ESSB 5581 -
By Representative Alexander
FAILED 05/17/2011
Strike everything after the enacting clause and insert the following:
"NEW SECTION. Sec. 1 A new section is added to chapter 18.51 RCW
to read as follows:
A nursing home that has voluntarily reduced its bed capacity for
lesser acuity purposes under RCW 70.38.111(8) may assign qualified
staff to perform duties concurrently in both the nursing home units of
the facility as well as the units with beds converted to the alternate
use. Staffing levels must comply with the department's standards for
the highest care need category of patient in each unit.
Sec. 2 RCW 74.46.431 and 2010 1st sp.s. c 34 s 3 are each amended
to read as follows:
(1) Nursing facility medicaid payment rate allocations shall be
facility-specific and shall have seven components: Direct care,
therapy care, support services, operations, property, financing
allowance, and variable return. The department shall establish and
adjust each of these components, as provided in this section and
elsewhere in this chapter, for each medicaid nursing facility in this
state.
(2) Component rate allocations in therapy care and support services
for all facilities shall be based upon a minimum facility occupancy of
eighty-five percent of licensed beds, regardless of how many beds are
set up or in use. Component rate allocations in operations, property,
and financing allowance for essential community providers shall be
based upon a minimum facility occupancy of ((eighty-five)) eighty
percent of licensed beds, regardless of how many beds are set up or in
use. Component rate allocations in operations, property, and financing
allowance for small nonessential community providers shall be based
upon a minimum facility occupancy of ninety percent of licensed beds,
regardless of how many beds are set up or in use. Component rate
allocations in operations, property, and financing allowance for large
nonessential community providers shall be based upon a minimum facility
occupancy of ninety-two percent of licensed beds, regardless of how
many beds are set up or in use. For all facilities, the component rate
allocation in direct care shall be based upon actual facility
occupancy. The median cost limits used to set component rate
allocations shall be based on the applicable minimum occupancy
percentage. In determining each facility's therapy care component rate
allocation under RCW 74.46.511, the department shall apply the
applicable minimum facility occupancy adjustment before creating the
array of facilities' adjusted therapy costs per adjusted resident day.
In determining each facility's support services component rate
allocation under RCW 74.46.515(3), the department shall apply the
applicable minimum facility occupancy adjustment before creating the
array of facilities' adjusted support services costs per adjusted
resident day. In determining each facility's operations component rate
allocation under RCW 74.46.521(3), the department shall apply the
minimum facility occupancy adjustment before creating the array of
facilities' adjusted general operations costs per adjusted resident
day.
(3) Information and data sources used in determining medicaid
payment rate allocations, including formulas, procedures, cost report
periods, resident assessment instrument formats, resident assessment
methodologies, and resident classification and case mix weighting
methodologies, may be substituted or altered from time to time as
determined by the department.
(4)(a) Direct care component rate allocations shall be established
using adjusted cost report data covering at least six months.
Effective July 1, 2009, the direct care component rate allocation shall
be rebased, using the adjusted cost report data for the calendar year
two years immediately preceding the rate rebase period, so that
adjusted cost report data for calendar year 2007 is used for July 1,
2009, through June 30, 2012. Beginning July 1, 2012, the direct care
component rate allocation shall be rebased biennially during every
even-numbered year thereafter using adjusted cost report data from two
years prior to the rebase period, so adjusted cost report data for
calendar year 2010 is used for July 1, 2012, through June 30, 2014, and
so forth.
(b) Direct care component rate allocations established in
accordance with this chapter shall be adjusted annually for economic
trends and conditions by a factor or factors defined in the biennial
appropriations act. The economic trends and conditions factor or
factors defined in the biennial appropriations act shall not be
compounded with the economic trends and conditions factor or factors
defined in any other biennial appropriations acts before applying it to
the direct care component rate allocation established in accordance
with this chapter. When no economic trends and conditions factor or
factors for either fiscal year are defined in a biennial appropriations
act, no economic trends and conditions factor or factors defined in any
earlier biennial appropriations act shall be applied solely or
compounded to the direct care component rate allocation established in
accordance with this chapter.
(5)(a) Therapy care component rate allocations shall be established
using adjusted cost report data covering at least six months.
