BILL REQ. #: Z-0796.3
| State of Washington | 61st Legislature | 2010 Regular Session |
Read first time 01/18/10. Referred to Committee on Health & Human Services Appropriations.
AN ACT Relating to maintaining the current medicaid nursing facility payment methodology through simplification of the nursing facility medicaid payment system statute; amending RCW 74.46.010, 74.46.020, 74.46.431, 74.46.433, 74.46.435, 74.46.437, 74.46.439, 74.46.475, 74.46.496, 74.46.501, 74.46.506, 74.46.508, 74.46.511, 74.46.515, 74.46.521, 74.46.835, and 74.46.800; creating a new section; and repealing RCW 74.46.030, 74.46.040, 74.46.050, 74.46.060, 74.46.080, 74.46.090, 74.46.100, 74.46.155, 74.46.165, 74.46.190, 74.46.200, 74.46.220, 74.46.230, 74.46.240, 74.46.250, 74.46.270, 74.46.280, 74.46.290, 74.46.300, 74.46.310, 74.46.320, 74.46.330, 74.46.340, 74.46.350, 74.46.360, 74.46.370, 74.46.380, 74.46.390, 74.46.410, 74.46.445, 74.46.533, 74.46.600, 74.46.610, 74.46.620, 74.46.625, 74.46.630, 74.46.640, 74.46.650, 74.46.660, 74.46.680, 74.46.690, 74.46.700, 74.46.711, 74.46.770, 74.46.780, 74.46.790, 74.46.820, 74.46.900, 74.46.901, 74.46.902, 74.46.905, and 74.46.906.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 74.46.010 and 1998 c 322 s 1 are each amended to read
as follows:
This chapter may be known and cited as the "nursing facility
medicaid payment system."
The purposes of this chapter are to set forth principles to guide
the nursing facility medicaid payment system and specify the manner by
which legislative appropriations for medicaid nursing facility services
are to be allocated as payment rates among nursing facilities((, and to
set forth auditing, billing, and other administrative standards
associated with payments to nursing home facilities)).
Sec. 2 RCW 74.46.020 and 2007 c 508 s 7 are each amended to read
as follows:
Unless the context clearly requires otherwise, the definitions in
this section apply throughout this chapter.
(1) (("Accrual method of accounting" means a method of accounting
in which revenues are reported in the period when they are earned,
regardless of when they are collected, and expenses are reported in the
period in which they are incurred, regardless of when they are paid.)) "Appraisal" means the process of estimating the fair market
value or reconstructing the historical cost of an asset acquired in a
past period as performed by a professionally designated real estate
appraiser with no pecuniary interest in the property to be appraised.
It includes a systematic, analytic determination and the recording and
analyzing of property facts, rights, investments, and values based on
a personal inspection and inventory of the property.
(2)
(((3))) (2) "Arm's-length transaction" means a transaction
resulting from good-faith bargaining between a buyer and seller who are
not related organizations and have adverse positions in the market
place. Sales or exchanges of nursing home facilities among two or more
parties in which all parties subsequently continue to own one or more
of the facilities involved in the transactions shall not be considered
as arm's-length transactions for purposes of this chapter. Sale of a
nursing home facility which is subsequently leased back to the seller
within five years of the date of sale shall not be considered as an
arm's-length transaction for purposes of this chapter.
(((4))) (3) "Assets" means economic resources of the contractor,
recognized and measured in conformity with generally accepted
accounting principles.
(((5))) (4) "Audit" or "department audit" means an examination of
the records of a nursing facility participating in the medicaid payment
system, including but not limited to: The contractor's financial and
statistical records, cost reports and all supporting documentation and
schedules, receivables, and resident trust funds, to be performed as
deemed necessary by the department and according to department rule.
(((6) "Bad debts" means amounts considered to be uncollectible from
accounts and notes receivable.)) (5) "Capitalization" means the recording of an expenditure as
an asset.
(7) "Beneficial owner" means:
(a) Any person who, directly or indirectly, through any contract,
arrangement, understanding, relationship, or otherwise has or shares:
(i) Voting power which includes the power to vote, or to direct the
voting of such ownership interest; and/or
(ii) Investment power which includes the power to dispose, or to
direct the disposition of such ownership interest;
(b) Any person who, directly or indirectly, creates or uses a
trust, proxy, power of attorney, pooling arrangement, or any other
contract, arrangement, or device with the purpose or effect of
divesting himself or herself of beneficial ownership of an ownership
interest or preventing the vesting of such beneficial ownership as part
of a plan or scheme to evade the reporting requirements of this
chapter;
(c) Any person who, subject to (b) of this subsection, has the
right to acquire beneficial ownership of such ownership interest within
sixty days, including but not limited to any right to acquire:
(i) Through the exercise of any option, warrant, or right;
(ii) Through the conversion of an ownership interest;
(iii) Pursuant to the power to revoke a trust, discretionary
account, or similar arrangement; or
(iv) Pursuant to the automatic termination of a trust,
discretionary account, or similar arrangement;
except that, any person who acquires an ownership interest or power
specified in (c)(i), (ii), or (iii) of this subsection with the purpose
or effect of changing or influencing the control of the contractor, or
in connection with or as a participant in any transaction having such
purpose or effect, immediately upon such acquisition shall be deemed to
be the beneficial owner of the ownership interest which may be acquired
through the exercise or conversion of such ownership interest or power;
(d) Any person who in the ordinary course of business is a pledgee
of ownership interest under a written pledge agreement shall not be
deemed to be the beneficial owner of such pledged ownership interest
until the pledgee has taken all formal steps necessary which are
required to declare a default and determines that the power to vote or
to direct the vote or to dispose or to direct the disposition of such
pledged ownership interest will be exercised; except that:
(i) The pledgee agreement is bona fide and was not entered into
with the purpose nor with the effect of changing or influencing the
control of the contractor, nor in connection with any transaction
having such purpose or effect, including persons meeting the conditions
set forth in (b) of this subsection; and
(ii) The pledgee agreement, prior to default, does not grant to the
pledgee:
(A) The power to vote or to direct the vote of the pledged
ownership interest; or
(B) The power to dispose or direct the disposition of the pledged
ownership interest, other than the grant of such power(s) pursuant to
a pledge agreement under which credit is extended and in which the
pledgee is a broker or dealer.
(8)
(((9))) (6) "Case mix" means a measure of the intensity of care and
services needed by the residents of a nursing facility or a group of
residents in the facility.
(((10))) (7) "Case mix index" means a number representing the
average case mix of a nursing facility.
(((11))) (8) "Case mix weight" means a numeric score that
identifies the relative resources used by a particular group of a
nursing facility's residents.
(((12))) (9) "Certificate of capital authorization" means a
certification from the department for an allocation from the biennial
capital financing authorization for all new or replacement building
construction, or for major renovation projects, receiving a certificate
of need or a certificate of need exemption under chapter 70.38 RCW
after July 1, 2001.
(((13))) (10) "Contractor" means a person or entity licensed under
chapter 18.51 RCW to operate a medicare and medicaid certified nursing
facility, responsible for operational decisions, and contracting with
the department to provide services to medicaid recipients residing in
the facility.
(((14))) (11) "Default case" means no initial assessment has been
completed for a resident and transmitted to the department by the
cut-off date, or an assessment is otherwise past due for the resident,
under state and federal requirements.
