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THE SENATE |
S.B. NO. |
1361 |
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THIRTY-SECOND LEGISLATURE, 2023 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO THE NURSING FACILITY SUSTAINABILITY PROGRAM.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
The legislature further finds that, even with this program, nursing facilities in the State face major challenges. These challenges are due in part to the health and financial pressures related to the COVID-19 pandemic. Medicaid is jointly financed by the federal and state governments by statutory formula; the federal government pays between fifty per cent and seventy-four per cent, with assistance levels determined by each state's per capita income. States with the lowest per capita income receive higher federal matching rates. Under federal rules, the state share must be public funds that are not federal funds. The legislature finds that public funding to help sustain Hawaii's nursing facilities financially may be accessed through a provider fee.
The legislature further finds that provider fees exist in forty-nine states and the District of Columbia as a means of drawing down federal funds to sustain their medicaid programs, increasing health care costs, and expanding medicaid enrollment. Provider fees, which are collected from specific categories of health care providers, may be imposed on different classes of health care services, including inpatient and outpatient hospital and nursing facility services.
The legislature therefore finds that, in Hawaii, a provider fee on nursing facilities can result in a substantial increase in medicaid payments, without putting additional constraints on the State's budget. The additional federal funds obtained via the fee program authorized by the nursing facility sustainability program can maintain access to care for medicaid recipients. This will allow nursing facilities in the State to continue to serve under- or uninsured patients in a timely, effective matter. This helps to ensure the overall sustainability of the health care system in the State during the challenging time of the COVID-19 pandemic.
The purpose of this Act is to preserve access to health care for medicaid recipients by continuing indefinitely the nursing facility sustainability fee program and making other nonsubstantive changes for consistency and clarity, appropriating $15,000,000 from the nursing facility sustainability special fund, and continuing exemptions from the central service expenses assessment and the administrative expenses assessment under sections 36-27(a) and 36-30(a), Hawaii Revised Statutes, respectively.
SECTION 2. Section 346F-2, Hawaii Revised Statutes, is amended to read as follows:
"[[]§346F-2[]] Findings and declaration of
necessity. It is the intent of the
legislature to establish a special fund within the state treasury to receive
revenue from the imposition of a nursing facility sustainability fee to
be administered by the department [of human services], which shall use
the revenue from the fee and associated federal medicaid matching funds exclusively
to make payments to nursing facilities and for other purposes as set forth in
this chapter."
SECTION 3. Section 346F-4, Hawaii Revised Statutes, is amended to read as follows:
"§346F-4
Nursing facility sustainability program
special fund. (a) There is created in the state treasury the
nursing facility sustainability program special fund to be administered by the
department into which shall be deposited all moneys collected under this
chapter.
(b) Moneys
in the special fund shall consist of:
(1) All revenues collected or received by the department from the nursing facility sustainability fee as required by this chapter;
[(2) All federal medicaid funds received by
the department as a result of matching expenditures made with the nursing
facility sustainability fees;
(3)] (2) Any interest or penalties levied in
conjunction with the administration of this chapter; and
[(4)] (3) Any designated appropriations, federal
funds, donations, gifts, or moneys from any other sources.
(c) [Revenue]
Moneys from the nursing facility sustainability fee shall be used
exclusively as follows:
(1) No less than eighty-eight per cent of the revenue from the nursing facility sustainability fee shall be used for one or more of the following:
(A) To match federal medicaid funds, with the combined total to be used to enhance capitated rates to medicaid managed care health plans for the purpose of increasing medicaid payments to private nursing facilities to support the availability of services and ensure access to care for the medicaid managed care health plan enrollees; or
(B) To match federal medicaid funds, with
the combined total to enhance capitated rates for the purpose of paying quality
incentives; and
(2) Twelve per cent of the revenue from the
nursing facility sustainability fee may be used by the department for other
departmental purposes[; and
(3) All moneys remaining in the special
fund on June 30, 2024, shall be distributed to nursing facilities within thirty
days in the same proportions as received from the nursing facilities].
(d)
The department shall utilize federal funds derived from state long-term
care facility certified expenditures to make [supplemental] payments to
state long-term care facilities to the extent permitted by federal law. The department may receive intergovernmental
transfers from the state long-term care facilities to support [direct
supplemental] payments and increased capitation rates to health plans for
the benefit of the state long-term care facilities. During any period in which the nursing
facility sustainability fee is in effect, certified expenditures of state
long-term care facilities shall not be used to make or support [direct]
payments to private nursing facilities."
SECTION 4. Section 346F-5, Hawaii Revised Statutes, is amended to read as follows:
"§346F-5 Nursing facility sustainability fee. (a) Effective July 1, 2012, the department shall charge and collect a provider fee on health care items or services provided by nursing facilities.
