To amend sections 3721.50 and 3721.53 of the Revised Code, to amend Section 309.30.25 of Am. Sub. H.B. 1 of the 128th General Assembly, as subsequently amended, and to repeal Section 309.30.70 of Am. Sub. H.B. 1 of the 128th General Assembly to revise the law governing the nursing home and hospital long-term care unit franchise permit fee and to revise the law governing fiscal year 2011 Medicaid payments to nursing facilities and intermediate care facilities for the mentally retarded.

Section 1.  That sections 3721.50 and 3721.53 of the Revised Code be amended to read as follows:

Sec. 3721.50.  As used in sections 3721.50 to 3721.58 of the Revised Code:

(A) "Franchise permit fee rate" means the amount determined as follows:

(1) Determine the difference between the following:

(a) The total net patient revenue, less medicaid per diem payments, of all nursing homes and hospital long-term care units as shown on cost reports filed under section 5111.26 of the Revised Code for the calendar year immediately preceding the fiscal year for which the franchise permit fee is assessed under section 3721.51 of the Revised Code;

(b) The total net patient revenue, less medicaid per diem payments, of all nursing homes and hospital long-term care units as shown on cost reports filed under section 5111.26 of the Revised Code for the calendar year immediately preceding the calendar year that immediately precedes the fiscal year for which the franchise permit fee is assessed under section 3721.51 of the Revised Code.

(2) Multiply the amount determined under division (A)(1) of this section by five and five-tenths per cent;

(3) Divide the amount determined under division (A)(2) of this section by the total number of days in the fiscal year for which the franchise permit fee is assessed under section 3721.51 of the Revised Code;

(4) Subtract eleven dollars and ninety-five cents from the amount determined under division (A)(3) of this section;

(5) Add eleven dollars and ninety-five cents to the amount determined under division (A)(4) of this section six dollars and twenty-five cents.

(B) "Hospital" has the same meaning as in section 3727.01 of the Revised Code.

(C) "Hospital long-term care unit" means any distinct part of a hospital in which any of the following beds are located:

(1) Beds registered pursuant to section 3701.07 of the Revised Code as skilled nursing facility beds or long-term care beds;

(2) Beds licensed as nursing home beds under section 3721.02 or 3721.09 of the Revised Code.

(D) "Inpatient days" means all days during which a resident of a nursing facility, regardless of payment source, occupies a bed in the nursing facility that is included in the facility's certified capacity under Title XIX. Therapeutic or hospital leave days for which payment is made under section 5111.26 of the Revised Code are considered inpatient days proportionate to the percentage of the facility's per resident per day rate paid for those days.

(E) "Medicaid" has the same meaning as in section 5111.01 of the Revised Code.

(F) "Medicaid day" means all days during which a resident who is a medicaid recipient occupies a bed in a nursing facility that is included in the facility's certified capacity under Title XIX. Therapeutic or hospital leave days for which payment is made under section 5111.26 of the Revised Code are considered medicaid days proportionate to the percentage of the nursing facility's per resident per day rate for those days.

(G) "Medicare" means the program established by Title XVIII.

(H) "Nursing facility" has the same meaning as in section 5111.20 of the Revised Code.

(I)(1) "Nursing home" means all of the following:

(a) A nursing home licensed under section 3721.02 or 3721.09 of the Revised Code, including any part of a home for the aging licensed as a nursing home;

(b) A facility or part of a facility, other than a hospital, that is certified as a skilled nursing facility under Title XVIII;

(c) A nursing facility, other than a portion of a hospital certified as a nursing facility.

(2) "Nursing home" does not include any of the following:

(a) A county home, county nursing home, or district home operated pursuant to Chapter 5155. of the Revised Code;

(b) A nursing home maintained and operated by the department of veterans services under section 5907.01 of the Revised Code;

(c) A nursing home or part of a nursing home licensed under section 3721.02 or 3721.09 of the Revised Code that is certified as an intermediate care facility for the mentally retarded under Title XIX.

(J) "Title XIX" means Title XIX of the "Social Security Act," 79 Stat. 286 (1965), 42 U.S.C. 1396, as amended.

(K) "Title XVIII" means Title XVIII of the "Social Security Act," 79 Stat. 286 (1965), 42 U.S.C. 1395, as amended.

Sec. 3721.53.  (A) Not later than the fifteenth day of September August of each year, the department of job and family services shall determine the annual franchise permit fee for each nursing home and hospital in accordance with section 3721.51 of the Revised Code and any adjustments made in accordance with sections 3721.512 and 3721.513 of the Revised Code.

(B) Not later than the first day of October September of each year, the department shall mail to each nursing home and hospital notice of the amount of the franchise permit fee that has been determined for the nursing home or hospital.

(C) Each nursing home and hospital shall pay its fee under section 3721.51 of the Revised Code, as adjusted in accordance with sections 3721.512 and 3721.513 of the Revised Code, to the department in four installment payments not later than forty-five days after the last day of each October September, December, March, and June.

(D) No nursing home or hospital shall directly bill its residents for the fee paid under this section, or otherwise directly pass the fee through to its residents.

Section 2.  That existing sections 3721.50 and 3721.53 of the Revised Code are hereby repealed.