Effective July 1, 2009, the therapy care component rate allocation
shall be cost rebased, so that adjusted cost report data for calendar
year 2007 is used for July 1, 2009, through June 30, 2012. Beginning
July 1, 2012, the therapy care component rate allocation shall be
rebased biennially during every even-numbered year thereafter using
adjusted cost report data from two years prior to the rebase period, so
adjusted cost report data for calendar year 2010 is used for July 1,
2012, through June 30, 2014, and so forth.
(b) Therapy care component rate allocations established in
accordance with this chapter shall be adjusted annually for economic
trends and conditions by a factor or factors defined in the biennial
appropriations act. The economic trends and conditions factor or
factors defined in the biennial appropriations act shall not be
compounded with the economic trends and conditions factor or factors
defined in any other biennial appropriations acts before applying it to
the therapy care component rate allocation established in accordance
with this chapter. When no economic trends and conditions factor or
factors for either fiscal year are defined in a biennial appropriations
act, no economic trends and conditions factor or factors defined in any
earlier biennial appropriations act shall be applied solely or
compounded to the therapy care component rate allocation established in
accordance with this chapter.
(6)(a) Support services component rate allocations shall be
established using adjusted cost report data covering at least six
months. Effective July 1, 2009, the support services component rate
allocation shall be cost rebased, so that adjusted cost report data for
calendar year 2007 is used for July 1, 2009, through June 30, 2012.
Beginning July 1, 2012, the support services component rate allocation
shall be rebased biennially during every even-numbered year thereafter
using adjusted cost report data from two years prior to the rebase
period, so adjusted cost report data for calendar year 2010 is used for
July 1, 2012, through June 30, 2014, and so forth.
(b) Support services component rate allocations established in
accordance with this chapter shall be adjusted annually for economic
trends and conditions by a factor or factors defined in the biennial
appropriations act. The economic trends and conditions factor or
factors defined in the biennial appropriations act shall not be
compounded with the economic trends and conditions factor or factors
defined in any other biennial appropriations acts before applying it to
the support services component rate allocation established in
accordance with this chapter. When no economic trends and conditions
factor or factors for either fiscal year are defined in a biennial
appropriations act, no economic trends and conditions factor or factors
defined in any earlier biennial appropriations act shall be applied
solely or compounded to the support services component rate allocation
established in accordance with this chapter.
(7)(a) Operations component rate allocations shall be established
using adjusted cost report data covering at least six months.
Effective July 1, 2009, the operations component rate allocation shall
be cost rebased, so that adjusted cost report data for calendar year
2007 is used for July 1, 2009, through June 30, 2012. Beginning July
1, 2012, the operations care component rate allocation shall be rebased
biennially during every even-numbered year thereafter using adjusted
cost report data from two years prior to the rebase period, so adjusted
cost report data for calendar year 2010 is used for July 1, 2012,
through June 30, 2014, and so forth.
(b) Operations component rate allocations established in accordance
with this chapter shall be adjusted annually for economic trends and
conditions by a factor or factors defined in the biennial
appropriations act. The economic trends and conditions factor or
factors defined in the biennial appropriations act shall not be
compounded with the economic trends and conditions factor or factors
defined in any other biennial appropriations acts before applying it to
the operations component rate allocation established in accordance with
this chapter. When no economic trends and conditions factor or factors
for either fiscal year are defined in a biennial appropriations act, no
economic trends and conditions factor or factors defined in any earlier
biennial appropriations act shall be applied solely or compounded to
the operations component rate allocation established in accordance with
this chapter.
(8) Total payment rates under the nursing facility medicaid payment
system shall not exceed facility rates charged to the general public
for comparable services.
(9) The department shall establish in rule procedures, principles,
and conditions for determining component rate allocations for
facilities in circumstances not directly addressed by this chapter,
including but not limited to: Inflation adjustments for partial-period
cost report data, newly constructed facilities, existing facilities
entering the medicaid program for the first time or after a period of
absence from the program, existing facilities with expanded new bed
capacity, existing medicaid facilities following a change of ownership
of the nursing facility business, facilities temporarily reducing the
number of set-up beds during a remodel, facilities having less than six
months of either resident assessment, cost report data, or both, under
the current contractor prior to rate setting, and other circumstances.
