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Sub. S. B. No. 264 As Passed by the HouseAs Passed by the House
129th General Assembly | Regular Session | 2011-2012 |
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Cosponsors:
Senators Niehaus, Burke, Lehner, Widener, Patton, Balderson, Beagle, Coley, Daniels, Eklund, Hite, Manning, Sawyer, Schaffer, Smith, Tavares, Wagoner
Representatives Adams, R., Amstutz, Anielski, Antonio, Baker, Blair, Boose, Bubp, Combs, Dovilla, Fende, Garland, Grossman, Hackett, Hill, Hottinger, Johnson, Kozlowski, Letson, Luckie, Lundy, Maag, Mallory, Martin, McClain, McGregor, Milkovich, Newbold, O'Brien, Phillips, Ramos, Ruhl, Sears, Slaby, Slesnick, Sprague, Thompson, Weddington, Young, Yuko
A BILL
To amend sections 173.47, 5111.222, and 5111.244 and
to enact section 5111.245 of the Revised Code and
to amend Section 309.30.70 of Am. Sub. H.B. 153 of
the 129th General Assembly regarding quality
incentive payments and quality bonuses paid to
nursing facilities under the Medicaid program.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 173.47, 5111.222, and 5111.244 be
amended and section 5111.245 of the Revised Code be enacted to
read as follows:
Sec. 173.47. (A) For purposes of publishing the Ohio
long-term care consumer guide, the department of aging shall
conduct or provide for the conduct of an annual customer
satisfaction survey of each long-term care facility. The results
of the surveys may include information obtained from long-term
care facility residents, their families, or both.
A survey that is
to include information obtained from nursing facility residents
shall include the questions specified in divisions (C)(7)(a) and
(b) and (18) of section 5111.244 of the Revised Code. A survey
that is to include information obtained from the families of
nursing facility residents shall include the questions specified
in divisions (C)(8)(a) and (b) and (19) of section 5111.244 of the
Revised Code.
(B) Each long-term care facility shall cooperate in the
conduct of its annual customer satisfaction survey.
Sec. 5111.222. (A) Except as otherwise provided by sections
5111.20 to 5111.331 of the Revised Code and by division (B) of
this section, the payments total rate that the department of job
and family services shall agree to make pay for a fiscal year to
the provider of a nursing facility pursuant to a provider
agreement shall equal the sum of all of the following:
(1) The rate for direct care costs determined for the nursing
facility under section 5111.231 of the Revised Code;
(2) The rate for ancillary and support costs determined for
the nursing facility's ancillary and support cost peer group under
section 5111.24 of the Revised Code;
(3) The rate for tax costs determined for the nursing
facility under section 5111.242 of the Revised Code;
(4) The quality incentive payment paid to the nursing
facility under section 5111.244 of the Revised Code;
(5) The rate for capital costs determined for the nursing
facility's capital costs peer group under section 5111.25 of the
Revised Code.
(B) The department shall adjust the rates otherwise
determined under division (A) of this section as directed by the
general assembly through the enactment of law governing medicaid
payments to providers of nursing facilities, including any law
that establishes factors by which the rates are to be adjusted.
(C) In addition to paying a nursing facility provider the
total rate determined for the nursing facility under division (A)
of this section for a fiscal year, the department shall pay the
provider a quality bonus under section 5111.245 of the Revised
Code for that fiscal year if the provider's nursing facility is a
qualifying nursing facility, as defined in that section, for that
fiscal year. The quality bonus shall not be part of the total
rate.
Sec. 5111.244. (A) As used in this section, "deficiency" and
"standard survey" have the same meanings as in section 5111.35 of
the Revised Code:
(1) "Applicable percentage" means, for the accountability
measures identified in divisions (C)(10) to (13) of this section,
the following:
(a) For fiscal year 2013, whichever of the following applies:
(i) The percentage that the department of job and family
services specifies for an accountability measure pursuant to
division (E)(1)(b) or (E)(2)(a)(ii) of this section;
(ii) The percentage specified for an accountability measure
in division (E)(2)(b), (ii), (iii), (iv), or (v) of this section.
