3202-S AMH GREE MATC 141
SHB 3202 - H AMD 1592
By Representative Green
NOT CONSIDERED 3/11/2010
On page 1, beginning on line
13, after "have" strike "((seven)) six" and
insert "seven"
On page 1, line 15, after "property," strike "and"
On page 1, line 15, after "allowance" strike
"((, and variable return))" and insert ", and variable
return"
On page 2, at the beginning of line 2, strike "((variable
return,))" and insert "variable return,"
On page 2, line 11, strike "that have set up or use sixty beds or fewer"
On page 2, beginning on line 15, after "use))."
strike all material through "beds." on line 19
On page 9, line 12, after "on ((eighty-five))"
strike "ninety-two" and insert "ninety"
On page 9, line 13, after "occupancy" strike all material through "beds" on line 15
On page 10, line 5, after "providers" strike "or nonessential community providers with sixty beds or fewer"
On page 10, line 22, after "on ((eighty-five))"
strike "ninety-two" and insert "ninety"
On page 10, beginning on line 22, after "occupancy"
strike all material through "occupancy.))" on line 29 and
insert "Effective July 1, 2002, the financing allowance component rate
allocation for all facilities, other than essential community providers, shall
be set by using the greater of a facility's total resident days from the most
recent cost report period or resident days calculated at ninety percent
facility occupancy."
On page 10, line 31, after ".075" insert "for the period of July 1, 2010, through June 30, 2011. Beginning July 1, 2011, a financing factor of .085 shall be applied"
On page 10, line 32, after ".075" insert ", or .085 beginning July 1, 2011,"
On page 11, line 5, after "or ((eighty-five))"
strike "ninety-two" and insert "ninety"
On page 11, beginning on line 6, strike all material through "beds" on line 7
On page 11, line 9, after "providers" strike all material through "beds" on line 10
On page 11, line 14, after "ninety" strike "-two"
On page 12, beginning on line 7, after "providers" strike all material through "beds" on line 8
On page 12, line 8, after "ninety" strike "-two"
On page 14, line 31, after "section." insert "All case mix adjustments for the period October 1, 2010, through June 30, 2011, are frozen, and there shall be no retrospective correction of case mix rates for the period of the freeze."
On page 23, line 12, after "property," strike "and"
On page 23, line 12, after "allowance" strike
"((, and variable return))" and insert ", and variable
return"
On page 23, line 18, after "providers" strike all material through "beds" on line 19
On page 23, line 19, after "ninety" strike "-two"
On page 23, beginning on line 29, after "ninety" strike "-two"
On page 23, line 31, after "ninety" strike "-two"
On page 24, line 3, after "ninety" strike "-two"
On page 24, after line 23, strike all material through "turnover." on line 32 and insert the following:
"The department shall develop recommendations on performance incentives and standards designed to affect the recruitment, training, and retention of staff and the quality of care for residents. The department shall collaborate with representatives of the following groups on these recommendations:
(1) providers;
(2) nursing home residents; and
(3) nursing home workers.
The department shall provide the recommendations of the group to the legislature no later than December 1, 2011."
On page 24, beginning on line 33, strike all of section 10 and insert the following:
"Sec. 10. RCW 74.46.433 and 2006 c 258 s 3 are each amended to read as follows:
(1) The department shall establish for each medicaid nursing facility a variable return component rate allocation. In determining the variable return allowance:
(a) Except as provided in (((e))) (d) of
this subsection, the variable return array and percentage shall be assigned
whenever rebasing of noncapital rate allocations is scheduled under RCW
74.46.431 (4), (5), (6), and (7).