(b)
The nursing [[]facility[]]
sustainability fee shall be based on the [net patient service revenue] total
resident days of all nursing facilities that are subject to the
sustainability fee, as determined by the department.
(c)
The nursing facility sustainability fee shall not exceed [5.5] 6
per cent of overall net patient service revenue and shall be calculated and
paid on a per resident day basis, unless the facility qualifies for an
exemption identified in subsection (d)(1). The facilities described in subsection (d)(2)
shall pay a reduced daily fee compared to other facilities participating in the
program.
(d) In accordance with the redistribution method set forth in title 42 Code of Federal Regulations section 433.68(e)(1) and (2), the department shall seek a waiver of the broad-based and uniformity provider fee requirements under federal law from which to exclude certain nursing facilities and to permit certain high volume medicaid nursing facilities or facilities with a high number of total annual patient days to pay the sustainability fee at a lesser amount per resident day, as follows:
(1) The department shall exempt the following nursing facility providers from the nursing facility sustainability fee subject to federal approval under title 42 Code of Federal Regulations section 433.68(e)(2):
(A) Nursing facilities with twenty-eight or fewer licensed beds;
(B) Nursing facilities owned, operated by, or affiliated with the Hawaii health systems corporation; and
(C) Continuing care retirement communities.
(2) The department shall reduce the fee for
[high volume medicaid nursing facilities or facilities with high patient
volumes] facilities with high medicaid resident days in order to
meet the redistributive tests of title 42 Code of Federal Regulations section
433.68(e)(2).
(3) The department, [with agreement by]
upon good faith consultation and negotiations with the nursing facility
trade [associations] association located in Hawaii, may modify,
add to, or [reduce the categories of] exclude facilities [exempt
from] in the assessment if necessary to obtain and maintain approval
of the waiver by the Centers for Medicare and Medicaid Services, if the
modification, addition, or exclusion is consistent with the purposes of
this chapter."
SECTION 5. Section 346F-6, Hawaii Revised Statutes, is amended by amending subsection (c) to read as follows:
"(c) The department shall [collect and each
nursing facility shall pay in twelve equal installments] impose a
nursing facility sustainability fee [in section 346F-5 on a monthly basis,
subject to the terms of this section.
The fee shall be due within sixty days after the end of each month, with
the initial payment due on the later of July 31, 2012, or forty-five days after
the required federal approvals for the assessment and any increase in health
plan capitation payments have been secured from the Centers for Medicare and
Medicaid Services.] on a monthly basis, which a nursing facility shall
pay no later than the sixtieth day after the end of the calendar month that the
department imposed the fee; provided that, if required federal approvals have
not been secured by the end of a calendar month, the fees for that month shall
be paid within ten days after the notification to the nursing facilities that
the required approvals have been received."
SECTION 6. Section 346F-9, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:
"(a)
If a nursing facility fails to pay the full amount of the nursing facility
sustainability fee when due, there
shall be added to the fee, unless waived by the department for reasonable cause, a penalty equal to two per cent of the fee
that was not paid when due. Any
subsequent payments shall be credited first to unpaid fee amounts [rather
than to penalty or interest amounts,] beginning with the most delinquent
installment[.] rather than to penalty or interest amounts."
SECTION 7. Section 346F-10, Hawaii Revised Statutes, is amended to read as follows:
"§346F-10 Enhanced rates to medicaid managed care
health plans. (a) In accordance with title 42 Code of Federal
Regulations part 438, the department shall use revenues from the nursing
facility sustainability fee and federal matching funds to enhance the capitated
rates paid to medicaid managed care health plans [for the period of July 1
through December 31, 2021, and calendar years 2022 and 2023,] consistent
with the following objectives:
(1) [The rate enhancement shall be used
exclusively for increasing reimbursements to private nursing facilities to
support the availability of services and to ensure access to care to the
medicaid managed care health plan enrollees;] The department shall use
moneys from the nursing facility sustainability program solely to fulfill the
requirements of section 346F-4(c);
(2) The rate enhancement shall be [made
part of the monthly capitated rates] paid by the department to
medicaid managed care health plans, which shall provide documentation to the
department and the nursing facility trade association located in Hawaii
certifying that the revenues received under paragraph [(1)] (3)
are used in accordance with this section;
(3) The rate enhancement shall be used
exclusively to increase reimbursements to private nursing facilities to support
the availability of services and to ensure access to care for medicaid managed
care health plan enrollees;
[(3)] (4) The rate enhancement shall be actuarially
sound and approved by the federal government for federal fund participation;
[(4)] (5) The department shall modify the
fee-for-service reimbursement rates of the nursing facilities to recognize the
medicaid portion of the nursing facility sustainability fee as an additional
cost of serving medicaid patients, and to provide a uniform percentage increase
in preexisting facility-specific rates; [and]
[(5)] (6) Payments made by the medicaid managed care
health plans shall be made within thirty calendar days upon receipt of [monthly
capitation rates] payment from the department[.]; and
(7) Each medicaid managed health care plan
shall expend 100 per cent of any increased payments it receives under this
section to carry out the goals of this program.