(((15))) (12) "Department" means the department of social and
health services (DSHS) and its employees.
(((16))) (13) "Depreciation" means the systematic distribution of
the cost or other basis of tangible assets, less salvage, over the
estimated useful life of the assets.
(((17))) (14) "Direct care" means nursing care and related care
provided to nursing facility residents. Therapy care shall not be
considered part of direct care.
(((18))) (15) "Direct care supplies" means medical, pharmaceutical,
and other supplies required for the direct care of a nursing facility's
residents.
(((19))) (16) "Entity" means an individual, partnership,
corporation, limited liability company, or any other association of
individuals capable of entering enforceable contracts.
(((20))) (17) "Equity" means the net book value of all tangible and
intangible assets less the recorded value of all liabilities, as
recognized and measured in conformity with generally accepted
accounting principles.
(((21))) (18) "Essential community provider" means a facility which
is the only nursing facility within a commuting distance radius of at
least forty minutes duration, traveling by automobile.
(((22))) (19) "Facility" or "nursing facility" means a nursing home
licensed in accordance with chapter 18.51 RCW, excepting nursing homes
certified as institutions for mental diseases, or that portion of a
multiservice facility licensed as a nursing home, or that portion of a
hospital licensed in accordance with chapter 70.41 RCW which operates
as a nursing home.
(((23))) (20) "Fair market value" means the replacement cost of an
asset less observed physical depreciation on the date for which the
market value is being determined.
(((24))) (21) "Financial statements" means statements prepared and
presented in conformity with generally accepted accounting principles
including, but not limited to, balance sheet, statement of operations,
statement of changes in financial position, and related notes.
(((25))) (22) "Generally accepted accounting principles" means
accounting principles approved by the financial accounting standards
board (FASB) or its successor.
(((26) "Goodwill" means the excess of the price paid for a nursing
facility business over the fair market value of all net identifiable
tangible and intangible assets acquired, as measured in accordance with
generally accepted accounting principles.)) (23) "Grouper" means a computer software product that groups
individual nursing facility residents into case mix classification
groups based on specific resident assessment data and computer logic.
(27)
(((28))) (24) "High labor-cost county" means an urban county in
which the median allowable facility cost per case mix unit is more than
ten percent higher than the median allowable facility cost per case mix
unit among all other urban counties, excluding that county.
(((29))) (25) "Historical cost" means the actual cost incurred in
acquiring and preparing an asset for use, including feasibility
studies, architect's fees, and engineering studies.
(((30))) (26) "Home and central office costs" means costs that are
incurred in the support and operation of a home and central office.
Home and central office costs include centralized services that are
performed in support of a nursing facility. The department may exclude
from this definition costs that are nonduplicative, documented,
ordinary, necessary, and related to the provision of care services to
authorized patients.
(((31) "Imprest fund" means a fund which is regularly replenished
in exactly the amount expended from it.)) (27) "Lease agreement" means a contract between two parties
for the possession and use of real or personal property or assets for
a specified period of time in exchange for specified periodic payments.
Elimination (due to any cause other than death or divorce) or addition
of any party to the contract, expiration, or modification of any lease
term in effect on January 1, 1980, or termination of the lease by
either party by any means shall constitute a termination of the lease
agreement. An extension or renewal of a lease agreement, whether or
not pursuant to a renewal provision in the lease agreement, shall be
considered a new lease agreement. A strictly formal change in the
lease agreement which modifies the method, frequency, or manner in
which the lease payments are made, but does not increase the total
lease payment obligation of the lessee, shall not be considered
modification of a lease term.
(32) "Joint facility costs" means any costs which represent
resources which benefit more than one facility, or one facility and any
other entity.
(33)
(((34))) (28) "Medical care program" or "medicaid program" means
medical assistance, including nursing care, provided under RCW
74.09.500 or authorized state medical care services.
(((35))) (29) "Medical care recipient," "medicaid recipient," or
"recipient" means an individual determined eligible by the department
for the services provided under chapter 74.09 RCW.
(((36))) (30) "Minimum data set" means the overall data component
of the resident assessment instrument, indicating the strengths, needs,
and preferences of an individual nursing facility resident.
(((37))) (31) "Net book value" means the historical cost of an
asset less accumulated depreciation.
(((38))) (32) "Net invested funds" means the net book value of
tangible fixed assets employed by a contractor to provide services
under the medical care program, including land, buildings, and
equipment as recognized and measured in conformity with generally
accepted accounting principles.
(((39))) (33) "Nonurban county" means a county which is not located
in a metropolitan statistical area as determined and defined by the
United States office of management and budget or other appropriate
agency or office of the federal government.
(((40) "Operating lease" means a lease under which rental or lease
expenses are included in current expenses in accordance with generally
accepted accounting principles.)) (34) "Owner" means a sole proprietor, general or limited
partners, members of a limited liability company, and beneficial
interest holders of five percent or more of a corporation's outstanding
stock.
(41)
(((42) "Ownership interest" means all interests beneficially owned
by a person, calculated in the aggregate, regardless of the form which
such beneficial ownership takes.)) (35) "Patient day" or "resident day" means a calendar day of
care provided to a nursing facility resident, regardless of payment
source, which will include the day of admission and exclude the day of
discharge; except that, when admission and discharge occur on the same
day, one day of care shall be deemed to exist. A "medicaid day" or
"recipient day" means a calendar day of care provided to a medicaid
recipient determined eligible by the department for services provided
under chapter 74.09 RCW, subject to the same conditions regarding
admission and discharge applicable to a patient day or resident day of
care.
(43)
(((44) "Professionally designated real estate appraiser" means an
individual who is regularly engaged in the business of providing real
estate valuation services for a fee, and who is deemed qualified by a
nationally recognized real estate appraisal educational organization on
the basis of extensive practical appraisal experience, including the
writing of real estate valuation reports as well as the passing of
written examinations on valuation practice and theory, and who by
virtue of membership in such organization is required to subscribe and
adhere to certain standards of professional practice as such
organization prescribes.)) (36) "Qualified therapist" means:
(45)
(a) A mental health professional as defined by chapter 71.05 RCW;
(b) A mental retardation professional who is a therapist approved
by the department who has had specialized training or one year's
experience in treating or working with the mentally retarded or
developmentally disabled;
(c) A speech pathologist who is eligible for a certificate of
clinical competence in speech pathology or who has the equivalent
education and clinical experience;
(d) A physical therapist as defined by chapter 18.74 RCW;
(e) An occupational therapist who is a graduate of a program in
occupational therapy, or who has the equivalent of such education or
training; and
(f) A respiratory care practitioner certified under chapter 18.89
RCW.
(((46))) (37) "Rate" or "rate allocation" means the medicaid per-patient-day payment amount for medicaid patients calculated in
accordance with the allocation methodology set forth in part E of this
chapter.
(((47) "Real property," whether leased or owned by the contractor,
means the building, allowable land, land improvements, and building
improvements associated with a nursing facility.)) (38) "Rebased rate" or "cost-rebased rate" means a facility-specific component rate assigned to a nursing facility for a particular
rate period established on desk-reviewed, adjusted costs reported for
that facility covering at least six months of a prior calendar year
designated as a year to be used for cost-rebasing payment rate
allocations under the provisions of this chapter.