(b) For fiscal year 2014, whichever of the following applies:
(i) The percentage used pursuant to division (F)(2) of this
section;
(ii) The percentage that the department specifies for an
accountability measure pursuant to division (F)(3)(a) of this
section.
(c) For fiscal year 2015 and thereafter, whichever of the
following applies:
(i) The percentage used pursuant to division (F)(2) of this
section;
(ii) The percentage used pursuant to division (F)(3)(b) of
this section.
(2) "Complaint surveys" has the same meaning as in 42 C.F.R.
488.30.
(3) "Customer satisfaction survey" means the annual survey of
long-term care facilities required by section 173.47 of the
Revised Code.
(4) "Deficiency" has the same meaning as in 42 C.F.R.
488.301.
(5) "Family satisfaction survey" means a customer
satisfaction survey, or part of a customer satisfaction survey,
that contains the results of information obtained from the
families of a nursing facility's residents.
(6) "Minimum data set" means the standardized, uniform
comprehensive assessment of nursing facility residents that is
used to identify potential problems, strengths, and preferences of
residents and is part of the resident assessment instrument
required by section 1919(e)(5) of the "Social Security Act," 101
Stat. 1330-197 (1987), 42 U.S.C. 1396r(e)(5), as amended.
(7) "National voluntary consensus standards for nursing
homes" means measures used to determine the quality of care
provided by nursing facilities as endorsed by the national quality
forum.
(8) "Nurse aide" has the same meaning as in section 3721.21
of the Revised Code.
(9) "Resident satisfaction survey" means a customer
satisfaction survey, or part of a customer satisfaction survey,
that contains the results of information obtained from a nursing
facility's residents.
(10) "Room mirror" means a mirror that is located in either
of the following rooms:
(a) A resident bathroom if the sink used by a resident after
the resident uses the resident bathroom is in the resident
bathroom;
(b) A resident's room if the sink used by a resident after
the resident uses the resident bathroom is in the resident's room.
(11) "Room sink" means a sink that is located in either of
the following rooms:
(a) A resident bathroom if the sink used by a resident after
the resident uses the resident bathroom is in the resident
bathroom;
(b) A resident's room if the sink used by a resident after
the resident uses the resident bathroom is in the resident's room.
(12) "Standard survey" has the same meaning as in 42 C.F.R.
488.301.
(B) The (1) Each fiscal year, the department of job and
family services shall pay a quality incentive payment to the
provider of each nursing facility a quality incentive payment that
is awarded one or more points for meeting accountability measures
under division (C) of this section. The Subject to division (B)(2)
of this section, the per medicaid day amount of a quality
incentive payment paid to a provider shall be
based on the
product of the following:
(a) The number of points the provider's nursing facility is
awarded for meeting accountability measures under division (C) of
this section;
(b) Three dollars and twenty-nine cents. The amount of a
quality incentive payment paid to a provider of a nursing facility
that is awarded no points may be zero.
(2) The maximum quality incentive payment that may be paid to
the provider of a nursing facility for a fiscal year shall be
sixteen dollars and forty-four cents per medicaid day.
(C)(1) For fiscal year 2012 only and subject Subject to
division (C)(2) divisions (D), (E), and (F) of this section, the
department shall award each nursing facility participating in the
medicaid program points
one point for meeting each of the
following accountability measures the facility meets:
(a) The facility had no health deficiencies on the facility's
most recent standard survey.
(b) The facility had no health deficiencies with a scope and
severity level greater than E, as determined under nursing
facility certification standards established under Title XIX, on
the facility's most recent standard survey.
(c) The facility's resident satisfaction is above the
statewide average.
(d) The facility's family satisfaction is above the statewide
average.
(e) The number of hours the facility employs nurses is above
the statewide average.
(f) The facility's employee retention rate is above the
average for the facility's peer group established in division (C)
of section 5111.231 of the Revised Code.
