Bill Text: OH SB295 | 2009-2010 | 128th General Assembly | Introduced

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Bill Title: To amend Section 309.30.25 of Am. Sub. H.B. 1 of the 128th General Assembly, as subsequently amended, to revise the law governing Medicaid payments to nursing facilities for fiscal year 2011.

Spectrum: Slight Partisan Bill (Republican 5-2)

Status: (Introduced - Dead) 2010-08-19 - To Finance & Financial Institutions [SB295 Detail]

Download: Ohio-2009-SB295-Introduced.html

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As Introduced

128th General Assembly Regular Session 2009-2010

S. B. No. 295

Senator Patton 

Cosponsors: Senators Wagoner, Goodman, Stewart, Wilson, Smith, Schuring 

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A BILL

To amend Section 309.30.25 of Am. Sub. H.B. 1 of the

1

128th General Assembly, as subsequently amended,

2

to revise the law governing Medicaid payments to

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nursing facilities for fiscal year 2011.

4

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That Section 309.30.25 of Am. Sub. H.B. 1 of the	5
128th General Assembly, as amended by Sub. H.B. 198 of the 128th	6
General Assembly, be amended to read as follows:	7

Sec. 309.30.25. FISCAL YEAR 2011 MEDICAID REIMBURSEMENT	8
SYSTEM FOR NURSING FACILITIES FOR THE FIRST HALF OF FISCAL YEAR	9
2011	10

(A) As used in this section:

11

"Fiscal year 2010 partial rate" means the total rate a	12
provider of a nursing facility is paid for nursing facility	13
services the nursing facility provides on June 30, 2010, less the	14
portion of that total rate that equals the sum of the workforce	15
development incentive payment and consolidated services rate	16
included in the total rate pursuant to divisions (D) and (E) of	17
Section 309.30.20 of Am. Sub. H.B. 1 of the 128th General	18
Assembly.	19

"Franchise permit fee," "inpatient days," "Medicaid days,"	20
"nursing facility," and "provider" have the same meanings as in	21
section 5111.20 of the Revised Code.	22

"Nursing facility services" means nursing facility services	23
covered by the Medicaid program that a nursing facility provides	24
to a resident of the nursing facility who is a Medicaid recipient	25
eligible for Medicaid-covered nursing facility services.	26

(B) Except as otherwise provided by this section, the	27
provider of a nursing facility that has a valid Medicaid provider	28
agreement on June 30, 2010, and a valid Medicaid provider	29
agreement during the first half of fiscal year 2011 shall be paid,	30
for nursing facility services the nursing facility provides during	31
fiscal year 2011the period beginning July 1, 2010, and ending	32
December 31, 2010, the rate calculated for the nursing facility	33
under sections 5111.20 to 5111.33 of the Revised Code with the	34
following adjustments:	35

(1) The cost per case mix-unit calculated under section	36
5111.231 of the Revised Code, the rate for ancillary and support	37
costs calculated under section 5111.24 of the Revised Code, the	38
rate for tax costs calculated under section 5111.242 of the	39
Revised Code, and the rate for capital costs calculated under	40
section 5111.25 of the Revised Code shall each be adjusted as	41
follows:	42

(a) Increase the cost and rates so calculated by two per	43
cent;	44

(b) Increase the cost and rates determined under division	45
(B)(1)(a) of this section by two per cent;	46

(c) Increase the cost and rates determined under division	47
(B)(1)(b) of this section by one per cent.	48

(2) The mean payment used in the calculation of the quality	49
incentive payment made under section 5111.244 of the Revised Code	50
shall be, weighted by Medicaid days, three dollars and three cents	51
per Medicaid day.	52

(3) The rate, after the adjustments under divisions (B)(1)	53
and (2) of this section are made, shall be further adjusted by a	54
percentage that the Department of Job and Family Services shall	55
determine in consultation with the Ohio Health Care Association;	56
Ohio Academy of Nursing Homes; and the Association of Ohio	57
Philanthropic Homes, Housing, and Services for the Aging. The	58
percentage shall be based on expending an amount equal to the	59
amount determined as follows:	60