(10) The department shall establish in rule procedures, principles,
and conditions, including necessary threshold costs, for adjusting
rates to reflect capital improvements or new requirements imposed by
the department or the federal government. Any such rate adjustments
are subject to the provisions of RCW 74.46.421.
(11) Effective July 1, 2010, there shall be no rate adjustment for
facilities with banked beds. For purposes of calculating minimum
occupancy, licensed beds include any beds banked under chapter 70.38
RCW.
(12) Facilities obtaining a certificate of need or a certificate of
need exemption under chapter 70.38 RCW after June 30, 2001, must have
a certificate of capital authorization in order for (a) the
depreciation resulting from the capitalized addition to be included in
calculation of the facility's property component rate allocation; and
(b) the net invested funds associated with the capitalized addition to
be included in calculation of the facility's financing allowance rate
allocation.
Sec. 3 RCW 74.46.435 and 2010 1st sp.s. c 34 s 5 are each amended
to read as follows:
(1) The property component rate allocation for each facility shall
be determined by dividing the sum of the reported allowable prior
period actual depreciation, subject to department rule, adjusted for
any capitalized additions or replacements approved by the department,
and the retained savings from such cost center, by the greater of a
facility's total resident days in the prior period or resident days as
calculated on ((eighty-five)) eighty percent facility occupancy for
essential community providers, ninety percent occupancy for small
nonessential community providers, or ninety-two percent facility
occupancy for large nonessential community providers. If a capitalized
addition or retirement of an asset will result in a different licensed
bed capacity during the ensuing period, the prior period total resident
days used in computing the property component rate shall be adjusted to
anticipated resident day level.
(2) A nursing facility's property component rate allocation shall
be rebased annually, effective July 1st, in accordance with this
section and this chapter.
(3) When a certificate of need for a new facility is requested, the
department, in reaching its decision, shall take into consideration
per-bed land and building construction costs for the facility which
shall not exceed a maximum to be established by the secretary.
(4) The property component rate allocations calculated in
accordance with this section shall be adjusted to the extent necessary
to comply with RCW 74.46.421.
Sec. 4 RCW 74.46.521 and 2010 1st sp.s. c 34 s 16 are each
amended to read as follows:
(1) The operations component rate allocation corresponds to the
general operation of a nursing facility for one resident for one day,
including but not limited to management, administration, utilities,
office supplies, accounting and bookkeeping, minor building
maintenance, minor equipment repairs and replacements, and other
supplies and services, exclusive of direct care, therapy care, support
services, property, financing allowance, and variable return.
(2) The department shall determine each medicaid nursing facility's
operations component rate allocation using cost report data specified
by RCW 74.46.431(7)(a). Operations component rates for essential
community providers shall be based upon a minimum occupancy of
((eighty-five)) eighty percent of licensed beds. Operations component
rates for small nonessential community providers shall be based upon a
minimum occupancy of ninety percent of licensed beds. Operations
component rates for large nonessential community providers shall be
based upon a minimum occupancy of ninety-two percent of licensed beds.
(3) For all calculations and adjustments in this subsection, the
department shall use the greater of the facility's actual occupancy or
an imputed occupancy equal to ((eighty-five)) eighty percent for
essential community providers, ninety percent for small nonessential
community providers, or ninety-two percent for large nonessential
community providers. To determine each facility's operations component
rate the department shall:
(a) Array facilities' adjusted general operations costs per
adjusted resident day, as determined by dividing each facility's total
allowable operations cost by its adjusted resident days for the same
report period for facilities located within urban counties and for
those located within nonurban counties and determine the median
adjusted cost for each peer group;
(b) Set each facility's operations component rate at the lower of:
(i) The facility's per resident day adjusted operations costs from
the applicable cost report period adjusted if necessary for minimum
occupancy; or
(ii) The adjusted median per resident day general operations cost
for that facility's peer group, urban counties or nonurban counties;
and
(c) Adjust each facility's operations component rate for economic
trends and conditions as provided in RCW 74.46.431(7)(b).