(48)
(((49))) (39) "Records" means those data supporting all financial
statements and cost reports including, but not limited to, all general
and subsidiary ledgers, books of original entry, and transaction
documentation, however such data are maintained.
(((50) "Related organization" means an entity which is under common
ownership and/or control with, or has control of, or is controlled by,
the contractor.)) (40) "Resident assessment instrument," including federally
approved modifications for use in this state, means a federally
mandated, comprehensive nursing facility resident care planning and
assessment tool, consisting of the minimum data set and resident
assessment protocols.
(a) "Common ownership" exists when an entity is the beneficial
owner of five percent or more ownership interest in the contractor and
any other entity.
(b) "Control" exists where an entity has the power, directly or
indirectly, significantly to influence or direct the actions or
policies of an organization or institution, whether or not it is
legally enforceable and however it is exercisable or exercised.
(51) "Related care" means only those services that are directly
related to providing direct care to nursing facility residents. These
services include, but are not limited to, nursing direction and
supervision, medical direction, medical records, pharmacy services,
activities, and social services.
(52)
(((53))) (41) "Resident assessment protocols" means those
components of the resident assessment instrument that use the minimum
data set to trigger or flag a resident's potential problems and risk
areas.
(((54))) (42) "Resource utilization groups" means a case mix
classification system that identifies relative resources needed to care
for an individual nursing facility resident.
(((55) "Restricted fund" means those funds the principal and/or
income of which is limited by agreement with or direction of the donor
to a specific purpose.)) (43) "Secretary" means the secretary of the department of
social and health services.
(56)
(((57))) (44) "Support services" means food, food preparation,
dietary, housekeeping, and laundry services provided to nursing
facility residents.
(((58))) (45) "Therapy care" means those services required by a
nursing facility resident's comprehensive assessment and plan of care,
that are provided by qualified therapists, or support personnel under
their supervision, including related costs as designated by the
department.
(((59))) (46) "Title XIX" or "medicaid" means the 1965 amendments
to the social security act, P.L. 89-07, as amended and the medicaid
program administered by the department.
(((60))) (47) "Urban county" means a county which is located in a
metropolitan statistical area as determined and defined by the United
States office of management and budget or other appropriate agency or
office of the federal government.
(((61) "Vital local provider" means a facility that meets the
following qualifications:))
(a) It reports a home office with an address located in Washington
state; and
(b) The sum of medicaid days for all Washington facilities
reporting that home office as their home office was greater than two
hundred fifteen thousand in 2003; and
(c) The facility was recognized as a "vital local provider" by the
department as of April 1, 2007.
The definition of "vital local provider" shall expire, and have no
force or effect, after June 30, 2007. After that date, no facility's
payments under this chapter shall in any way be affected by its prior
determination or recognition as a vital local provider.
NEW SECTION. Sec. 3 The department shall establish, by rule, the
procedures, principles, and conditions for the nursing facility
medicaid payment system addressed by the following principles:
(1) The department must receive complete, annual reporting of all
costs and the financial condition of each contractor, prepared and
presented in a standardized manner. The department shall establish, by
rule, due dates, requirements for cost report completion, actions
required for improperly completed or late cost reports, fines for any
statutory or regulatory noncompliance, retention requirements, and
public disclosure requirements.
(2) The department shall examine all cost reports to determine
whether the information is correct, complete, and reported in
compliance with chapter 74.46 RCW, department rules and instructions,
and generally accepted accounting principles.
(3) Each contractor must establish and maintain, as a service to
the resident, a bookkeeping system incorporated into the business
records for all resident funds entrusted to the contractor and received
by the contractor for the resident. The department shall adopt rules
to ensure that resident personal funds handled by the contractor are
maintained by each contractor in a manner that is, at a minimum,
consistent with federal requirements.
(4) The department shall have the authority to audit resident trust
funds and receivables, at its discretion.
(5) Contractors shall provide the department access to the nursing
facility, all financial and statistical records, and all working papers
that are in support of the cost report, receivables, and resident trust
funds.
(6) The department shall establish a settlement process in order to
reconcile medicaid resident days to billed days and medicaid payments
for the preceding calendar year. The settlement process shall ensure
that any savings in the direct care or therapy care component rates be
shifted only between direct care and therapy care component rates, and
shall not be shifted into any other rate components.
(7) The department shall define and identify allowable and
unallowable costs.
(8) A contractor shall bill the department for care provided to
medicaid recipients, and the department shall pay a contractor for
service rendered under the facility contract and appropriately billed.
Billing and payment procedures shall be specified by rule.
(9) The department shall establish the conditions for participation
in the nursing facility medicaid payment system.
(10) The department shall establish procedures and a rate setting
methodology for a change of ownership.
(11) The department shall establish, consistent with federal
requirements for nursing facilities participating in the medicaid
program, an appeals or exception procedure that allows individual
nursing home providers an opportunity to receive prompt administrative
review of payment rates with respect to such issues as the department
deems appropriate.
(12) The department shall have authority to adopt, amend, and
rescind such administrative rules and definitions as it deems necessary
to carry out the policies and purposes of chapter 74.46 RCW.
Sec. 4 RCW 74.46.431 and 2009 c 570 s 1 are each amended to read
as follows:
(1) ((Effective July 1, 1999,)) 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, support services,
variable return, operations, property, and financing allowance for
essential community providers as defined in this chapter 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. For all
facilities other than essential community providers, ((effective July
1, 2001,)) the component rate allocations in ((direct care,)) therapy
care, support services, and variable return shall be based upon a
minimum facility occupancy of eighty-five percent of licensed beds.
For all facilities other than essential community providers,
((effective July 1, 2002,)) the component rate allocations in
operations, property, and financing allowance 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. For all facilities,
((effective July 1, 2006,)) 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.
((Adjusted cost report data from 1996 will be used for October 1, 1998,
through June 30, 2001, direct care component rate allocations; adjusted
cost report data from 1999 will be used for July 1, 2001, through June
30, 2006, direct care component rate allocations. Adjusted cost report
data from 2003 will be used for July 1, 2006, through June 30, 2007,
direct care component rate allocations. Adjusted cost report data from
2005 will be used for July 1, 2007, through June 30, 2009, direct care
component rate allocations.)) Effective July 1, 2009, the direct care
component rate allocation shall be rebased biennially, and thereafter
for each odd-numbered year beginning July 1st, 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, 2011, and so forth.
(b) ((Direct care component rate allocations based on 1996 cost
report data shall be adjusted annually for economic trends and
conditions by a factor or factors defined in the biennial
appropriations act. A different economic trends and conditions
adjustment factor or factors may be defined in the biennial
appropriations act for facilities whose direct care component rate is
set equal to their adjusted June 30, 1998, rate, as provided in RCW
74.46.506(5)(i).)) 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.
(c) Direct care component rate allocations based on 1999 cost
report data shall be adjusted annually for economic trends and
conditions by a factor or factors defined in the biennial
appropriations act. A different economic trends and conditions
adjustment factor or factors may be defined in the biennial
appropriations act for facilities whose direct care component rate is
set equal to their adjusted June 30, 1998, rate, as provided in RCW
74.46.506(5)(i).
