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H0010........................................................by MR. SPEAKER
Requested by: Department of Health and Welfare
VETERANS HOMES/STATE HOSPITAL SOUTH - Amends existing law to provide that
reimbursement of costs for the nursing facilities at Idaho State Veterans
Homes and State Hospital South shall be based upon medicare reasonable cost
provisions.
01/08 House intro - 1st rdg - to printing
Rpt prt - to Health/Wel
02/13 Rpt out - rec d/p - to 2nd rdg
02/14 2nd rdg - to 3rd rdg
02/16 3rd rdg - PASSED - 43-23-4
AYES -- Barraclough, Bedke, Bell, Bieter, Bolz, Bradford, Bruneel,
Campbell, Chase, Collins, Crow, Cuddy, Deal, Ellsworth, Eskridge,
Field(13), Field(20), Gagner, Gould, Henbest, Jaquet, Jones, Kellogg,
Kunz, Lake, Loertscher, Mader, Montgomery, Mortensen, Moss, Moyle,
Pomeroy, Raybould, Robison, Sellman, Shepherd, Smith, Smylie,
Stevenson, Stone, Swan, Trail, Mr. Speaker
NAYS -- Barrett, Callister, Clark, Denney, Ellis, Hadley, Hammond,
Harwood, Higgins, Hornbeck, Kendell, Langford, McKague, Meyer,
Pearce, Pischner, Ridinger, Roberts, Sali, Schaefer, Tilman, Wood,
Young
Absent and excused -- Black, Boe, Marley, Wheeler
Floor Sponsor -- Henbest
Title apvd - to Senate
02/19 Senate intro - 1st rdg - to Health/Wel
02/22 Rpt out - rec d/p - to 2nd rdg
02/23 2nd rdg - to 3rd rdg
03/13 3rd rdg - PASSED - 33-0-2
AYES -- Andreason, Boatright, Branch(Bartlett), Brandt, Bunderson,
Burtenshaw, Cameron, Danielson, Darrington, Davis, Deide, Dunklin,
Frasure, Geddes, Goedde, Hawkins, Ingram, Ipsen, Keough,
King-Barrutia, Lee, Lodge, Noh, Richardson, Risch, Sandy, Schroeder,
Sims, Sorensen, Stegner, Stennett, Thorne, Wheeler, Whitworth,
Williams,
NAYS -- None
Absent and excused -- Keough, Sims
Floor Sponsor -- Ipsen
Title apvd - to House
03/14 To enrol
03/15 Rpt enrol - Sp signed
03/16 Pres signed
03/19 To Governor
03/20 Governor signed
Session Law Chapter 68
Effective: 07/01/01
|||| LEGISLATURE OF THE STATE OF IDAHO |||| Fifty-sixth Legislature First Regular Session - 2001IN THE HOUSE OF REPRESENTATIVES HOUSE BILL NO. 10 BY MR. SPEAKER Requested by: Department of Health and Welfare 1 AN ACT 2 RELATING TO PAYMENTS FOR SKILLED CARE SERVICES; AMENDING SECTION 56-102, IDAHO 3 CODE, TO PROVIDE AN EXCEPTION TO PAYMENT PRINCIPLES FOR THE IDAHO STATE 4 VETERANS HOMES AND STATE HOSPITAL SOUTH AND TO MAKE TECHNICAL CORRECTIONS. 5 Be It Enacted by the Legislature of the State of Idaho: 6 SECTION 1. That Section 56-102, Idaho Code, be, and the same is hereby 7 amended to read as follows: 8 56-102. PRINCIPLES OF PROSPECTIVE RATES AND PAYMENT. The following prin- 9 ciples shall apply to the reimbursement of freestanding skilled care and 10 hospital-based skilled care facilities, with the exception of the nursing 11 facilities at Idaho state veterans homes and state hospital south, which shall 12 be reimbursed costs based on medicare reasonable cost provisions: 13 (1) Payments to facilities shall be through a prospective cost-based sys- 14 tem which includes facility-specific case mix adjustments. Details of the 15 methodology shall be set forth in rules based on negotiations between the 16 department, the state association(s) representing freestanding skilled care 17 facilities, and the state associations(s) representing hospital-based skilled 18 care facilities. In no event shall reimbursement to any facility exceed the 19 usual and customary charges made to private pay patients; and 20 (2) Each skilled care facility's case mix index shall be calculated quar- 21 terly and rates shall be adjusted based on the case mix of that facility's 22 medicaid residents as of a certain date during the preceding quarter specified 23 in rule; and 24 (3) In state fiscal year 2000, the total amount paid to skilled care 25 facilities shall approximate the same amount in medicaid expenditures as would 26 have been paid using the methodology in effect in state fiscal year 1999, and 27 the percentages of medicaid funds projected to be paid to freestanding skilled 28 care facilities and hospital-based skilled care facilities shall be the same 29 percentages that are projected to be paid using the methodology in