(4) The operations component rate allocations calculated in
accordance with this section shall be adjusted to the extent necessary
to comply with RCW 74.46.421.
NEW SECTION. Sec. 5 It is the intent of the legislature to
encourage maximization of financial resources eligible and available
for nursing home residents by establishing a quality incentive payment
system through a temporary nursing home licensing fee surcharge that
will ensure better quality nursing facility care for all residents, and
which may also be used to secure additional federal matching funds
under federally prescribed programs available through the state
medicaid plan. The legislature intends to refund any excess fee
collections if funding is not sufficient to support the payments
provided in this act or if federal financial participation is not
received.
NEW SECTION. Sec. 6 The definitions in this section apply
throughout this chapter unless the context clearly requires otherwise.
(1) "Department" means the department of social and health
services.
(2) "Fund" means the nursing facility quality assurance trust fund
created in section 7 of this act.
(3) "Hospital-based" means a nursing facility that is part of, or
a related organization of, a hospital. For the purposes of this
subsection, "related organization" means an entity which is under
common ownership or control with, or has control of, or is controlled
by, the entity that has a contract with the department to provide
nursing facility services to medicaid recipients.
(4) "Low medicaid nursing facility" means a nursing facility with
less than or equal to one hundred medicaid resident days in fiscal year
2009.
(5) "Medicare patient day" means a patient day for medicare
beneficiaries on a medicare part A stay, medicare hospice stay, and a
patient day for persons who have opted for managed care coverage using
their medicare benefit.
(6) "Nonexempt nursing facility" means a nursing facility that is
not exempt from the licensing fee surcharge under section 8 of this
act.
(7) "Nursing facility" has the same meaning as "nursing home" in
RCW 18.51.010.
(8) "Resident day" means a calendar day of care provided to a
nursing facility resident, excluding medicare patient days. Resident
days include the day of admission and exclude the day of discharge. An
admission and discharge on the same day count as one day of care.
Resident days include nursing facility hospice days and exclude bedhold
days for all residents.
NEW SECTION. Sec. 7 (1) There is hereby established in the state
treasury the nursing facility quality assurance trust fund.
(2) The nursing facility quality assurance trust fund must be a
separate and continuing fund, and no money in the fund reverts to the
state general fund at any time. The legislature may not appropriate
funds from the trust fund inconsistent with this section unless
approved by an affirmative vote of at least two-thirds of the members
of each house of the legislature. The interest and income on the money
in the fund, after deducting any applicable charges, must be credited
to the fund. Disbursements from the fund must be made in the omnibus
appropriations act consistent with this section.
(3) Any money received under section 8 of this act must be
deposited in the state treasury for credit to the nursing facility
quality assurance trust fund, and must be expended in accordance with
this chapter. To the extent authorized by federal law, money in the
fund may be used to obtain federal financial participation in the
medicaid program to maintain and enhance nursing facility rates in a
manner set forth in subsection (6) of this section.
(4) Disbursements from the nursing facility quality assurance trust
fund must only be used for the following:
(a) As an immediate pass-through or rate add-on to reimburse the
medicaid share of the nursing facility licensing fee surcharge as a
medicaid allowable cost;
(b) To make medicaid payments for nursing facility services in an
amount sufficient for maintenance and enhancement of the medicaid
nursing home rates paid on June 30, 2010; for subsequent enhancement of
the medicaid nursing home rate settings; and for funding new standards
imposed by the federal government;
(c) For quality incentive payments to a nursing facility developed
under section 12 of this act; and
(d) If federal financial participation in the medicaid program is
received by the state, to lower or refund the nursing facility
licensing fee surcharge.
(5) To administer the provisions of this chapter the department may
expend an amount not to exceed one-half of one percent of the money
received from the surcharges assessed, and must not exceed the amount
authorized for expenditure by the legislature for administrative
expenses in a fiscal year.
(6) Any positive balance in the fund at the end of a fiscal year
must be refunded to nursing facilities in proportion to the amounts
paid by such facilities.
(7) Expenditures from the nursing facility quality assurance trust
fund may not be included in the calculation of the annual statewide
weighted average nursing facility payment rate for the purposes of
implementing the provisions of RCW 74.46.421(4).