(a) Determine how much of the revenue to be generated under	61
section 3721.51 of the Revised Code for fiscal year 2011 reflects	62
the calculations made under divisions (A)(1) to (4) of section	63
3721.50 of the Revised Code;	64

(b) From the amount determined under division (B)(3)(a) of	65
this section, subtract the portion of the amount to be expended	66
under division (F) of this section that reflects the part of the	67
calculation made under division (F)(2) of this section.	68

(C) Except as provided in division (G) of this section, if	69
the rate determined for a nursing facility under division (B) of	70
this section for nursing facility services provided during the	71
first half of fiscal year 2011 is more than one hundred two and	72
twenty-five hundredths per cent of the nursing facility's fiscal	73
year 2010 partial rate, the Department of Job and Family Services	74
shall reduce the nursing facility's rate determined under division	75
(B) of this section for the first half of fiscal year 2011 so	76
that the rate is not more than one hundred two and twenty-five	77
hundredths per cent of the nursing facility's fiscal year 2010	78
partial rate. Except as provided in division (G) of this section,	79
if the rate determined for a nursing facility under division (B)	80
of this section for nursing facility services provided during the	81
first half of fiscal year 2011 is less than ninety-nine per cent	82
of the nursing facility's fiscal year 2010 partial rate, the	83
Department shall increase the nursing facility's rate determined	84
under division (B) of this section for the first half of fiscal	85
year 2011 so that the rate is not less than ninety-nine per cent	86
of the nursing facility's fiscal year 2010 partial rate.	87

(D) After the adjustments under divisions (B) and (C) of this	88
section are made to a nursing facility's rate for the first half	89
of fiscal year 2011 rate, the Department of Job and Family	90
Services shall increase the nursing facility's rate for the first	91
half of fiscal year 2011 rate by the amount of real estate taxes	92
reported on the nursing facility's cost report for calendar year	93
2004 divided by the number of inpatient days reported on that cost	94
report if the nursing facility had a credit regarding its real	95
estate taxes reflected on its cost report for calendar year 2003.	96

(E) After the adjustments under divisions (B), (C), and (D)	97
of this section are made to a nursing facility's rate for the	98
first half of fiscal year 2011 rate, the Department of Job and	99
Family Services shall increase the nursing facility's rate for the	100
first half of fiscal year 2011 rate by five dollars and seventy	101
cents per Medicaid day. This increase shall be known as the	102
workforce development incentive payment. The total amount of	103
workforce development incentive payments paid to providers of	104
nursing facilities shall be used to improve nursing facilities'	105
employee retention and direct care staffing levels, including by	106
increasing wages paid to nursing facilities' direct care staff.	107
Not later than September 30, 2012, the Department shall submit a	108
report to the Governor and, in accordance with section 101.68 of	109
the Revised Code, the General Assembly detailing the impact that	110
the workforce development incentive payments have on nursing	111
facilities' employee retention, direct care staffing levels, and	112
direct care staff wages.	113

(F) After the adjustment under division (E) of this section	114
is made to a nursing facility's rate for the first half of fiscal	115
year 2011 rate, the Department of Job and Family Services shall	116
increase the nursing facility's rate for the first half of fiscal	117
year 2011 rate by the consolidated services rate per Medicaid day.	118
The consolidated services rate shall equal the sum of the	119
following:	120

(1) Three dollars and ninety-one cents;

121

(2) The amount calculated under divisions (A)(1) to (4) of	122
section 3721.50 of the Revised Code for fiscal year 2011.	123

(G) If the fiscal year 2010 rate for a nursing facility as	124
initially determined under division (B) of Section 309.30.20 of	125
Am. Sub. H.B. 1 of the 128th General Assembly is not subject to an	126
adjustment under division (C) of that section, the nursing	127
facility's rate for the first half of fiscal year 2011 rate as	128
initially determined under division (B) of this section shall not	129
be subject to an adjustment under division (C) of this section	130
regardless of whether the nursing facility's rate for the first	131
half of fiscal year 2011 rate as initially determined under	132
division (B) of this section would, if not for this division, be	133
subject to the adjustment.	134

