BP BHEAD INT S [atlas:bill]

AN ACT Relating to medicaid nursing facility contracting moratorium; and adding a new section to chapter 74.09 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. A new section is added to chapter 74.09 RCW to read as follows:

(1) The legislature finds that alternative placement of residents and potential residents of nursing facilities and utilization of home and community-based long-term care services has reduced the demand for nursing facility capacity in the state, and that the best interest of frail elders and vulnerable adults is served by continuing to decrease their reliance on medically unnecessary nursing facility care in favor of home and community-based long-term care options, which are often preferred over placement in a nursing facility, more responsive to individual needs, and more cost-effective. Accordingly the department is authorized to impose a limited, selective moratorium on new medicaid nursing facility provider contracts, and on the expansion of such contracts, consistent with the principles expressed in subsections (2), (3), and (4) of this section. The department may adopt rules, if necessary, to implement the moratorium and such other measures as may result from initiatives undertaken pursuant to subsection (5) of this section.

(2) The department may refuse to grant a contract, or may refuse to renew or replace a contract, to provide care to medicaid residents at a nursing facility if, at the time application for a contract is made, or at the time the prior contract expires or is terminated for any reason, one or more of the following conditions is met:

(a) The nursing facility is being operated under one or more department-granted waivers and/or exemptions of space, occupancy, equipment, or any other state or federal requirement relating to the building site, the building, or any real property improvement associated with the nursing facility;

(b) The nursing facility has been denied a waiver or exemption of a state or federal requirement relating to the building site, the building, or any real property improvement associated with the nursing facility, and the deficiency leading to application for the waiver or exemption has not been corrected;

(c) The nursing facility has been cited in a past survey for any deficiency relating to the building site, the building, or any real property improvement associated with the facility, and the deficiency has not been corrected;

(d) The contractor whose contract is expiring or being terminated owes funds to the department representing medicaid overpayments from prior settlement periods, erroneous payments, civil fines, or other obligations to the department from any source, and the debt is not secured to the satisfaction of the department in whole or in part; or

(e) The department determines that the community or geographical area served by the nursing facility has adequate community and nursing facility capacity to meet the needs of medicaid recipients without renewing or replacing the expired or terminated contract.

(3) Notwithstanding any condition, agreement, or understanding relating to a certificate of need approval, the department shall not enter a contract with a nursing facility licensee to provide care to medicaid residents at any new nursing facility, and shall not expand such a contract to include increased capacity resulting from a nursing facility capitalized addition or replacement, if all construction permits and approvals are not obtained and actual building or improvement construction is not commenced before July 1, 1997.

(4) The department shall not amend a contract to include any banked or delicensed beds that are not converted back to service before July 1, 1997.

(5) The department, in consultation with the nursing facility industry, is authorized to explore with federal medicaid officials and encouraged to implement, if possible, other ways of limiting or reducing medicaid nursing facility provider contracts, including but not limited to waivers of federal requirements, the employment of selective or competitive bid contracting, and development of managed care programs that include payment for long-term care services, consistent with the needs of medicaid recipients state-wide. The department is further authorized to explore and implement ways of increasing the quality, cost-effectiveness, range of services offered, and general availability of home and community-based long-term care.