(g) The facility's occupancy rate is above the statewide
average.
(h) The facility's case-mix score is above the statewide
average.
(i) The facility's medicaid utilization rate is above the
statewide average.
(2) A nursing facility shall be awarded one point for each of
the accountability measures specified in divisions (C)(1)(a) to
(h) of this section that the nursing facility meets. A nursing
facility shall be awarded three points for meeting the
accountability measure specified in division (C)(1)(i) of this
section. The
(1) The facility's overall score on its resident satisfaction
survey is at least eighty-six.
(2) The facility's overall score on its family satisfaction
survey is at least eighty-eight.
(3) The facility satisfies the requirements for participation
in the advancing excellence in America's nursing homes campaign.
(4) The facility had neither of the following on the
facility's most recent standard survey conducted not later than
the last day of the calendar year preceding the fiscal year for
which the point is to be awarded or any complaint surveys
conducted in the calendar year preceding the fiscal year for which
the point is to be awarded:
(a) A health deficiency with a scope and severity level
greater than F;
(b) A deficiency that constitutes a substandard quality of
care.
(5) The facility offers at least fifty per cent of its
residents at least one of the following dining choices for at
least one meal each day:
(a) Restaurant-style dining in which food is brought from the
food preparation area to residents per the residents' orders;
(b) Buffet-style dining in which residents obtain their own
food, or have the facility's staff bring food to them per the
residents' directions, from the buffet;
(c) Family-style dining in which food is customarily served
on a serving dish and shared by residents;
(d) Open dining in which residents have at least a two-hour
period to choose when to have a meal;
(e) Twenty-four-hour dining in which residents may order
meals from the facility any time of the day.
(6) At least fifty per cent of the facility's residents are
able to take a bath or shower as often as they choose.
(7) The facility has at least both of the following scores on
its resident satisfaction survey:
(a) With regard to the question in the survey regarding
residents' ability to choose when to go to bed in the evening, at
least eighty-nine;
(b) With regard to the question in the survey regarding
residents' ability to choose when to get out of bed in the
morning, at least seventy-six.
(8) The facility has at least both of the following scores on
its family satisfaction survey:
(a) With regard to the question in the survey regarding
residents' ability to choose when to go to bed in the evening, at
least eighty-eight;
(b) With regard to the question in the survey regarding
residents' ability to choose when to get out of bed in the
morning, at least seventy-five.
(9) All of the following apply to the facility:
(a) At least seventy-five per cent of the facility's
residents have the opportunity, following admission to the
facility and before completing or quarterly updating their
individual plans of care, to discuss their goals for the care they
are to receive at the facility, including their preferences for
advance care planning, with a member of the residents' healthcare
teams that the facility, residents, and residents' sponsors
consider appropriate.
(b) The facility records the residents' care goals, including
the residents' advance care planning preferences, in their medical
records.
(c) The facility uses the residents' care goals, including
the residents' advance care planning preferences, in the
development of the residents' individual plans of care.
(10) Not more than the applicable percentage of the
facility's long-stay residents report severe to moderate pain
during the minimum data set assessment process.
(11) Not more than the applicable percentage of the
facility's long-stay, high-risk residents have been assessed as
having one or more stage two, three, or four pressure ulcers
during the minimum data set assessment process.
(12) Not more than the applicable percentage of the
facility's long-stay residents were physically restrained as
reported during the minimum data set assessment process.
(13) Less than the applicable percentage of the facility's
long-stay residents had a urinary tract infection as reported
during the minimum data set assessment process.
(14) The facility uses a tool for tracking residents'
admissions to hospitals.
(15) An average of at least fifty per cent of the facility's
medicaid-certified beds are in private rooms.
(16) The facility has accessible resident bathrooms, all of
which meet at least two of the following standards and at least
some of which meet all of the following standards:
(a) There are room mirrors that are accessible to residents
in wheelchairs, can be adjusted so as to be visible to residents
who are seated or standing, or both.