(b) To calculate the array of facilities ((for the
July 1, 2001, rate setting)), the department, without using peer groups,
shall first rank all facilities in numerical order from highest to lowest
according to each facility's examined and documented, but unlidded, combined
direct care, therapy care, support services, and operations per resident day
cost ((from the 1999 cost report period)) from the applicable cost
report period specified in RCW 74.46.431(4)(a). However, before being
combined with other per resident day costs and ranked, a facility's direct care
cost per resident day shall be adjusted to reflect its facility average case
mix index, to be averaged from the four calendar quarters of ((1999)) the
cost report period identified in RCW 74.46.431(4)(a), weighted by the
facility's resident days from each quarter, under RCW 74.46.501(7)(b)(ii). The
array shall then be divided into four quartiles, each containing, as nearly as
possible, an equal number of facilities, and four percent shall be assigned to
facilities in the lowest quartile, three percent to facilities in the next
lowest quartile, two percent to facilities in the next highest quartile, and
one percent to facilities in the highest quartile.
(c) The department shall((, subject to (d) of this
subsection,)) compute the variable return allowance by multiplying a
facility's assigned percentage by the sum of the facility's direct care,
therapy care, support services, and operations component rates determined in
accordance with this chapter and rules adopted by the department.
(d) ((Effective July 1, 2001, if a facility's
examined and documented direct care cost per resident day for the preceding
report year is lower than its average direct care component rate weighted by
medicaid resident days for the same year, the facility's direct care cost shall
be substituted for its July 1, 2001, direct care component rate, and its
variable return component rate shall be determined or adjusted each July 1st by
multiplying the facility's assigned percentage by the sum of the facility's
July 1, 2001, therapy care, support services, and operations component rates,
and its direct care cost per resident day for the preceding year.
(e) Effective July 1, 2006,))
The variable return component rate allocation for each facility shall be one-half of the facility's June 30, 2006, variable return component rate allocation.
(2) The variable return rate allocation calculated in accordance with this section shall be adjusted to the extent necessary to comply with RCW 74.46.421.
Sec. 11. RCW 74.46.485 and 2009 c 570 s 2 are each amended to read as follows:
(1) The department shall:
(a) Employ the resource utilization group III case mix classification methodology. The department shall use the forty-four group index maximizing model for the resource utilization group III grouper version 5.10, but the department may revise or update the classification methodology to reflect advances or refinements in resident assessment or classification, subject to federal requirements; and
(b) Implement minimum data set 3.0 under the authority
of this section and RCW 74.46.431(3). The department must notify nursing home
contractors twenty-eight days in advance the date of implementation of the
minimum data set 3.0. ((In the notification, the department must identify
for all quarterly rate settings following the date of minimum data set 3.0
implementation a previously established quarterly case mix adjustment
established for the quarterly rate settings that will be used for quarterly
case mix calculations in direct care until minimum data set 3.0 is fully
implemented. After the department has fully implemented minimum data set 3.0,
it must adjust any quarter in which it used the previously established
quarterly case mix adjustment using the new minimum data set 3.0 data.))
(2) A default case mix group shall be established for cases in which the resident dies or is discharged for any purpose prior to completion of the resident's initial assessment. The default case mix group and case mix weight for these cases shall be designated by the department.
(3) A default case mix group may also be established for cases in which there is an untimely assessment for the resident. The default case mix group and case mix weight for these cases shall be designated by the department."
Renumber the remaining subsections consecutively and correct any internal references accordingly.
Correct the title.
EFFECT: Variable return is restored as a rate component and funded at 1/2 of the facility's June 30, 2006, allocation.
Restores minimum occupancy to the currently funded level of 90
percent for the operations, property, and finance components.
Temporarily freezes case mix for a nine-month period from October 1, 2010 to June 30, 2011 and requires no retroactive adjustments to that period.
The reduction on the percent change for return on investments in the finance component from 8.5 percent to 7.5 will expire on July
1, 2011.
Removes the provision that authorizes the department to establish a pay-for-performance payment structure.
Adds language that requires a workgroup made up of the department, providers, residents and workers to develop recommendations for performance incentives and standards to affect recruitment, training, and retention of staff.
Restores language that requires the financing component rate
allocation for all facilities other than essential community
providers, to be set by the greater of a facility's total resident days for the cost reports or ninety percent occupancy.
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