2022 -- S 2618 | |
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LC005122 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2022 | |
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A N A C T | |
RELATING TO HUMAN SERVICES - MEDICAL ASSISTANCE | |
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Introduced By: Senators DiPalma, Miller, Sosnowski, and Felag | |
Date Introduced: March 10, 2022 | |
Referred To: Senate Health & Human Services | |
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 authorized |
15 | to modify the principles of reimbursement to replace the current cost-based methodology rates with |
16 | rates based on a price-based methodology to be paid to all facilities with recognition of the acuity |
17 | of patients and the relative Medicaid occupancy, and to include the following elements to be |
18 | developed by the executive office: |
19 | (i) A direct-care rate adjusted for resident acuity; |
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1 | (ii) An indirect-care rate comprised of a base per diem for all facilities; |
2 | (iii) A rearray of costs for all facilities every three (3) years beginning October, 2015, that |
3 | may or may not result in automatic per diem revisions 2022 utilizing data from the most recent |
4 | finalized year of facility cost reports. The per diem rate components described in subsections (a) |
5 | (2)(i) and (a)(2)(ii) of this section shall be adjusted accordingly to reflect changes in direct and |
6 | indirect care costs since the previous rearray; |
7 | (iv) Application of a fair-rental value system; |
8 | (v) Application of a pass-through system; and |
9 | (vi) Adjustment of rates by the change in a recognized national nursing home inflation |
10 | index to be applied on October 1 of each year, beginning October 1, 2012. This adjustment will not |
11 | occur on October 1, 2013, October 1, 2014, or October 1, 2015, but will occur on April 1, 2015. |
12 | The adjustment of rates will also not occur on October 1, 2017, October 1, 2018, and October 1, |
13 | 2019. Effective July 1, 2018, rates paid to nursing facilities from the rates approved by the Centers |
14 | for Medicare and Medicaid Services and in effect on October 1, 2017, both fee-for-service and |
15 | managed care, will be increased by one and one-half percent (1.5%) and further increased by one |
16 | percent (1%) on October 1, 2018, and further increased by one percent (1%) on October 1, 2019. |
17 | In addition to the annual nursing home inflation index adjustment, there shall be a base rate staffing |
18 | adjustment of one-half percent (0.5%) on October 1, 2021, one percent (1.0%) on October 1, 2022, |
19 | and one and one-half percent (1.5%) on October 1, 2023. The inflation index shall be applied |
20 | without regard for the transition factors in subsections (b)(1) and (b)(2). For purposes of October |
21 | 1, 2016, adjustment only, any rate increase that results from application of the inflation index to |
22 | subsections (a)(2)(i) and (a)(2)(ii) shall be dedicated to increase compensation for direct-care |
23 | workers in the following manner: Not less than 85% of this aggregate amount shall be expended to |
24 | fund an increase in wages, benefits, or related employer costs of direct-care staff of nursing homes. |
25 | For purposes of this section, direct-care staff shall include registered nurses (RNs), licensed |
26 | practical nurses (LPNs), certified nursing assistants (CNAs), certified medical technicians, |
27 | housekeeping staff, laundry staff, dietary staff, or other similar employees providing direct-care |
28 | services; provided, however, that this definition of direct-care staff shall not include: (i) RNs and |
29 | LPNs who are classified as "exempt employees" under the federal Fair Labor Standards Act (29 |
30 | U.S.C. § 201 et seq.); or (ii) CNAs, certified medical technicians, RNs, or LPNs who are contracted, |
31 | or subcontracted, through a third-party vendor or staffing agency. By July 31, 2017, nursing |
32 | facilities shall submit to the secretary, or designee, a certification that they have complied with the |
33 | provisions of this subsection (a)(2)(vi) with respect to the inflation index applied on October 1, |
34 | 2016. Any facility that does not comply with terms of such certification shall be subjected to a |
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1 | clawback, paid by the nursing facility to the state, in the amount of increased reimbursement subject |
2 | to this provision that was not expended in compliance with that certification. |
3 | (3) Commencing on October 1, 2021, eighty percent (80%) of any rate increase that results |
4 | from application of the inflation index to subsections (a)(2)(i) and (a)(2)(ii) of this section shall be |
5 | dedicated to increase compensation for all eligible direct-care workers in the following manner on |
6 | October 1, of each year. |
7 | (i) For purposes of this subsection, compensation increases shall include base salary or |
8 | hourly wage increases, benefits, other compensation, and associated payroll tax increases for |
9 | eligible direct-care workers. This application of the inflation index shall apply for Medicaid |
10 | reimbursement in nursing facilities for both managed care and fee-for-service. For purposes of this |
11 | subsection, direct-care staff shall include registered nurses (RNs), licensed practical nurses (LPNs), |