(b) There are room sinks that are accessible to residents in
wheelchairs and have clearance for wheelchairs.
(c) There are room sinks that have faucets with adaptive or
easy-to-use lever or paddle handles.
(17) The facility does both of the following:
(a) Maintains a written policy that prohibits the use of
overhead paging systems or limits the use of overhead paging
systems to emergencies, as defined in the policy;
(b) Communicates the policy to its staff, residents, and
families of residents.
(18) The facility has a score of at least ninety on its
resident satisfaction survey with regard to the question in the
survey regarding residents' ability to personalize their rooms
with personal belongings.
(19) The facility has a score of at least ninety-five on its
family satisfaction survey with regard to the question in the
survey regarding residents' ability to personalize their rooms
with personal belongings.
(20) The facility does both of the following:
(a) Maintains a written policy that requires consistent
assignment of nurse aides and specifies the goal of having a
resident receive nurse aide care from not more than eight
different nurse aides during a thirty-day period;
(b) Communicates the policy to its staff, residents, and
families of residents.
(21) The facility's staff retention rate is at least
seventy-five per cent.
(22) The facility's turnover rate for nurse aides is not
higher than sixty-five per cent.
(23) For at least fifty per cent of the resident care
conferences in the facility, a nurse aide who is a primary
caregiver for the resident attends and participates in the
conference.
(D)(1) To be awarded a point for meeting an accountability
measure under division (C) of this section other than the
accountability measure identified in division (C)(4) of this
section, a nursing facility must meet the accountability measure
in the calendar year preceding the fiscal year for which the point
is to be awarded. However, a nursing facility must meet the
accountability measures specified in divisions (C)(3), (5), (6),
(9), (14) to (17), (20), (22), and (23) of this section in the
period beginning January 1, 2012, and ending March 31, 2012, to be
awarded points for those accountability measures for fiscal year
2013.
(2) The department shall award points pursuant to division
(C)(1)(c), (7), or (d)(18) of this section to a nursing facility
only if a
survey of resident or family satisfaction survey was
conducted initiated under section 173.47 of the Revised Code for
the nursing facility in the calendar year 2010 preceding the
fiscal year for which the points are to be awarded.
(D)(1) For fiscal year 2013 and thereafter, the department
shall award each nursing facility participating in the medicaid
program points for meeting accountability measures in accordance
with amendments to be made to this section not later than December
31, 2011, that provide for all of the following:
(a) Meaningful accountability measures of quality of care,
quality of life, and nursing facility staffing;
(b) The maximum number of points that a nursing facility may
earn for meeting accountability measures;
(c) A methodology for calculating the quality incentive
payment that recognizes different business and care models in
nursing facilities by providing flexibility in nursing facilities'
ability to earn the entire quality incentive payment;
(d) A quality bonus to be paid at the end of a fiscal year in
a manner that provides for all funds that the general assembly
intends to be used for the quality incentive payment for that
fiscal year are distributed to nursing facilities.
(2) For the purpose of division (D)(1)(d) of this section,
the amount of funds that the general assembly intends to be used
for the quality incentive payment for a fiscal year shall be the
product of the following:
(a) The number of medicaid days in the fiscal year;
(b) The maximum quality incentive payment the general
assembly has specified in law to be paid to nursing facilities for
that fiscal year.
(3) The department shall award points pursuant to division
(C)(2), (8), or (19) of this section to a nursing facility only if
a family satisfaction survey was initiated under section 173.47 of
the Revised Code for the nursing facility in the calendar year
preceding the fiscal year for which the points are to be awarded.
(4) Not later than July 1, 2013, the department shall adjust
the score used for the purpose of division (C)(8)(b) of this
section in a manner that causes at least fifty per cent of nursing
facilities to meet division (C)(8)(b) of this section.