If the fiscal year 2011 rate for a nursing facility as	135
initially determined under division (B) of this section is not	136
subject to an adjustment under division (C) of this section, the	137
nursing facility's rate shall not be subject to an adjustment	138
under that division for the remainder of fiscal year 2011	139
regardless of any other adjustment made to the nursing facility's	140
fiscal year 2011 rate under sections 5111.20 to 5111.33 of the	141
Revised Code.	142

(H) Not later than October 1, 2010, the Department of Job and	143
Family Services shall determine the rates to be paid providers of	144
nursing facilities under this section. Until the rates are	145
determined, the Department shall continue to pay a provider the	146
rate the provider is paid for nursing facility services the	147
provider's nursing facility provides on June 30, 2010. When the	148
Department determines the rates to be paid under this section, the	149
Department shall pay the rates retroactive to July 1, 2010.	150

(I) If the United States Centers for Medicare and Medicaid	151
Services requires that the franchise permit fee be reduced or	152
eliminated, the Department of Job and Family Services shall reduce	153
the amount it pays providers of nursing facility services under	154
this section as necessary to reflect the loss to the state of the	155
revenue and federal financial participation generated from the	156
franchise permit fee.	157

(J) The Department of Job and Family Services shall follow	158
this section in determining the rate to be paid to the provider of	159
a nursing facility that has a valid Medicaid provider agreement on	160
June 30, 2010, and a valid Medicaid provider agreement during the	161
first half of fiscal year 2011 notwithstanding anything to the	162
contrary in sections 5111.20 to 5111.33 of the Revised Code.	163

Section 2. That existing Section 309.30.25 of Am. Sub. H.B. 1	164
of the 128th General Assembly, as amended by Sub. H.B. 198 of the	165
128th General Assembly, is hereby repealed.	166

Section 3.  MEDICAID REIMBURSEMENT SYSTEM FOR NURSING	167
FACILITIES FOR THE SECOND HALF OF FISCAL YEAR 2011	168

(A) As used in this section:

169

"Franchise permit fee," "inpatient days," "Medicaid days,"	170
"nursing facility," and "provider" have the same meanings as in	171
section 5111.20 of the Revised Code.	172

"Nursing facility services" means nursing facility services	173
covered by the Medicaid program that a nursing facility provides	174
to a resident of the nursing facility who is a Medicaid recipient	175
eligible for Medicaid-covered nursing facility services.	176

(B) Except as otherwise provided by this section, the	177
provider of a nursing facility that has a valid Medicaid provider	178
agreement on December 31, 2010, and a valid Medicaid provider	179
agreement during the second half of fiscal year 2011 shall be	180
paid, for nursing facility services the nursing facility provides	181
during the period beginning January 1, 2011, and ending June 30,	182
2011, the rate calculated for the nursing facility under sections	183
5111.20 to 5111.33 of the Revised Code with the following	184
adjustments:	185

(1) The cost per case mix-unit calculated under section	186
5111.231 of the Revised Code, the rate for ancillary and support	187
costs calculated under section 5111.24 of the Revised Code, the	188
rate for tax costs calculated under section 5111.242 of the	189
Revised Code, and the rate for capital costs calculated under	190
section 5111.25 of the Revised Code shall each be adjusted as	191
follows:	192

(a) Increase the cost and rates so calculated by two per	193
cent;	194

(b) Increase the cost and rates determined under division	195
(B)(1)(a) of this section by two per cent;	196

(c) Increase the cost and rates determined under division	197
(B)(1)(b) of this section by one per cent.	198

(2) After the adjustment under division (B)(1) of this	199
section is made to a nursing facility's cost per case mix-unit,	200
the nursing facility's cost per case mix-unit shall be further	201
adjusted by adding to it the amount determined as follows:	202

(a) Determine the mean per diem rate for July 1, 2010, for	203
all nursing facilities in the state, weighted by Medicaid days,	204
calculated under Section 309.30.25 of Am. Sub. H.B. 1 of the 128th	205
General Assembly, as amended by Sub. H.B. 198 of the 128th General	206
Assembly;	207