Section 3. That Section 309.30.25 of Am. Sub. H.B. 1 of the 128th General Assembly, as amended by Sub. H.B. 198 of the 128th General Assembly, be amended to read as follows:

Sec. 309.30.25. FISCAL YEAR 2011 MEDICAID REIMBURSEMENT SYSTEM FOR NURSING FACILITIES

(A) As used in this section:

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

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

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

(B) Except as otherwise provided by this section, the provider of a nursing facility that has a valid Medicaid provider agreement on June 30, 2010, and a valid Medicaid provider agreement during fiscal year 2011 shall be paid, for nursing facility services the nursing facility provides during fiscal year 2011, the rate calculated for the nursing facility under sections 5111.20 to 5111.33 of the Revised Code with the following adjustments:

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

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

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

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

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

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

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

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

(C) Except as provided in division (G)(F) of this section, if the rate determined for a nursing facility under division (B) of this section for nursing facility services provided during fiscal year 2011 is more than one hundred two and twenty-five hundredths per cent of the nursing facility's fiscal year 2010 partial rate, the Department of Job and Family Services shall reduce the nursing facility's rate determined under division (B) of this section for fiscal year 2011 so that the rate is not more than one hundred two and twenty-five hundredths per cent of the nursing facility's fiscal year 2010 partial rate. Except as provided in division (G)(F) of this section, if the rate determined for a nursing facility under division (B) of this section for nursing facility services provided during fiscal year 2011 is less than ninety-nine per cent of the nursing facility's fiscal year 2010 partial rate, the Department shall increase the nursing facility's rate determined under division (B) of this section for fiscal year 2011 so that the rate is not less than ninety-nine per cent of the nursing facility's fiscal year 2010 partial rate.

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

(E) After the adjustments under divisions (B), (C), and (D) of this section are made to a nursing facility's fiscal year 2011 rate, the Department of Job and Family Services shall increase the nursing facility's fiscal year 2011 rate by five three dollars and seventy ninety-one cents per Medicaid day. This increase shall be known as the workforce development incentive payment consolidated services rate. The total amount of workforce development incentive payments paid to providers of nursing facilities shall be used to improve nursing facilities' employee retention and direct care staffing levels, including by increasing wages paid to nursing facilities' direct care staff. Not later than September 30, 2012, the Department shall submit a report to the Governor and, in accordance with section 101.68 of the Revised Code, the General Assembly detailing the impact that the workforce development incentive payments have on nursing facilities' employee retention, direct care staffing levels, and direct care staff wages.

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

(1) Three dollars and ninety-one cents;

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

(G)(F) If the fiscal year 2010 rate for a nursing facility as initially determined under division (B) of Section 309.30.20 of Am. Sub. H.B. 1 of the 128th General Assembly is not subject to an adjustment under division (C) of that section, the nursing facility's fiscal year 2011 rate as initially determined under division (B) of this section shall not be subject to an adjustment under division (C) of this section regardless of whether the nursing facility's fiscal year 2011 rate as initially determined under division (B) of this section would, if not for this division, be subject to the adjustment.

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

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

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

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

Section 4. That existing Section 309.30.25 of Am. Sub. H.B. 1 of the 128th General Assembly, as amended by Sub. H.B. 198 of the 128th General Assembly, is hereby repealed.

Section 5. That Section 309.30.70 of Am. Sub. H.B. 1 of the 128th General Assembly is hereby repealed.

Section 6. (A) As used in this section:

"ICF/MR" means an intermediate care facility for the mentally retarded as defined in section 5111.20 of the Revised Code.

"ICF/MR services" means services covered by the Medicaid program that an ICF/MR provides to a Medicaid recipient who is eligible for the services.

"Provider" and "provider agreement" have the same meanings as in section 5111.20 of the Revised Code.

(B) The provider of an ICF/MR shall be paid the amount determined for the ICF/MR under sections 5111.20 to 5111.34 of the Revised Code for each month during fiscal year 2011 for which the provider has a valid provider agreement for the ICF/MR and during which the ICF/MR provides ICF/MR services. During fiscal year 2011, the Department of Job and Family Services shall make each monthly payment that is due a provider under this section.

(C) If, pursuant to former Section 309.30.70 of Am. Sub. H.B. 1 of the 128th General Assembly, a provider of an ICF/MR was paid an amount for providing ICF/MR services during a month occurring in fiscal year 2011 and the amount that was paid is less than the amount the provider is to be paid pursuant to division (B) of this section, the Department of Job and Family Services shall pay the provider the difference between the amount that was paid and the amount that is to be paid.

Section 7. (A) As used in this section:

(1) "Franchise permit fee" means the fee imposed by sections 3721.50 to 3721.58 of the Revised Code.

(2) "Hospital" and "nursing home" have the same meanings as in section 3721.50 of the Revised Code.

(B) The Department of Job and Family Services shall redetermine each nursing home's and hospital's franchise permit fee for the last quarter of fiscal year 2010 using a franchise permit fee rate of six dollars and twenty-five cents. The Department shall mail to each nursing home and hospital notice of the redetermination. If, before the effective date of this section, a nursing home or hospital has already paid its franchise permit fee for the last quarter of fiscal year 2010 and the amount the nursing home or hospital paid is higher than the amount redetermined for the nursing home or hospital, the Department shall reimburse the nursing home or hospital the amount of the difference.