12 | certified nursing assistants (CNAs), certified medication technicians, licensed physical therapists, |
13 | licensed occupational therapists, licensed speech-language pathologists, mental health workers |
14 | who are also certified nurse assistants, physical therapist assistants, housekeeping staff, laundry |
15 | staff, dietary staff or other similar employees providing direct-care services; provided, however |
16 | that this definition of direct-care staff shall not include: |
17 | (A) RNs and LPNs who are classified as "exempt employees" under the federal Fair Labor |
18 | Standards Act (29 U.S.C. § 201 et seq.); or |
19 | (B) CNAs, certified medication technicians, RNs or LPNs who are contracted or |
20 | subcontracted through a third-party vendor or staffing agency. |
21 | (4)(i) By July 31, 2021, and July 31 of each year thereafter, nursing facilities shall submit |
22 | to the secretary or designee a certification that they have complied with the provisions of subsection |
23 | (a)(3) of this section with respect to the inflation index applied on October 1. The executive office |
24 | of health and human services (EOHHS) shall create the certification form nursing facilities must |
25 | complete with information on how each individual eligible employee's compensation increased, |
26 | including information regarding hourly wages prior to the increase and after the compensation |
27 | increase, hours paid after the compensation increase, and associated increased payroll taxes. A |
28 | collective bargaining agreement can be used in lieu of the certification form for represented |
29 | employees. All data reported on the compliance form is subject to review and audit by EOHHS. |
30 | The audits may include field or desk audits, and facilities may be required to provide additional |
31 | supporting documents including, but not limited to, payroll records. |
32 | (ii) Any facility that does not comply with the terms of certification shall be subjected to a |
33 | clawback and twenty-five percent (25%) penalty of the unspent or impermissibly spent funds, paid |
34 | by the nursing facility to the state, in the amount of increased reimbursement subject to this |
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1 | provision that was not expended in compliance with that certification. |
2 | (iii) In any calendar year where no inflationary index is applied, eighty percent (80%) of |
3 | the base rate staffing adjustment in that calendar year pursuant to subsection (a)(2)(vi) of this |
4 | section shall be dedicated to increase compensation for all eligible direct-care workers in the |
5 | manner referenced in subsections (a)(3)(i), (a)(3)(i)(A), and (a)(3)(i)(B) of this section. |
6 | (b) Transition to full implementation of rate reform. For no less than four (4) years after |
7 | the initial application of the price-based methodology described in subsection (a)(2) to payment |
8 | rates, the executive office of health and human services shall implement a transition plan to |
9 | moderate the impact of the rate reform on individual nursing facilities. The transition shall include |
10 | the following components: |
11 | (1) No nursing facility shall receive reimbursement for direct-care costs that is less than |
12 | the rate of reimbursement for direct-care costs received under the methodology in effect at the time |
13 | of passage of this act; for the year beginning October 1, 2017, the reimbursement for direct-care |
14 | costs under this provision will be phased out in twenty-five-percent (25%) increments each year |
15 | until October 1, 2021, when the reimbursement will no longer be in effect; and |
16 | (2) No facility shall lose or gain more than five dollars ($5.00) in its total, per diem rate the |
17 | first year of the transition. An adjustment to the per diem loss or gain may be phased out by twenty- |
18 | five percent (25%) each year; except, however, for the years beginning October 1, 2015, there shall |
19 | be no adjustment to the per diem gain or loss, but the phase out shall resume thereafter; and |
20 | (3) The transition plan and/or period may be modified upon full implementation of facility |
21 | per diem rate increases for quality of care-related measures. Said modifications shall be submitted |
22 | in a report to the general assembly at least six (6) months prior to implementation. |
23 | (4) Notwithstanding any law to the contrary, for the twelve-month (12) period beginning |
24 | July 1, 2015, Medicaid payment rates for nursing facilities established pursuant to this section shall |
25 | not exceed ninety-eight percent (98%) of the rates in effect on April 1, 2015. Consistent with the |
26 | other provisions of this chapter, nothing in this provision shall require the executive office to restore |
27 | the rates to those in effect on April 1, 2015, at the end of this twelve-month (12) period. |
28 | 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 - MEDICAL ASSISTANCE | |
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1 | This act would for purposes of rates of payment to nursing facilities under the "Medical |
2 | Assistance" chapter, adjust the elements to be developed by the executive office in determining |
3 | Medicaid payment methods to nursing facilities. |
4 | This act would take effect upon passage. |
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LC005122 | |
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