(E) For the purposes of awarding points under divisions
(C)(10) to (13) of this section for fiscal year 2013, the
following apply:
(1) If, by July 1, 2012, the United States centers for
medicare and medicaid services makes calculations using the 3.0
version of the minimum data set that indicate whether nursing
facilities meet those accountability measures, the department
shall do both of the following:
(a) Rely on those calculations;
(b) Specify the percentages to be used for the purposes of
those accountability measures and, in specifying the percentages,
provide for at least fifty per cent of nursing facilities to earn
points for meeting those accountability measures.
(2) If, by July 1, 2012, the United States centers for
medicare and medicaid services does not make calculations using
the 3.0 version of the minimum data set that indicate whether
nursing facilities meet those accountability measures, the
department shall do either of the following:
(a) Do both of the following:
(i) Make the calculations using the 3.0 version of the
minimum data set in accordance with the national voluntary
consensus standards for nursing homes;
(ii) Specify the percentages to be used for the purposes of
those accountability measures and, in specifying the percentages,
provide for at least fifty per cent of nursing facilities to earn
points for meeting those accountability measures.
(b) Do all of the following:
(i) Rely on the most recent calculations the United States
centers for medicare and medicaid services made using the 2.0
version of the minimum data set that indicate whether nursing
facilities meet those accountability measures;
(ii) Use four per cent as the applicable percentage for the
accountability measure identified in division (C)(10) of this
section;
(iii) Use nine per cent as the applicable percentage for the
accountability measure identified in division (C)(11) of this
section;
(iv) Use two per cent as the applicable percentage for the
accountability measure identified in division (C)(12) of this
section;
(v) Use ten per cent as the applicable percentage for the
accountability measure identified in division (C)(13) of this
section.
(F) For the purposes of awarding points under divisions
(C)(10) to (13) of this section for fiscal year 2014 and
thereafter, the department shall do the following:
(1) Rely on calculations the United States centers for
medicare and medicaid services makes using the 3.0 version of the
minimum data set that indicate whether nursing facilities meet
those accountability measures;
(2) If the department takes action pursuant to division
(E)(1) of this section for fiscal year 2013, continue to use the
percentages the department specifies pursuant to division
(E)(1)(b) of this section for the purposes of those accountability
measures;
(3) If the department takes action pursuant to division
(E)(2) of this section for fiscal year 2013, do the following:
(a) For fiscal year 2014, specify the percentages to be used
for the purposes of those accountability measures and, in
specifying the percentages, provide for at least fifty per cent of
nursing facilities to earn points for meeting those accountability
measures;
(b) For fiscal year 2015 and thereafter, continue to use the
percentages the department specifies pursuant to division
(F)(3)(a) of this section for the purposes of those accountability
measures.
(G) The director of job and family services shall adopt rules
under section 5111.02 of the Revised Code as necessary to
implement this section.
The rules may specify what is meant by "some" as that word is
used in division (C)(16) of this section.
Sec. 5111.245. (A) As used in this section:
(1) "Point days for a fiscal year" means the product of the
following:
(a) A qualifying nursing facility's quality bonus points for
the fiscal year;
(b) The number of the qualifying nursing facility's medicaid
days in the fiscal year.
(2) "Qualifying nursing facility" means a nursing facility
that qualifies for a quality bonus for a fiscal year as determined
under division (B) of this section.
(3) "Quality bonus points for a fiscal year" means the amount
determined by subtracting five from the number of points awarded
to a qualifying nursing facility under division (C) of section
5111.244 of the Revised Code for a fiscal year.
(4) "Residual budgeted amount for quality incentive payments
for a fiscal year" means the amount determined for a fiscal year
as follows:
(a) Multiply the total number of medicaid days in the fiscal
year by sixteen dollars and forty-four cents;
(b) Determine the total amount of quality incentive payments
that was paid under section 5111.244 of the Revised Code to all
nursing facility providers for the fiscal year;
(c) Subtract the amount determined under division (A)(4)(b)
of this section from the product calculated under division
(A)(4)(a) of this section.
(B) The department of job and family services shall pay a
nursing facility provider a quality bonus for a fiscal year if
both of the following apply:
(1) The provider's nursing facility is awarded more than five
points under division (C) of section 5111.244 of the Revised Code
for the fiscal year.
