2023 Session

Budget Amendments - SB800 (Member Request)

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Chief Patron: Deeds
Nursing Facility Rate Improvements

Item 304 #11s

Item 304 #11s

First Year - FY2023 Second Year - FY2024
Health and Human Resources
Department of Medical Assistance Services FY2023 $0 FY2024 $58,434,947 GF
FY2023 $0 FY2024 $64,509,381 NGF

Page 355, line 40, strike "$22,919,178,986" and insert "$23,042,123,314".

Page 384, after Line 31, insert:

"YYYY. 1. Effective July 1, 2023, the department shall modify nursing facility direct and indirect peer group pricing. Specifically, the department shall determine the prices by using the relevant facility with the 75th percentile day in place of the currently-mandated facility with the 50th percentile, or “day-weighted median” day. The department shall utilize the data from the most recent rebasing to make this change effective for FY 2024 and subsequent rate years until the next scheduled rebasing. Any subsequent rebasing shall apply this methodology change, but shall use the specified base year data according to the normal or otherwise mandated schedule.

2. Effective July 1, 2023, the department shall modify the fair rental value capital rate component for nursing facilities to (i) create a private room capital component for annually designated private rooms of no more than 20 percent of a nursing facility's total Medicaid or dually certified beds under the same methodology as the remainder of beds except that the imputed gross square feet per bed levels shall be multiplied by a factor of 1.5; and, (ii) reset the “facility average age” to 21 years for any building with a calculated “facility average age” in excess of 21 years. This reset “facility average age” shall serve as the maximum age for all facilities for seven years from implementation of this change. After seven years, facility average age shall not be subject to this maximum, and shall begin to increase annually from the calculated actual facility average age on that date or age 21, whichever is less.

3. Effective July 1, 2023, the department shall eliminate the application of a “Medicaid allowable” limit in determining the Medicaid liability for dually eligible nursing facility recipients' unreimbursed coinsurance amounts for services received under Medicare Part A. The department shall apply this to fee-for-service and also require Medicaid managed care plans to adopt this payment policy.

4. The department shall have the authority to implement these reimbursement changes prior to the completion of any regulatory process to effect such changes. To the extent federal approval requires alternative approaches to achieve the same general results, the department shall have the authority to follow the federal guidance."


(This amendment provides $58.4 million from the general fund and $64.5 million from nongeneral funds by directing the Department of Medical Assistance Services to modify the Medicaid program to cover incurred costs for a larger percentage of Medicaid days and remove Medicaid’s non-payment of dually eligible individuals’ patient responsibility under Medicare, recognize the need for some amount of private beds for infection prevention and control through reimbursement recognition, and encourage reinvestment in facility infrastructure.)