(b) If federal approval pursuant to section
346F-7 is not received until after the end of any month for which the nursing
facility sustainability fee is applicable, the department shall make the
initial monthly payments within five days after receipt of the nursing facility
sustainability fee for the respective month.
(c) To the extent the nursing facility
sustainability program is not effective for the entire year, the nursing
facility sustainability fee, the state medicaid expenses and administrative
fee, and the corresponding payments to fulfill the requirements of section
346F-4(c) shall be based on the proportion of the fiscal year the program is in
effect."
SECTION 8. Section 346F-13, Hawaii Revised Statutes, is amended to read as follows:
"(a) Collection of the nursing facility sustainability fee under section 346F-5 shall be discontinued if:
(1) The waiver in section 346F-7 or the enhanced capitation rates in section 346F-10 have not been approved by the Centers for Medicare and Medicaid Services;
(2) The department reduces [funding for
nursing facility services below the state appropriation in effect on June 30,
2023 2021;] reimbursement rates for private nursing facility services to
medicaid patients with the intention of using the sustainability funds to
supplant the planned or permanent reduction in rates;
(3) The department or any other state agency uses the money in the special fund for any use other than the uses permitted pursuant to this chapter; or
(4) Federal financial participation to match the nursing facility sustainability fee becomes unavailable under federal law. In such case, the department shall terminate the collection of the fee beginning on the effective date of the federal statutory, regulatory, or interpretive change.
(b) If collection of the nursing facility
sustainability fee is discontinued [as provided in this section], any
remaining money in the nursing facility sustainability program special
fund shall be [returned] distributed to the nursing facilities [from
which the fee was collected] within [thirty days] six months of
the date of discontinuation in the same proportions as received from the
nursing facilities."
SECTION 9. Act 156, Session Laws of Hawaii 2012, as amended by section 3 of Act 142, Session Laws of Hawaii 2013, as amended by section 2 of Act 124, Session Laws of Hawaii 2014, as amended by section 2 of Act 69, Session Laws of Hawaii 2015, as amended by section 2 of Act 59, Session Laws of Hawaii 2016, as amended by section 5 of Act 60, Session Laws of Hawaii 2017, as amended by section 6 of Act 163, Session Laws of Hawaii 2019, as amended by section 7 of Act 24, Session Laws of Hawaii 2021, is amended by amending section 5 to read as follows:
"SECTION
5. This Act shall take effect on July 1,
2012[, and shall be repealed on December 31, 2023; provided
that section -4, Hawaii Revised Statutes, established by section 2 of this Act,
and the amendment made to section 36-30(a), Hawaii Revised Statutes, in section
3 of this Act, shall be repealed on June 30, 2024]."
SECTION 10. Act 124, Session Laws of Hawaii 2014, as amended by section 3 of Act 69, Session Laws of Hawaii 2015, as amended by section 3 of Act 59, Session Laws of Hawaii 2016, as amended by section 6 of Act 60, Session Laws of Hawaii 2017, as amended by section 7 of Act 163, Session Laws of Hawaii 2019, as amended by section 8 of Act 24, Session Laws of Hawaii 2021, is amended by amending section 7 to read as follows:
"SECTION
7. This Act shall take effect on June
29, 2014[; provided that:
(1) Section
5 shall take effect on July 1, 2014; and
(2) The
amendments made to sections 36-27(a)
and 36-30(a),Hawaii Revised Statutes, in sections 3 and 4 of this Act shall be
repealed on June 30, 2024]."
SECTION 11. There is appropriated out of the nursing facility sustainability program special fund the sum of $15,000,000 or so much thereof as may be necessary for fiscal year 2023-2024 and the same sum or so much thereof as may be necessary for fiscal year 2024-2025 for uses consistent with section 346F-4, Hawaii Revised Statutes.
The sums appropriated shall be expended by the department of human services for the purposes of this Act.
SECTION 12. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 13. This Act shall take effect upon its approval.
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INTRODUCED BY: |
_____________________________ |
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BY REQUEST |
Report Title:
Nursing Facility Sustainability Program; Appropriation; Department of Human Services
Description:
Making the nursing facility sustainability program and exemptions from the special fund assessments permanent. Make changes to strengthen the nursing facility sustainability program and other nonsubstantive changes for consistency and clarify. Appropriates funds out of the nursing facility sustainability program special fund for fiscal years 2023-2024 and 2024-2025.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.