(d) Direct care component rate allocations based on 2003 cost
report data shall be adjusted annually for economic trends and
conditions by a factor or factors defined in the biennial
appropriations act. A different economic trends and conditions
adjustment factor or factors may be defined in the biennial
appropriations act for facilities whose direct care component rate is
set equal to their adjusted June 30, 2006, rate, as provided in RCW
74.46.506(5)(i).
(e)
(5)(a) Therapy care component rate allocations shall be established
using adjusted cost report data covering at least six months.
((Adjusted cost report data from 1996 will be used for October 1, 1998,
through June 30, 2001, therapy care component rate allocations;
adjusted cost report data from 1999 will be used for July 1, 2001,
through June 30, 2005, therapy care component rate allocations.
Adjusted cost report data from 1999 will continue to be used for July
1, 2005, through June 30, 2007, therapy care component rate
allocations. Adjusted cost report data from 2005 will be used for July
1, 2007, through June 30, 2009, therapy care component rate
allocations.)) Effective July 1, 2009, and thereafter for each
odd-numbered year beginning July 1st, the therapy care component rate
allocation shall be cost rebased biennially, 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, 2011, 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. ((Adjusted cost report data from 1996 shall be used for
October 1, 1998, through June 30, 2001, support services component rate
allocations; adjusted cost report data from 1999 shall be used for July
1, 2001, through June 30, 2005, support services component rate
allocations. Adjusted cost report data from 1999 will continue to be
used for July 1, 2005, through June 30, 2007, support services
component rate allocations. Adjusted cost report data from 2005 will
be used for July 1, 2007, through June 30, 2009, support services
component rate allocations.)) Effective July 1, 2009, and thereafter
for each odd-numbered year beginning July 1st, the support services
component rate allocation shall be cost rebased biennially, 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, 2011, 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.
((Adjusted cost report data from 1996 shall be used for October 1,
1998, through June 30, 2001, operations component rate allocations;
adjusted cost report data from 1999 shall be used for July 1, 2001,
through June 30, 2006, operations component rate allocations. Adjusted
cost report data from 2003 will be used for July 1, 2006, through June
30, 2007, operations component rate allocations. Adjusted cost report
data from 2005 will be used for July 1, 2007, through June 30, 2009,
operations component rate allocations.)) Effective July 1, 2009, and
thereafter for each odd-numbered year beginning July 1st, the
operations component rate allocation shall be cost rebased biennially,
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, 2011, 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. ((A different economic trends and conditions adjustment
factor or factors may be defined in the biennial appropriations act for
facilities whose operations component rate is set equal to their
adjusted June 30, 2006, rate, as provided in RCW 74.46.521(4).)) (8) Total payment rates under the nursing facility medicaid
payment system shall not exceed facility rates charged to the general
public for comparable services.
(8) For July 1, 1998, through September 30, 1998, a facility's
property and return on investment component rates shall be the
facility's June 30, 1998, property and return on investment component
rates, without increase. For October 1, 1998, through June 30, 1999,
a facility's property and return on investment component rates shall be
rebased utilizing 1997 adjusted cost report data covering at least six
months of data.
(9)
(((10) Medicaid contractors shall pay to all facility staff a
minimum wage of the greater of the state minimum wage or the federal
minimum wage.)) (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: ((
(11)The need to prorate)) 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 banking beds or converting beds back into service,
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.
(((12))) (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.
(((13))) (11) Effective July 1, 2001, medicaid rates shall continue
to be revised downward in all components, in accordance with department
rules, for facilities converting banked beds to active service under
chapter 70.38 RCW, by using the facility's increased licensed bed
capacity to recalculate minimum occupancy for rate setting. However,
for facilities other than essential community providers which bank beds
under chapter 70.38 RCW, after May 25, 2001, medicaid rates shall be
revised upward, in accordance with department rules, in direct care,
therapy care, support services, and variable return components only, by
using the facility's decreased licensed bed capacity to recalculate
minimum occupancy for rate setting, but no upward revision shall be
made to operations, property, or financing allowance component rates.
Effective July 1, 2006, the direct care component rate allocation shall
be ((adjusted, without using the minimum occupancy assumption, for
facilities that convert banked beds to active service, under chapter
70.38 RCW, beginning on July 1, 2006. Effective July 1, 2007,
component rate allocations for direct care shall be)) based on actual
patient days regardless of whether a facility has converted banked beds
to active service.
(((14))) (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. 5 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 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. 6 RCW 74.46.435 and 2001 1st sp.s. c 8 s 7 are each amended
to read as follows:
(1) ((Effective July 1, 2001,)) 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
((RCW 74.46.310 through 74.46.380)) 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 for the facility in the prior period or
resident days as calculated on ((eighty-five)) ninety percent facility
occupancy for all providers except essential community providers.
((Effective July 1, 2002, the property component rate allocation for
all facilities, except 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.)) 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) ((Effective July 1, 2001,)) For the purpose of calculating a
nursing facility's property component rate, if a contractor has elected
to bank licensed beds prior to April 1, 2001, or elects to convert
banked beds to active service at any time, under chapter 70.38 RCW, the
department shall use the facility's new licensed bed capacity to
recalculate minimum occupancy for rate setting and revise the property
component rate, as needed, effective as of the date the beds are banked
or converted to active service. However, ((in no case shall the
department use less than eighty-five percent occupancy of the
facility's licensed bed capacity after banking or conversion.
Effective July 1, 2002,)) in no case, other than essential community
providers, shall the department use less than ninety percent occupancy
of the facility's licensed bed capacity after banking or conversion.
(5) 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. 7 RCW 74.46.437 and 2001 1st sp.s. c 8 s 8 are each amended
to read as follows:
(1) ((Beginning July 1, 1999,)) The department shall establish for
each medicaid nursing facility a financing allowance component rate
allocation. The financing allowance component rate shall be rebased
annually, effective July 1st, in accordance with the provisions of this
section and this chapter.
(2) ((Effective July 1, 2001,)) The financing allowance shall be
determined by multiplying the net invested funds of each facility by
.10, and dividing by the greater of a nursing facility's total resident
days from the most recent cost report period or resident days
calculated on ((eighty-five)) ninety percent facility occupancy for all
providers except essential community providers. ((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.)) However, assets acquired on or after May 17,
1999, shall be grouped in a separate financing allowance calculation
that shall be multiplied by .085. The financing allowance factor of
.085 shall not be applied to the net invested funds pertaining to new
construction or major renovations receiving certificate of need
approval or an exemption from certificate of need requirements under
chapter 70.38 RCW, or to working drawings that have been submitted to
the department of health for construction review approval, prior to May
17, 1999. If a capitalized addition, renovation, replacement, 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 financing allowance shall be adjusted to the greater of
the anticipated resident day level or ((eighty-five)) ninety percent of
the new licensed bed capacity for all providers except essential
community providers. Effective July 1, 2002, for all facilities, other
than essential community providers, the total resident days used to
compute the financing allowance after a capitalized addition,
renovation, replacement, or retirement of an asset 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.