NEW SECTION. Sec. 8 (1) Annually, at the time of the billing for
the licensing fee under RCW 18.51.050, the department must collect from
all nonexempt nursing facilities a nursing facility licensing fee
surcharge of up to three hundred seventy-five percent of the licensing
fee established in RCW 18.51.050 excluding medicare patient days. The
department must provide an option for nursing facilities to pay the
licensing fee surcharge on a quarterly or monthly basis.
(2) All licensing fee surcharges collected pursuant to this section
by the department must be transmitted to the state treasurer who must
credit all such amounts to the nursing facility quality assurance trust
fund created in section 7 of this act.
(3) In accordance with the redistribution method set forth in 42
C.F.R. Sec. 433.68(e)(1) and (2), the department must seek a waiver of
the broad-based and uniform provider assessment requirements of federal
law to exclude certain nursing facilities from the licensing fee
surcharge. The department shall exempt the following nursing facility
providers from the licensing fee surcharge subject to federal approval:
(a) Nursing facilities operated by any agency of the state of
Washington;
(b) Nursing facilities operated by a public hospital district or
that are hospital-based; and
(c) As many nursing facilities with no or disproportionately low
numbers of medicaid-funded residents, as within the judgment of the
department, may be exempted from the licensing fee surcharge pursuant
to federal law.
(4) To the extent necessary to obtain federal approval, the
exemptions prescribed in subsection (3) of this section may be amended
by the department.
NEW SECTION. Sec. 9 (1) As of the effective date of this
section, the department, in cooperation with the office of financial
management, may adjust the fee amounts under section 8 of this act as
follows:
(a) If sufficient other funds for nursing facilities are available
to support the reimbursement rates and other payments under section 7
of this act without utilizing the full surcharge authorized under
section 8 of this act, the department must reduce the amount of the fee
to the minimum level necessary to support those reimbursement rates and
other payments.
(b) Any positive balance remaining in the fund at the end of the
fiscal year must be refunded to nursing facilities in proportion to the
amounts paid by such facilities.
(c) Any adjustment to the fee amounts pursuant to this subsection,
and the data supporting such adjustment, including but not limited to
relevant data listed in subsection (2) of this section, must be
submitted to the Washington health care association, and aging services
of Washington, for review and comment at least sixty calendar days
prior to implementation of such adjusted fee amounts. Any review and
comment provided by the Washington health care association, and aging
services of Washington, may not limit the ability of either association
or its members to challenge an adjustment or other action by the
department that is not made in accordance with this chapter.
(2) By November 30th of each year, the department must provide the
following data to the Washington health care association, and aging
services of Washington:
(a) The fund balance; and
(b) The amount of fee surcharges paid by each nursing facility.
NEW SECTION. Sec. 10 (1) For fiscal years 2012 and 2013 and
subject to appropriation, the department shall do a comparative
analysis of the facility-based payment rates calculated on July 1,
2011, using the payment methodology defined in chapter 74.46 RCW,
section 1 of this act, and RCW 74.46.431, 74.46.435, and 74.46.521, to
the facility-based payment rates in effect June 30, 2010. If the
facility-based payment rate calculated on July 1, 2011, is smaller than
the facility-based payment rate on June 30, 2011, the difference shall
be provided to the individual nursing facilities as an add-on payment
per medicaid resident day.
(2) To the extent that the revenue from the licensing fee surcharge
established in section 8 of this act exceeds the revenue needed to pay
the supplemental rate defined in subsection (1) of this section,
funding shall be allocated to a direct care add-on rate. During the
comparative analysis performed in subsection (1) of this section, if it
is found that the direct care rate for any facility would be greater at
the July 1, 2011, rate than the direct care rate in effect on June 30,
2010, then the facility shall receive a proportionate share of the
additional revenue as a rate add-on to compensate that facility for
taking on more acute clients than they have in the past. At no time
shall the rate add-on defined in this subsection exceed the revenue
collected under the facility licensing fee surcharge as defined in
section 8 of this act.
(3) The rate add-on provided in subsection (2) of this section is
subject to the reconciliation and settlement process provided in RCW
74.46.022(6).