effect dur- 30 ing state fiscal year 1999; and 31 (4) The cost limits used for the direct care and indirect care costs of 32 rural hospital-based skilled care facilities shall be higher than the cost 33 limits used for the direct care and indirect care costs of freestanding 34 skilled care and urban hospital-based skilled care facilities; and 35 (5) In computing the direct care per diem rate neither medicaid-related 36 ancillary services nor raw food shall be case-mix adjusted; and 37 (6) Property costs shall not be subject to a cost limitation or incen- 38 tive. Property costs of freestanding skilled care facilities shall be reim- 39 bursed as described in section 56-108, Idaho Code, and property costs of urban 40 and rural hospital-based skilled care facilities shall be reimbursed as 41 described in section 56-120, Idaho Code; and 42 (7) Cost limits shall apply to direct care costs and indirect care costs. 43 The cost limits shall be based on percentages above the bed-weighted median of 2 1 the combined costs of both freestanding skilled care and hospital-based 2 skilled care facilities; and 3 (8) Costs exempt from cost limits are property taxes, property insurance, 4 utilities and costs related to new legal mandates as defined by rule; and 5 (9) An incentive payment shall be paid to those facilities with indirect 6 per diem costs that are less than the established indirect care cost limit. 7 The incentive payment is calculated by taking the difference between the cost 8 limits and the provider's per diem indirect care cost times the incentive 9 percentage. Freestanding skilled care and hospital-based skilled care facili- 10 ties shall receive the same percentage incentive payments for indirect care 11 costs but no incentive payment for direct care costs. The percentage at which 12 the incentive payment will be set shall be based on negotiations between the 13 department, the state association(s) representing freestanding skilled care 14 facilities, and the state association(s) representing hospital-based skilled 15 care facilities; and 16 (10) A newly constructed facility shall be reimbursed at the median rate 17 for skilled care facilities of that type (freestanding or hospital-based) for 18 the first three (3) full years of operation; and 19 (11) A facility adding new beds will have its rates for the three (3) full 20 years following the addition of the beds subjected to an additional reimburse- 21 ment limitation. This limitation will apply beginning with the first rate set- 22 ting period which uses a cost report that includes the date when the beds were 23 added. The facility's rate will be limited to the bed-weighted average of two 24 (2) rates: the facility's rate in effect immediately prior to the rate first 25 subject to the limitation and the median rate for skilled care facilities of 26 that type (freestanding or hospital-based) at the time the beds were added; 27 and 28 (12) A facility acquired prior to the end of that facility's fiscal year 29 will be reimbursed at the rate then in effect for that facility until the next 30 cost report can be used for rate setting. If the department determines that 31 the facility is operationally or financially unstable, the department may 32 negotiate a reimbursement rate different than the rate then in effect for that 33 facility; and 34 (13) If the department determines that a facility is located in an under- 35 served area, or addresses an underserved need, the department may negotiate a 36 reimbursement rate different than the rate then in effect for that facility; 37 and 38 (14) From July 1, 1999, through June 30, 2002, the nursing facility infla- 39 tion rate plus one percent (1%) per year shall be added to the costs reported 40 in a facility's cost report for purposes of setting that facility's rate. The 41 inflation rate to be used effective July 1, 2002, and the period of its use 42 will be based on negotiations between the department, the state association(s) 43 representing freestanding skilled care facilities, and the state 44 association(s) representing hospital-based skilled care facilities; and 45 (15) To control the growth in the cost limits, the increase in the