(3) In computing the portion of net invested funds representing the
net book value of tangible fixed assets, the same assets, depreciation
bases, lives, and methods referred to in ((RCW 74.46.330, 74.46.350,
74.46.360, 74.46.370, and 74.46.380)) rule, including owned and leased
assets, shall be utilized, except that the capitalized cost of land
upon which the facility is located and such other contiguous land which
is reasonable and necessary for use in the regular course of providing
resident care shall also be included. Subject to provisions and
limitations contained in this chapter, for land purchased by owners or
lessors before July 18, 1984, capitalized cost of land shall be the
buyer's capitalized cost. For all partial or whole rate periods after
July 17, 1984, if the land is purchased after July 17, 1984,
capitalized cost shall be that of the owner of record on July 17, 1984,
or buyer's capitalized cost, whichever is lower. In the case of leased
facilities where the net invested funds are unknown or the contractor
is unable to provide necessary information to determine net invested
funds, the secretary shall have the authority to determine an amount
for net invested funds based on an appraisal conducted according to
((RCW 74.46.360(1))) department rule.
(4) ((Effective July 1, 2001,)) For the purpose of calculating a
nursing facility's financing allowance component rate, if a contractor
has elected to bank licensed beds prior to May 25, 2001, or elects to
convert banked beds to active service at any time, under chapter 70.38
RCW, the department shall use the facility's new licensed bed capacity
to recalculate minimum occupancy for rate setting and revise the
financing allowance component rate, as needed, effective as of the date
the beds are banked or converted to active service. However, ((in no
case shall the department use less than eighty-five percent occupancy
of the facility's licensed bed capacity after banking or conversion.
Effective July 1, 2002,)) in no case, other than for essential
community providers, shall the department use less than ninety percent
occupancy of the facility's licensed bed capacity after conversion.
(5) The financing allowance rate allocation calculated in
accordance with this section shall be adjusted to the extent necessary
to comply with RCW 74.46.421.
Sec. 8 RCW 74.46.439 and 1999 c 353 s 12 are each amended to read
as follows:
(1) In the case of a facility that was leased by the contractor as
of January 1, 1980, in an arm's-length agreement, which continues to be
leased under the same lease agreement, ((and for which the annualized
lease payment, plus any interest and depreciation expenses associated
with contractor-owned assets, for the period covered by the prospective
rates, divided by the contractor's total resident days, minus the
property component rate allocation, is more than the sum of the
financing allowance and the variable return rate determined according
to this chapter, the following shall apply:)) the financing allowance rate will be the greater of the rate
existing on June 30, 2010, or the rate calculated under RCW 74.46.437.
(a) The financing allowance shall be recomputed substituting the
fair market value of the assets as of January 1, 1982, as determined by
the department of general administration through an appraisal
procedure, less accumulated depreciation on the lessor's assets since
January 1, 1982, for the net book value of the assets in determining
net invested funds for the facility. A determination by the department
of general administration of fair market value shall be final unless
the procedure used to make such a determination is shown to be
arbitrary and capricious.
(b) The sum of the financing allowance computed under (a) of this
subsection and the variable return rate shall be compared to the
annualized lease payment, plus any interest and depreciation associated
with contractor-owned assets, for the period covered by the prospective
rates, divided by the contractor's total resident days, minus the
property component rate. The lesser of the two amounts shall be called
the alternate return on investment rate.
(c) The sum of the financing allowance and variable return rate
determined according to this chapter or the alternate return on
investment rate, whichever is greater, shall be added to the
prospective rates of the contractor.
(2) In the case of a facility that was leased by the contractor as
of January 1, 1980, in an arm's-length agreement, if the lease is
renewed or extended under a provision of the lease, the treatment
provided in subsection (1) of this section shall be applied, except
that in the case of renewals or extensions made subsequent to April 1,
1985, reimbursement for the annualized lease payment shall be no
greater than the reimbursement for the annualized lease payment for the
last year prior to the renewal or extension of the lease.
(3)
(2) The alternate return on investment component rate allocations
calculated in accordance with this section shall be adjusted to the
extent necessary to comply with RCW 74.46.421.
Sec. 9 RCW 74.46.475 and 1998 c 322 s 21 are each amended to read
as follows:
(((1))) The department shall analyze the submitted cost report or
a portion thereof of each contractor for each report period to
determine if the information is correct, complete, reported in
conformance with department instructions and generally accepted
accounting principles, the requirements of this chapter, and such rules
as the department may adopt. If the analysis finds that the cost
report is incorrect or incomplete, the department may make adjustments
to the reported information for purposes of establishing payment rate
allocations. A schedule of such adjustments shall be provided to
contractors and shall include an explanation for the adjustment and the
dollar amount of the adjustment. Adjustments shall be subject to
review and appeal as provided in this chapter.
(((2) The department shall accumulate data from properly completed
cost reports, in addition to assessment data on each facility's
resident population characteristics, for use in:))
(a) Exception profiling; and
(b) Establishing rates.
(3) The department may further utilize such accumulated data for
analytical, statistical, or informational purposes as necessary.
Sec. 10 RCW 74.46.496 and 2006 c 258 s 4 are each amended to read
as follows:
(1) Each case mix classification group shall be assigned a case mix
weight. The case mix weight for each resident of a nursing facility
for each calendar quarter shall be based on data from resident
assessment instruments completed for the resident and weighted by the
number of days the resident was in each case mix classification group.
Days shall be counted as provided in this section.
(2) The case mix weights shall be based on the average minutes per
registered nurse, licensed practical nurse, and certified nurse aide,
for each case mix group, and using the ((health care financing
administration of the)) United States department of health and human
services 1995 nursing facility staff time measurement study stemming
from its multistate nursing home case mix and quality demonstration
project. Those minutes shall be weighted by statewide ratios of
registered nurse to certified nurse aide, and licensed practical nurse
to certified nurse aide, wages, including salaries and benefits, which
shall be based on 1995 cost report data for this state.
(3) The case mix weights shall be determined as follows:
(a) Set the certified nurse aide wage weight at 1.000 and calculate
wage weights for registered nurse and licensed practical nurse average
wages by dividing the certified nurse aide average wage into the
registered nurse average wage and licensed practical nurse average
wage;
(b) Calculate the total weighted minutes for each case mix group in
the resource utilization group III classification system by multiplying
the wage weight for each worker classification by the average number of
minutes that classification of worker spends caring for a resident in
that resource utilization group III classification group, and summing
the products;
(c) Assign a case mix weight of 1.000 to the resource utilization
group III classification group with the lowest total weighted minutes
and calculate case mix weights by dividing the lowest group's total
weighted minutes into each group's total weighted minutes and rounding
weight calculations to the third decimal place.
(4) The case mix weights in this state may be revised if the
((health care financing administration)) United States department of
health and human services updates its nursing facility staff time
measurement studies. The case mix weights shall be revised, but only
when direct care component rates are cost-rebased as provided in
subsection (5) of this section, to be effective on the July 1st
effective date of each cost-rebased direct care component rate.
However, the department may revise case mix weights more frequently if,
and only if, significant variances in wage ratios occur among direct
care staff in the different caregiver classifications identified in
this section.
(5) Case mix weights shall be revised when direct care component
rates are cost-rebased as provided in RCW 74.46.431(4).
Sec. 11 RCW 74.46.501 and 2006 c 258 s 5 are each amended to read
as follows:
(1) From individual case mix weights for the applicable quarter,
the department shall determine two average case mix indexes for each
medicaid nursing facility, one for all residents in the facility, known
as the facility average case mix index, and one for medicaid residents,
known as the medicaid average case mix index.