NEW SECTION. Sec. 11 (1) The imposition, collection, and
disbursement of funds under this chapter become null and void if:
(a) Funding in the omnibus appropriations act does not fully
support the rates and quality incentive payments established in this
chapter for the upcoming fiscal year;
(b) Federal financial participation in the medicaid program is not
received by the state; or
(c) The waiver request under section 8(3) of this act is not
approved.
(2) This chapter does not take effect or ceases to be imposed, and
any moneys remaining in the fund must be refunded to nursing facilities
in proportion to the amounts paid by such facilities, if and to the
extent that an appellate court or the centers for medicare and medicaid
services makes a final determination that any element of this chapter
cannot be validly implemented.
NEW SECTION. Sec. 12 (1) The department, the department of
health, the Washington state health care association, and aging
services of Washington must design a system of nursing facility quality
incentive payments. The system must be based upon the following
principles:
(a) Evidence-based treatment and processes must be used to improve
health care outcomes for all nursing facility residents;
(b) Effective purchasing strategies to improve the quality of
health care services should involve the use of common quality
improvement measures, while recognizing that some measures may not be
appropriate for application to facilities with high bariatric,
behaviorally challenged, or rehabilitation populations;
(c) Quality measures chosen for the system should be consistent
with the standards that have been developed by national quality
improvement organizations, such as the national quality forum, the
federal centers for medicare and medicaid services, or the federal
agency for healthcare research and quality. New reporting burdens to
nursing facilities should be minimized by giving priority to measures
that nursing facilities are currently required to report to
governmental agencies, such as the nursing home compare measures
collected by the federal centers for medicare and medicaid services;
(d) Benchmarks for each quality improvement measure should be set
at levels that are feasible for nursing facilities to achieve, yet
represent real improvements in quality and performance for a majority
of nursing facilities in Washington state; and
(e) Nursing facilities performance and incentive payments should be
designed in a manner such that all facilities in Washington are able to
receive the incentive payments if performance is at or above the
benchmark score set in the system established under this section.
(2) Upon satisfaction of the applicable conditions set forth in
section 11 of this act, and for state fiscal year 2013 and each fiscal
year thereafter, fees may be used to support an additional three
percent increase in nursing facility reimbursement rates for facilities
that meet the quality incentive benchmarks established under this
section.
Sec. 13 RCW 43.84.092 and 2011 c 339 s 1, 2011 c 311 s 9, 2011 c
272 s 3, 2011 c 120 s 3, and 2011 c 83 s 7 are each reenacted and
amended to read as follows:
(1) All earnings of investments of surplus balances in the state
treasury shall be deposited to the treasury income account, which
account is hereby established in the state treasury.
(2) The treasury income account shall be utilized to pay or receive
funds associated with federal programs as required by the federal cash
management improvement act of 1990. The treasury income account is
subject in all respects to chapter 43.88 RCW, but no appropriation is
required for refunds or allocations of interest earnings required by
the cash management improvement act. Refunds of interest to the
federal treasury required under the cash management improvement act
fall under RCW 43.88.180 and shall not require appropriation. The
office of financial management shall determine the amounts due to or
from the federal government pursuant to the cash management improvement
act. The office of financial management may direct transfers of funds
between accounts as deemed necessary to implement the provisions of the
cash management improvement act, and this subsection. Refunds or
allocations shall occur prior to the distributions of earnings set
forth in subsection (4) of this section.
(3) Except for the provisions of RCW 43.84.160, the treasury income
account may be utilized for the payment of purchased banking services
on behalf of treasury funds including, but not limited to, depository,
safekeeping, and disbursement functions for the state treasury and
affected state agencies. The treasury income account is subject in all
respects to chapter 43.88 RCW, but no appropriation is required for
payments to financial institutions. Payments shall occur prior to
distribution of earnings set forth in subsection (4) of this section.
