, nursing facilities shall submit to the secretary, or |
28 | designee, a certification that they have complied with the provisions of this subsection (a)(2)(vi) |
29 | with respect to the inflation index applied on October 1, 2016. Any facility that does not comply |
30 | with terms of such certification shall be subjected to a clawback, paid by the nursing facility to |
31 | the state, in the amount of increased reimbursement subject to this provision that was not |
32 | expended in compliance with that certification. |
33 | (b) Transition to full implementation of rate reform. For no less than four (4) years after |
34 | the initial application of the price-based methodology described in subsection (a)(2) to payment |
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1 | rates, the executive office of health and human services shall implement a transition plan to |
2 | moderate the impact of the rate reform on individual nursing facilities. Said transition shall |
3 | include the following components: |
4 | (1) No nursing facility shall receive reimbursement for direct-care costs that is less than |
5 | the rate of reimbursement for direct-care costs received under the methodology in effect at the |
6 | time of passage of this act; for the year beginning October 1, 2017, the reimbursement for direct- |
7 | care costs under this provision will be phased out in twenty-five-percent (25%) increments each |
8 | year until October 1, 2021, when the reimbursement will no longer be in effect; and |
9 | (2) No facility shall lose or gain more than five dollars ($5.00) in its total, per diem rate |
10 | the first year of the transition. An adjustment to the per diem loss or gain may be phased out by |
11 | twenty-five percent (25%) each year; except, however, for the years beginning October 1, 2015, |
12 | there shall be no adjustment to the per diem gain or loss, but the phase out shall resume |
13 | thereafter; and |
14 | (3) The transition plan and/or period may be modified upon full implementation of |
15 | facility per diem rate increases for quality of care-related measures. Said modifications shall be |
16 | submitted in a report to the general assembly at least six (6) months prior to implementation. |
17 | (4) Notwithstanding any law to the contrary, for the twelve-month (12) period beginning |
18 | July 1, 2015, Medicaid payment rates for nursing facilities established pursuant to this section |
19 | shall not exceed ninety-eight percent (98%) of the rates in effect on April 1, 2015. Consistent |
20 | with the other provisions of this chapter, nothing in this provision shall require the executive |
21 | office to restore the rates to those in effect on April 1, 2015, at the end of this twelve-month (12) |
22 | period. |
23 | (c) Notwithstanding any language to the contrary in this section, whenever a nursing |
24 | home's cost of care provided to its residents increases due to a mandatory minimum hourly wage |
25 | increase, the state's medical assistance payments to the nursing home shall be correspondingly |
26 | increased to offset any mandated minimum wage increase costs. |
27 | SECTION 2. This act shall take effect upon passage. |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO HUMAN SERVICES -- NURSING HOME MEDICAL ASSISTANCE | |
PAYMENTS | |
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1 | This act would increase the state medical assistance payments made to nursing homes to |
2 | cover any increased costs resulting from a hike in the minimum hourly wage, benefitting some of |
3 | its employees. |
4 | This act would take effect upon passage. |
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