(2)(a) In calculating a facility's two average case mix indexes for
each quarter, the department shall include all residents or medicaid
residents, as applicable, who were physically in the facility during
the quarter in question based on the resident assessment instrument
completed by the facility and the requirements and limitations for the
instrument's completion and transmission (January 1st through March
31st, April 1st through June 30th, July 1st through September 30th, or
October 1st through December 31st).
(b) The facility average case mix index shall exclude all default
cases as defined in this chapter. However, the medicaid average case
mix index shall include all default cases.
(3) Both the facility average and the medicaid average case mix
indexes shall be determined by multiplying the case mix weight of each
resident, or each medicaid resident, as applicable, by the number of
days, as defined in this section and as applicable, the resident was at
each particular case mix classification or group, and then averaging.
(4)(((a))) In determining the number of days a resident is
classified into a particular case mix group, the department shall
determine a start date for calculating case mix grouping periods as
((follows:)) specified by rule.
(i) If a resident's initial assessment for a first stay or a return
stay in the nursing facility is timely completed and transmitted to the
department by the cutoff date under state and federal requirements and
as described in subsection (5) of this section, the start date shall be
the later of either the first day of the quarter or the resident's
facility admission or readmission date;
(ii) If a resident's significant change, quarterly, or annual
assessment is timely completed and transmitted to the department by the
cutoff date under state and federal requirements and as described in
subsection (5) of this section, the start date shall be the date the
assessment is completed;
(iii) If a resident's significant change, quarterly, or annual
assessment is not timely completed and transmitted to the department by
the cutoff date under state and federal requirements and as described
in subsection (5) of this section, the start date shall be the due date
for the assessment.
(b) If state or federal rules require more frequent assessment, the
same principles for determining the start date of a resident's
classification in a particular case mix group set forth in subsection
(4)(a) of this section shall apply.
(c) In calculating the number of days a resident is classified into
a particular case mix group, the department shall determine an end date
for calculating case mix grouping periods as follows:
(i) If a resident is discharged before the end of the applicable
quarter, the end date shall be the day before discharge;
(ii) If a resident is not discharged before the end of the
applicable quarter, the end date shall be the last day of the quarter;
(iii) If a new assessment is due for a resident or a new assessment
is completed and transmitted to the department, the end date of the
previous assessment shall be the earlier of either the day before the
assessment is due or the day before the assessment is completed by the
nursing facility
(5) The cutoff date for the department to use resident assessment
data, for the purposes of calculating both the facility average and the
medicaid average case mix indexes, and for establishing and updating a
facility's direct care component rate, shall be one month and one day
after the end of the quarter for which the resident assessment data
applies.
(6) ((A threshold of ninety percent, as described and calculated in
this subsection, shall be used to determine the case mix index each
quarter. The threshold shall also be used to determine which
facilities' costs per case mix unit are included in determining the
ceiling, floor, and price. For direct care component rate allocations
established on and after July 1, 2006, the threshold of ninety percent
shall be used to determine the case mix index each quarter and to
determine which facilities' costs per case mix unit are included in
determining the ceiling and price. If the facility does not meet the
ninety percent threshold, the department may use an alternate case mix
index to determine the facility average and medicaid average case mix
indexes for the quarter. The threshold is a count of unique minimum
data set assessments, and it shall include resident assessment
instrument tracking forms for residents discharged prior to completing
an initial assessment. The threshold is calculated by dividing a
facility's count of residents being assessed by the average census for
the facility. A daily census shall be reported by each nursing
facility as it transmits assessment data to the department. The
department shall compute a quarterly average census based on the daily
census. If no census has been reported by a facility during a
specified quarter, then the department shall use the facility's
licensed beds as the denominator in computing the threshold.))(a) Although the facility average and the medicaid average
case mix indexes shall both be calculated quarterly, the facility
average case mix index will be used throughout the applicable cost-rebasing period in combination with cost report data as specified by
RCW 74.46.431 and 74.46.506, to establish a facility's allowable cost
per case mix unit. A facility's medicaid average case mix index shall
be used to update a nursing facility's direct care component rate
quarterly.
(7)
(b) The facility average case mix index used to establish each
nursing facility's direct care component rate shall be based on an
average of calendar quarters of the facility's average case mix
indexes((.)) from the four calendar quarters occurring during the cost
report period used to rebase the direct care component rate allocations
as specified in RCW 74.46.431.
(i) For October 1, 1998, direct care component rates, the
department shall use an average of facility average case mix indexes
from the four calendar quarters of 1997.
(ii) For July 1, 2001, direct care component rates, the department
shall use an average of facility average case mix indexes from the four
calendar quarters of 1999.
(iii) Beginning on July 1, 2006, when establishing the direct care
component rates, the department shall use an average of facility case
mix indexes
(c) The medicaid average case mix index used to update or
recalibrate a nursing facility's direct care component rate quarterly
shall be from the calendar quarter commencing six months prior to the
effective date of the quarterly rate. For example, October 1, 1998,
through December 31, 1998, direct care component rates shall utilize
case mix averages from the April 1, 1998, through June 30, 1998,
calendar quarter, and so forth.
Sec. 12 RCW 74.46.506 and 2007 c 508 s 3 are each amended to read
as follows:
(1) The direct care component rate allocation corresponds to the
provision of nursing care for one resident of a nursing facility for
one day, including direct care supplies. Therapy services and
supplies, which correspond to the therapy care component rate, shall be
excluded. The direct care component rate includes elements of case mix
determined consistent with the principles of this section and other
applicable provisions of this chapter.
(2) ((Beginning October 1, 1998,)) The department shall determine
and update quarterly for each nursing facility serving medicaid
residents a facility-specific per-resident day direct care component
rate allocation, to be effective on the first day of each calendar
quarter. In determining direct care component rates the department
shall utilize, as specified in this section, minimum data set resident
assessment data for each resident of the facility, as transmitted to,
and if necessary corrected by, the department in the resident
assessment instrument format approved by federal authorities for use in
this state.
(3) The department may question the accuracy of assessment data for
any resident and utilize corrected or substitute information, however
derived, in determining direct care component rates. The department is
authorized to impose civil fines and to take adverse rate actions
against a contractor, as specified by the department in rule, in order
to obtain compliance with resident assessment and data transmission
requirements and to ensure accuracy.
(4) Cost report data used in setting direct care component rate
allocations shall be for rate periods as specified in RCW
74.46.431(4)(a).