(4) Monthly, the state treasurer shall distribute the earnings
credited to the treasury income account. The state treasurer shall
credit the general fund with all the earnings credited to the treasury
income account except:
(a) The following accounts and funds shall receive their
proportionate share of earnings based upon each account's and fund's
average daily balance for the period: The aeronautics account, the
aircraft search and rescue account, the budget stabilization account,
the capitol building construction account, the Cedar River channel
construction and operation account, the Central Washington University
capital projects account, the charitable, educational, penal and
reformatory institutions account, the cleanup settlement account, the
Columbia river basin water supply development account, the Columbia
river basin taxable bond water supply development account, the Columbia
river basin water supply revenue recovery account, the common school
construction fund, the county arterial preservation account, the county
criminal justice assistance account, the county sales and use tax
equalization account, the deferred compensation administrative account,
the deferred compensation principal account, the department of
licensing services account, the department of retirement systems
expense account, the developmental disabilities community trust
account, the drinking water assistance account, the drinking water
assistance administrative account, the drinking water assistance
repayment account, the Eastern Washington University capital projects
account, the education construction fund, the education legacy trust
account, the election account, the energy freedom account, the energy
recovery act account, the essential rail assistance account, The
Evergreen State College capital projects account, the federal forest
revolving account, the ferry bond retirement fund, the freight
congestion relief account, the freight mobility investment account, the
freight mobility multimodal account, the grade crossing protective
fund, the public health services account, the health system capacity
account, the high capacity transportation account, the state higher
education construction account, the higher education construction
account, the highway bond retirement fund, the highway infrastructure
account, the highway safety account, the high occupancy toll lanes
operations account, the hospital safety net assessment fund, the
industrial insurance premium refund account, the judges' retirement
account, the judicial retirement administrative account, the judicial
retirement principal account, the local leasehold excise tax account,
the local real estate excise tax account, the local sales and use tax
account, the marine resources stewardship trust account, the medical
aid account, the mobile home park relocation fund, the motor vehicle
fund, the motorcycle safety education account, the multiagency
permitting team account, the multimodal transportation account, the
municipal criminal justice assistance account, the municipal sales and
use tax equalization account, the natural resources deposit account,
the oyster reserve land account, the nursing facility quality assurance
trust fund, the pension funding stabilization account, the perpetual
surveillance and maintenance account, the public employees' retirement
system plan 1 account, the public employees' retirement system combined
plan 2 and plan 3 account, the public facilities construction loan
revolving account beginning July 1, 2004, the public health
supplemental account, the public transportation systems account, the
public works assistance account, the Puget Sound capital construction
account, the Puget Sound ferry operations account, the Puyallup tribal
settlement account, the real estate appraiser commission account, the
recreational vehicle account, the regional mobility grant program
account, the resource management cost account, the rural arterial trust
account, the rural mobility grant program account, the rural Washington
loan fund, the site closure account, the small city pavement and
sidewalk account, the special category C account, the special wildlife
account, the state employees' insurance account, the state employees'
insurance reserve account, the state investment board expense account,
the state investment board commingled trust fund accounts, the state
patrol highway account, the state route number 520 civil penalties
account, the state route number 520 corridor account, the state
wildlife account, the supplemental pension account, the Tacoma Narrows
toll bridge account, the teachers' retirement system plan 1 account,
the teachers' retirement system combined plan 2 and plan 3 account, the
tobacco prevention and control account, the tobacco settlement account,
the transportation 2003 account (nickel account), the transportation
equipment fund, the transportation fund, the transportation improvement
account, the transportation improvement board bond retirement account,
the transportation infrastructure account, the transportation
partnership account, the traumatic brain injury account, the tuition
recovery trust fund, the University of Washington bond retirement fund,
the University of Washington building account, the volunteer
firefighters' and reserve officers' relief and pension principal fund,
the volunteer firefighters' and reserve officers' administrative fund,
the Washington judicial retirement system account, the Washington law
enforcement officers' and firefighters' system plan 1 retirement
account, the Washington law enforcement officers' and firefighters'
system plan 2 retirement account, the Washington public safety
employees' plan 2 retirement account, the Washington school employees'
retirement system combined plan 2 and 3 account, the Washington state
economic development commission account, the Washington state health
insurance pool account, the Washington state patrol retirement account,
the Washington State University building account, the Washington State
University bond retirement fund, the water pollution control revolving
fund, and the Western Washington University capital projects account.