cost 46 limits shall not exceed the skilled nursing facility inflation rate estab- 47 lished by data resources, inc., or its successor, plus two percent (2%) per 48 year for the period from July 1, 1999, through June 30, 2002. The maximum rate 49 of growth in the cost limits to be used effective July 1, 2002, and the period 50 of its use will be based on negotiations between the department, the state 51 association(s) representing freestanding skilled care facilities, and the 52 state association(s) representing hospital-based skilled care facilities; and 53 (16) To control declines in the cost limits, the cost limits for the 54 period from July 1, 1999, through June 30, 2002, shall not be lower than the 55 respective cost limits effective July 1, 1999. The minimum cost limits to be 3 1 used effective July 1, 2002, and the period of its use will be based on nego- 2 tiations between the department, the state association(s) representing 3 freestanding skilled care facilities, and the state association(s) represent- 4 ing hospital-based skilled care facilities; and 5 (17) Rates shall berebasedre-based annually. Rate setting shall be pro- 6 spective with new rates effective July 1 of each year, using the principles 7 applying to skilled care facilities set forth in this chapter and the rules 8 promulgated pursuant to this chapter. There will be no settlement between 9 actual costs incurred during the rate year and the rate itself. Rates will be 10 established using the most recent audited cost report trended forward to the 11 rate year. Rates for skilled care facilities with unaudited cost reports will 12 be interim rates established by the department until a rate is calculated 13 based on an audited cost report. The draft audit of a cost report submitted by 14 a facility shall be issued by the department no later than five (5) months 15 from the date all information required for completion of the audit is filed 16 with the department; and 17 (18) Changes of more than fifty cents (50) per patient day in allowable 18 costs resulting from federal or state law or rule changes shall be treated as 19 costs separate from the cost limitations until such time as they become part 20 of the data used for calculating the cost limits and in cost reports used for 21 rate setting; and 22 (19) If a review of the data submitted by a facility reveals errors that 23 result in an incorrect case mix index, the department may retroactively adjust 24 the facility's rate and pay the facility any amount by which the facility was 25 underpaid or recoup from the facility any amount by which the facility was 26 overpaid; and 27 (20) The rates established under the principles set forth in this section 28 shall be phased in using a combination of the reimbursement methodology in 29 effect as of state fiscal year 1999 and the principles set forth in this sec- 30 tion and in rules based on negotiations between the department, the state 31 association(s) representing freestanding skilled care facilities, and the 32 state association(s) representing hospital-based skilled care facilities. 33 Effective July 1, 2001, the phase-in provisions will no longer apply and the 34 department shall pay rates solely based on the principles set forth in this 35 section and the applicable rules.
STATEMENT OF PURPOSE
RS 10538
During the 2000 session, the Legislature passed intent language for
state fiscal year 2001 to make Idaho State Veterans Homes eligible to
participate as providers in the Medicaid program with exemption from
the cost limits applicable to privately-operated nursing facilities.
The proposed legislation continues the exemption for Idaho State
Veterans Homes from the private facility cost limits and extends it
to the nursing facility at the State Hospital South. These state-
operated facilities will be subject to Medicare reasonable cost
provisions.
FISCAL IMPACT
Increased Medicaid payments to the Veterans facilities of $1,800,000.
70% federal 30% general funds (Annual impact assuming 65% eligibles
without grandfathering existing patients.)
CONTACT
Name: Kathleen Allyn
Agency: Division of Medicaid
Phone: (208) 334-5747
STATEMENT OF PURPOSE/FISCAL NOTE Bill No. H10