(5) ((Beginning October 1, 1998,)) The department shall rebase each
nursing facility's direct care component rate allocation as described
in RCW 74.46.431, adjust its direct care component rate allocation for
economic trends and conditions as described in RCW 74.46.431, and
update its medicaid average case mix index, consistent with the
following:
(a) ((Reduce)) Adjust total direct care costs reported by each
nursing facility for the applicable cost report period specified in RCW
74.46.431(4)(a) to reflect any department adjustments, and to eliminate
reported resident therapy costs and adjustments, in order to derive the
facility's total allowable direct care cost;
(b) Divide each facility's total allowable direct care cost by its
adjusted resident days for the same report period, ((increased if
necessary to a minimum occupancy of eighty-five percent; that is, the
greater of actual or imputed occupancy at eighty-five percent of
licensed beds,)) to derive the facility's allowable direct care cost
per resident day((. However, effective July 1, 2006, each facility's
allowable direct care costs shall be divided by its adjusted resident
days without application of a minimum occupancy assumption));
(c) ((Adjust the facility's per resident day direct care cost by
the applicable factor specified in RCW 74.46.431(4) to derive its
adjusted allowable direct care cost per resident day;)) Divide each facility's adjusted allowable direct care cost
per resident day by the facility average case mix index for the
applicable quarters specified by RCW 74.46.501((
(d)(7))) (6)(b) to derive
the facility's allowable direct care cost per case mix unit;
(((e) Effective for July 1, 2001, rate setting,)) (d) Divide
nursing facilities into at least two and, if applicable, three peer
groups: Those located in nonurban counties; those located in high
labor-cost counties, if any; and those located in other urban counties;
(((f))) (e) Array separately the allowable direct care cost per
case mix unit for all facilities in nonurban counties; for all
facilities in high labor-cost counties, if applicable; and for all
facilities in other urban counties, and determine the median allowable
direct care cost per case mix unit for each peer group;
(((g) Except as provided in (i) of this subsection, from October 1,
1998, through June 30, 2000, determine each facility's quarterly direct
care component rate as follows:)) (f) Determine each
facility's quarterly direct care component rate as follows:
(i) Any facility whose allowable cost per case mix unit is less
than eighty-five percent of the facility's peer group median
established under (f) of this subsection shall be assigned a cost per
case mix unit equal to eighty-five percent of the facility's peer group
median, and shall have a direct care component rate allocation equal to
the facility's assigned cost per case mix unit multiplied by that
facility's medicaid average case mix index from the applicable quarter
specified in RCW 74.46.501(7)(c);
(ii) Any facility whose allowable cost per case mix unit is greater
than one hundred fifteen percent of the peer group median established
under (f) of this subsection shall be assigned a cost per case mix unit
equal to one hundred fifteen percent of the peer group median, and
shall have a direct care component rate allocation equal to the
facility's assigned cost per case mix unit multiplied by that
facility's medicaid average case mix index from the applicable quarter
specified in RCW 74.46.501(7)(c);
(iii) Any facility whose allowable cost per case mix unit is
between eighty-five and one hundred fifteen percent of the peer group
median established under (f) of this subsection shall have a direct
care component rate allocation equal to the facility's allowable cost
per case mix unit multiplied by that facility's medicaid average case
mix index from the applicable quarter specified in RCW 74.46.501(7)(c);
(h) Except as provided in (i) of this subsection, from July 1,
2000, through June 30, 2006, determine each facility's quarterly direct
care component rate as follows:
(i) Any facility whose allowable cost per case mix unit is less
than ninety percent of the facility's peer group median established
under (f) of this subsection shall be assigned a cost per case mix unit
equal to ninety percent of the facility's peer group median, and shall
have a direct care component rate allocation equal to the facility's
assigned cost per case mix unit multiplied by that facility's medicaid
average case mix index from the applicable quarter specified in RCW
74.46.501(7)(c);
(ii) Any facility whose allowable cost per case mix unit is greater
than one hundred ten percent of the peer group median established under
(f) of this subsection shall be assigned a cost per case mix unit equal
to one hundred ten percent of the peer group median, and shall have a
direct care component rate allocation equal to the facility's assigned
cost per case mix unit multiplied by that facility's medicaid average
case mix index from the applicable quarter specified in RCW
74.46.501(7)(c);
(iii) Any facility whose allowable cost per case mix unit is
between ninety and one hundred ten percent of the peer group median
established under (f) of this subsection shall have a direct care
component rate allocation equal to the facility's allowable cost per
case mix unit multiplied by that facility's medicaid average case mix
index from the applicable quarter specified in RCW 74.46.501(7)(c);
(i)(i) Between October 1, 1998, and June 30, 2000, the department
shall compare each facility's direct care component rate allocation
calculated under (g) of this subsection with the facility's nursing
services component rate in effect on September 30, 1998, less therapy
costs, plus any exceptional care offsets as reported on the cost
report, adjusted for economic trends and conditions as provided in RCW
74.46.431. A facility shall receive the higher of the two rates.
(ii) Between July 1, 2000, and June 30, 2002, the department shall
compare each facility's direct care component rate allocation
calculated under (h) of this subsection with the facility's direct care
component rate in effect on June 30, 2000. A facility shall receive
the higher of the two rates. Between July 1, 2001, and June 30, 2002,
if during any quarter a facility whose rate paid under (h) of this
subsection is greater than either the direct care rate in effect on
June 30, 2000, or than that facility's allowable direct care cost per
case mix unit calculated in (d) of this subsection multiplied by that
facility's medicaid average case mix index from the applicable quarter
specified in RCW 74.46.501(7)(c), the facility shall be paid in that
and each subsequent quarter pursuant to (h) of this subsection and
shall not be entitled to the greater of the two rates.
(iii) Between July 1, 2002, and June 30, 2006, all direct care
component rate allocations shall be as determined under (h) of this
subsection.
(iv) Effective July 1, 2006, for all providers, except vital local
providers as defined in this chapter, all direct care component rate
allocations shall be as determined under (j) of this subsection.
(v) Effective July 1, 2006, through June 30, 2007, for vital local
providers, as defined in this chapter, direct care component rate
allocations shall be determined as follows:
(A) The department shall calculate:
(I) The sum of each facility's July 1, 2006, direct care component
rate allocation calculated under (j) of this subsection and July 1,
2006, operations component rate calculated under RCW 74.46.521; and
(II) The sum of each facility's June 30, 2006, direct care and
operations component rates.
(B) If the sum calculated under (i)(v)(A)(I) of this subsection is
less than the sum calculated under (i)(v)(A)(II) of this subsection,
the facility shall have a direct care component rate allocation equal
to the facility's June 30, 2006, direct care component rate allocation.
(C) If the sum calculated under (i)(v)(A)(I) of this subsection is
greater than or equal to the sum calculated under (i)(v)(A)(II) of this
subsection, the facility's direct care component rate shall be
calculated under (j) of this subsection;
(j) Except as provided in (i) of this subsection, from July 1,
2006, forward, and for all future rate setting,
(i) Any facility whose allowable cost per case mix unit is greater
than one hundred twelve percent of the peer group median established
under (((f))) (e) of this subsection shall be assigned a cost per case
mix unit equal to one hundred twelve percent of the peer group median,
and shall have a direct care component rate allocation equal to the
facility's assigned cost per case mix unit multiplied by that
facility's medicaid average case mix index from the applicable quarter
specified in RCW 74.46.501(((7))) (6)(c);
(ii) Any facility whose allowable cost per case mix unit is less
than or equal to one hundred twelve percent of the peer group median
established under (((f))) (e) of this subsection shall have a direct
care component rate allocation equal to the facility's allowable cost
per case mix unit multiplied by that facility's medicaid average case
mix index from the applicable quarter specified in RCW 74.46.501(((7)))
(6)(c).
(6) The direct care component rate allocations calculated in
accordance with this section shall be adjusted to the extent necessary
to comply with RCW 74.46.421.
(7) Costs related to payments resulting from increases in direct
care component rates, granted under authority of RCW 74.46.508(((1)))
for a facility's exceptional care residents, shall be offset against
the facility's examined, allowable direct care costs, for each report
year or partial period such increases are paid. Such reductions in
allowable direct care costs shall be for rate setting, settlement, and
other purposes deemed appropriate by the department.