Earnings derived from investing balances of the agricultural permanent
fund, the normal school permanent fund, the permanent common school
fund, the scientific permanent fund, and the state university permanent
fund shall be allocated to their respective beneficiary accounts.
(b) Any state agency that has independent authority over accounts
or funds not statutorily required to be held in the state treasury that
deposits funds into a fund or account in the state treasury pursuant to
an agreement with the office of the state treasurer shall receive its
proportionate share of earnings based upon each account's or fund's
average daily balance for the period.
(5) In conformance with Article II, section 37 of the state
Constitution, no treasury accounts or funds shall be allocated earnings
without the specific affirmative directive of this section.
NEW SECTION. Sec. 14 Sections 5 through 12 of this act
constitute a new chapter in Title
Correct the title.
EFFECT: A nursing facility quality assurance trust fund is
created and funds are used to maintain and enhance nursing facility
rates. This is similar to the underlying bill.
The Department of Social and Health Services (DSHS) is authorized
to assess and collect an annual nursing facility license surcharge of
up to 375 percent of the bed licensing fee. DSHS is required to
provide an option for facilities to pay the surcharge in quarterly or
monthly payments. Funds collected through the surcharge are deposited
into the nursing facility quality assurance trust fund. The
legislature may not appropriate funds from the trust fund inconsistent
with the bill unless approved by an affirmative vote of at least two-
thirds of the members of each house of the legislature. The underlying
bill creates a provider assessment fee which is assessed daily but is
also deposited into a trust account.
The DSHS is required to seek federal approval for the provider
licensing surcharge. This is similar to the underlying bill.
Medicare patient days are exempt from the licensing surcharge.
DSHS is required to submit a waiver application with exemptions for
State operated facilities, hospital-based facilities, and
disproportionately low Medicaid facilities. The underlying bill also
exempts Medicare patient days, and requires DSHS to submit a waiver
application with exemptions for State, tribal, or county operated
facilities, hospital-based facilities, continuing care retirement
communities (CCRCs); and nursing facilities with 35 or fewer beds.
Funds in the quality assurance trust fund may be used to reimburse
the Medicaid share for the license surcharge as a Medicaid allowable
cost. This is the same as the underlying bill.
A supplemental payment methodology is established to produce rates
equal to those paid on June 30, 2010. Any additional revenue that is
available after paying the rates at the June 30, 2010, payment levels
is used to provide a direct care rate add-on for facilities that have
experienced increases in client acuity since June 30, 2010. The rate
add-on is only provided to the extent that revenue is available and at
no time will this add-on cause the licensing fee surcharge to be raised
higher than is specified in the bill. The supplemental payment
methodology and the implementation of the direct care rate add-on is
the same as in the underlying bill, with the exception that the direct
care add-on rate included for facilities that have experienced
increases in client acuity is set at 10 percent in the underlying bill
whereas in this striking amendment it is allowable only up to available
revenue funds.
Minimum occupancy requirements for essential community providers
are lowered by 5 percent compared to current law in the property,
operations, and finance components. This will increase payment rates
for essential community providers. Minimum occupancy does not change
from current law for small and large provider types. In the underlying
bill, minimum occupancy is increased from current law by 2 percent for
small and essential community providers; and by 3 percent for large
providers. In addition, the underlying bill makes several other
changes to the nursing home rate components to produce lower rate
calculations.
Nursing homes are allowed to reduce bed capacity by converting beds
to serve lower acuity clients. Facilities are authorized to assign
staff to perform duties concurrently among regular nursing facility
units and those units which have been converted.
The DSHS, Washington State Health Care Association, and Aging
Services of Washington must design a system of nursing facility quality
incentive payments to include evidence-based treatment, effective
purchasing strategies, quality measures, and benchmarks for quality
improvement. This is the same as the underlying bill.
The licensing surcharge becomes null and void if federal financial
participation or the waiver request for the licensing surcharge is not
approved, or if the quality assurance payments cannot be validly
implemented as determined by an appellate court or the centers for
Medicare and Medicaid services. In that case, any licensing surcharge
funds collected must be refunded to the nursing facilities
proportionately to the amount paid. If the assessment fee is not
approved in the underlying bill, it is also null and void and funding
is refunded to providers.