(b) Determine what the mean per diem rate for July 1, 2010,	208
for all nursing facilities in the state, weighted by Medicaid	209
days, would be as calculated under Section 309.30.25 of Am. Sub.	210
H.B. 1 of the 128th General Assembly, as amended by Sub. H.B. 198	211
of the 128th General Assembly, if the adjustment provided for by	212
division (C) of that section were not made;	213

(c) Determine the difference between the amounts determined	214
under divisions (B)(2)(a) and (b) of this section;	215

(d) Determine the average amount by which the per diem rate	216
for July 1, 2010, for all nursing facilities in the state,	217
weighted by Medicaid days, was increased by the adjustment made	218
under division (B)(3) of Section 309.30.25 of Am. Sub. H.B. 1 of	219
the 128th General Assembly, as amended by Sub. H.B. 198 of the	220
128th General Assembly;	221

(e) To the amount determined under division (B)(2)(c) of this	222
section, add the amount determined under division (B)(2)(d) of	223
this section;	224

(f) To the amount determined under division (B)(2)(e) of this	225
section, add the consolidated services rate determined under	226
division (F) of Section 309.30.25 of Am. Sub. H.B. 1 of the 128th	227
General Assembly, as amended by Sub. H.B. 198 of the 128th General	228
Assembly;	229

(g) Divide the amount determined under division (B)(2)(f) of	230
this section by the mean semiannual case-mix score calculated	231
under section 5111.232 of the Revised Code for July 1, 2010, for	232
all nursing facilities in the state, weighted by Medicaid days.	233

(3) The mean payment used in the calculation of the quality	234
incentive payment made under section 5111.244 of the Revised Code	235
shall be, weighted by Medicaid days, three dollars and three cents	236
per Medicaid day.	237

(C) After the adjustments under division (B) of this section	238
are made to a nursing facility's rate for the second half of	239
fiscal year 2011, the Department of Job and Family Services shall	240
increase the nursing facility's rate for the second half of fiscal	241
year 2011 by the amount of real estate taxes reported on the	242
nursing facility's cost report for calendar year 2004 divided by	243
the number of inpatient days reported on that cost report if the	244
nursing facility had a credit regarding its real estate taxes	245
reflected on its cost report for calendar year 2003.	246

(D) After the adjustments under divisions (B) and (C) of this	247
section are made to a nursing facility's rate for the second half	248
of fiscal year 2011, the Department of Job and Family Services	249
shall increase the nursing facility's rate for the second half of	250
fiscal year 2011 by five dollars and seventy cents per Medicaid	251
day. This increase shall be known as the workforce development	252
incentive payment. The total amount of workforce development	253
incentive payments paid to providers of nursing facilities shall	254
be used to improve nursing facilities' employee retention and	255
direct-care staffing levels, including by increasing wages paid to	256
nursing facilities' direct-care staff. Not later than September	257
30, 2012, the Department shall submit a report to the Governor	258
and, in accordance with section 101.68 of the Revised Code, the	259
General Assembly detailing the impact that the workforce	260
development incentive payments have on nursing facilities'	261
employee retention, direct-care staffing levels, and direct-care	262
staff wages. The report may be combined with the report required	263
by division (E) of Section 309.30.25 of Am. Sub. H.B. 1 of the	264
128th General Assembly, as amended by Sub. H.B. 198 of the 128th	265
General Assembly.	266

(E) If the United States Centers for Medicare and Medicaid	267
Services requires that the franchise permit fee be reduced or	268
eliminated, the Department of Job and Family Services shall reduce	269
the amount it pays providers of nursing facility services under	270
this section as necessary to reflect the loss to the state of the	271
revenue and federal financial participation generated from the	272
franchise permit fee.	273

(F) The Department of Job and Family Services shall follow	274
this section in determining the rate to be paid to the provider of	275
a nursing facility that has a valid Medicaid provider agreement on	276
December 31, 2010, and a valid Medicaid provider agreement during	277
the second half of fiscal year 2011 notwithstanding anything to	278
the contrary in sections 5111.20 to 5111.33 of the Revised Code.	279