(2) The residual budgeted amount for quality incentive
payments for the fiscal year is greater than zero.
(C) The total quality bonus to be paid to the provider of a
qualifying nursing facility for a fiscal year shall equal the
product of the following:
(1) The quality bonus per medicaid day for the fiscal year
determined for the provider's qualifying nursing facility under
division (D) of this section;
(2) The number of the qualifying nursing facility's medicaid
days in the fiscal year.
(D) A qualifying nursing facility's quality bonus per
medicaid day for a fiscal year shall be the product of the
following:
(1) The nursing facility's quality bonus points for the
fiscal year;
(2) The quality bonus per point for the fiscal year
determined under division (E) of this section.
(E) The quality bonus per point for a fiscal year shall be
determined as follows:
(1) Determine the number of each qualifying nursing
facility's point days for the fiscal year;
(2) Determine the sum of all qualifying nursing facilities'
point days for the fiscal year;
(3) Divide the residual budgeted amount for quality incentive
payments for the fiscal year by the sum determined under division
(E)(2) of this section.
(F) The calculation of a qualifying nursing facility's bonus
payment is not subject to appeal under Chapter 119. of the Revised
Code.
(G) The director of job and family services may adopt rules
under section 5111.02 of the Revised Code as necessary to
implement this section.
Section 2. That existing sections 173.47, 5111.222, and
5111.244 of the Revised Code are hereby repealed.
Section 3. That Section 309.30.70 of Am. Sub. H.B. 153 of the
129th General Assembly be amended to read as follows:
Sec. 309.30.70. FISCAL YEAR 2013 MEDICAID REIMBURSEMENT
SYSTEM FOR NURSING FACILITIES
(A) As used in this section:
"Franchise permit fee," "Medicaid days," "nursing facility,"
and "provider" have the same meanings as in section 5111.20 of the
Revised Code.
"Low resource utilization resident" means a Medicaid
recipient residing in a nursing facility who, for purposes of
calculating the nursing facility's Medicaid reimbursement rate for
direct care costs, is placed in either of the two lowest resource
utilization groups, excluding any resource utilization group that
is a default group used for residents with incomplete assessment
data.
"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, 2012, and a valid Medicaid provider
agreement during fiscal year 2013 shall be paid, for nursing
facility services the nursing facility provides during fiscal year
2013, the rate calculated for the nursing facility under sections
5111.20 to 5111.331 of the Revised Code with the following
adjustments:
(1) The, except that the cost per 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 increased by
5.08 per cent;
(2) The maximum quality incentive payment made under section
5111.244 of the Revised Code shall be $16.44 per Medicaid day.
(C) The rate determined under division (B) of this section
shall not be paid for nursing facility services provided to low
resource utilization residents. Except as provided in division (D)
of this section, the provider of a nursing facility that has a
valid Medicaid provider agreement on June 30, 2012, and a valid
Medicaid provider agreement during fiscal year 2013 shall be paid,
for nursing facility services the nursing facility provides during
fiscal year 2013 to low resource utilization residents, $130.00
per Medicaid day.
(D) If the franchise permit fee must be reduced or eliminated
to comply with federal law, 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.
(E) 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, 2012, and a valid Medicaid provider agreement during
fiscal year 2013 notwithstanding anything to the contrary in
sections 5111.20 to 5111.331 of the Revised Code.
Section 4. That existing Section 309.30.70 of Am. Sub. H.B.
153 of the 129th General Assembly is hereby repealed.
Section 5. Sections 1 to 4 of this act shall take effect July
1, 2012.
Section 6. It is the intent of the General Assembly
periodically to amend section 5111.244 of the Revised Code in a
manner that increasingly provides for the quality incentive
payments paid under that section to serve as opportunities for
nursing facilities to earn portions of their total Medicaid rates
by satisfying accountability measures and therefore help
differentiate higher-quality nursing facilities from lower-quality
nursing facilities.
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