Sec. 13 RCW 74.46.508 and 2003 1st sp.s. c 6 s 1 are each amended
to read as follows:
(((1))) The department is authorized to increase the direct care
component rate allocation calculated under RCW 74.46.506(5) for
residents who have unmet exceptional care needs as determined by the
department in rule. The department may, by rule, establish criteria,
patient categories, and methods of exceptional care payment.
(((2) The department may by July 1, 2003, adopt rules and implement
a system of exceptional care payments for therapy care.))
(a) Payments may be made on behalf of facility residents who are
under age sixty-five, not eligible for medicare, and can achieve
significant progress in their functional status if provided with
intensive therapy care services.
(b) Payments may be made only after approval of a rehabilitation
plan of care for each resident on whose behalf a payment is made under
this subsection, and each resident's progress must be periodically
monitored.
Sec. 14 RCW 74.46.511 and 2008 c 263 s 3 are each amended to read
as follows:
(1) The therapy care component rate allocation corresponds to the
provision of medicaid one-on-one therapy provided by a qualified
therapist as defined in this chapter, including therapy supplies and
therapy consultation, for one day for one medicaid resident of a
nursing facility. ((The therapy care component rate allocation for
October 1, 1998, through June 30, 2001, shall be based on adjusted
therapy costs and days from calendar year 1996. The therapy component
rate allocation for July 1, 2001, through June 30, 2007, shall be based
on adjusted therapy costs and days from calendar year 1999. Effective
July 1, 2007,)) The therapy care component rate allocation shall be
based on adjusted therapy costs and days as described in RCW
74.46.431(5). The therapy care component rate shall be adjusted for
economic trends and conditions as specified in RCW 74.46.431(5), and
shall be determined in accordance with this section. In determining
each facility's therapy care component rate allocation, the department
shall apply the applicable minimum facility occupancy adjustment before
creating the array of facilities' adjusted therapy care costs per
adjusted resident day.
(2) In rebasing, as provided in RCW 74.46.431(5)(a), the department
shall take from the cost reports of facilities the following reported
information:
(a) Direct one-on-one therapy charges for all residents by payer
including charges for supplies;
(b) The total units or modules of therapy care for all residents by
type of therapy provided, for example, speech or physical. A unit or
module of therapy care is considered to be fifteen minutes of one-on-one therapy provided by a qualified therapist or support personnel; and
(c) Therapy consulting expenses for all residents.
(3) The department shall determine for all residents the total cost
per unit of therapy for each type of therapy by dividing the total
adjusted one-on-one therapy expense for each type by the total units
provided for that therapy type.
(4) The department shall divide medicaid nursing facilities in this
state into two peer groups:
(a) Those facilities located within urban counties; and
(b) Those located within nonurban counties.
The department shall array the facilities in each peer group from
highest to lowest based on their total cost per unit of therapy for
each therapy type. The department shall determine the median total
cost per unit of therapy for each therapy type and add ten percent of
median total cost per unit of therapy. The cost per unit of therapy
for each therapy type at a nursing facility shall be the lesser of its
cost per unit of therapy for each therapy type or the median total cost
per unit plus ten percent for each therapy type for its peer group.
(5) The department shall calculate each nursing facility's therapy
care component rate allocation as follows:
(a) To determine the allowable total therapy cost for each therapy
type, the allowable cost per unit of therapy for each type of therapy
shall be multiplied by the total therapy units for each type of
therapy;
(b) The medicaid allowable one-on-one therapy expense shall be
calculated taking the allowable total therapy cost for each therapy
type times the medicaid percent of total therapy charges for each
therapy type;
(c) The medicaid allowable one-on-one therapy expense for each
therapy type shall be divided by total adjusted medicaid days to arrive
at the medicaid one-on-one therapy cost per patient day for each
therapy type;
(d) The medicaid one-on-one therapy cost per patient day for each
therapy type shall be multiplied by total adjusted patient days for all
residents to calculate the total allowable one-on-one therapy expense.
The lesser of the total allowable therapy consultant expense for the
therapy type or a reasonable percentage of allowable therapy consultant
expense for each therapy type, as established in rule by the
department, shall be added to the total allowable one-on-one therapy
expense to determine the allowable therapy cost for each therapy type;
(e) The allowable therapy cost for each therapy type shall be added
together, the sum of which shall be the total allowable therapy expense
for the nursing facility;
(f) The total allowable therapy expense will be divided by the
greater of adjusted total patient days from the cost report on which
the therapy expenses were reported, or patient days at eighty-five
percent occupancy of licensed beds. The outcome shall be the nursing
facility's therapy care component rate allocation.
(6) The therapy care component rate allocations calculated in
accordance with this section shall be adjusted to the extent necessary
to comply with RCW 74.46.421.
(7) The therapy care component rate shall be suspended for medicaid
residents in qualified nursing facilities designated by the department
who are receiving therapy paid by the department outside the facility
daily rate ((under RCW 74.46.508(2))).
Sec. 15 RCW 74.46.515 and 2008 c 263 s 4 are each amended to read
as follows:
(1) The support services component rate allocation corresponds to
the provision of food, food preparation, dietary, housekeeping, and
laundry services for one resident for one day.
(2) ((Beginning October 1, 1998,)) The department shall determine
each medicaid nursing facility's support services component rate
allocation using cost report data specified by RCW 74.46.431(6).
(3) To determine each facility's support services component rate
allocation, the department shall:
(a) Array facilities' adjusted support services costs per adjusted
resident day, as determined by dividing each facility's total allowable
support services costs by its adjusted resident days for the same
report period, increased if necessary to a minimum occupancy provided
by RCW 74.46.431(2), for each facility from facilities' cost reports
from the applicable report year, 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 support services component rate at the
lower of the facility's per resident day adjusted support services
costs from the applicable cost report period or the adjusted median per
resident day support services cost for that facility's peer group,
either urban counties or nonurban counties, plus ten percent; and
(c) Adjust each facility's support services component rate for
economic trends and conditions as provided in RCW 74.46.431(6).
(4) The support services component rate allocations calculated in
accordance with this section shall be adjusted to the extent necessary
to comply with RCW 74.46.421.
Sec. 16 RCW 74.46.521 and 2007 c 508 s 5 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) ((Except as provided in subsection (4) of this section,
beginning October 1, 1998,)) 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). ((Effective July 1,
2002,)) Operations component rates for all facilities except essential
community providers shall be based upon a minimum occupancy of ninety
percent of licensed beds, and no operations component rate shall be
revised in response to beds banked on or after May 25, 2001, under
chapter 70.38 RCW.
(3) ((Except as provided in subsection (4) of this section,)) 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, increased if necessary to a minimum occupancy of ninety
percent; that is, the greater of actual or imputed occupancy at ninety
percent of licensed beds, for each facility from facilities' cost
reports from the applicable report year, 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 to a minimum
occupancy of ((eighty-five percent of licensed beds before July 1,
2002, and)) ninety percent ((effective July 1, 2002)); 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)(((a) Effective July 1, 2006, through June 30, 2007, for any
facility whose direct care component rate allocation is set equal to
its June 30, 2006, direct care component rate allocation, as provided
in RCW 74.46.506(5), the facility's operations component rate
allocation shall also be set equal to the facility's June 30, 2006,
operations component rate allocation.)) 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.
(b) The operations component rate allocation for facilities whose
operations component rate is set equal to their June 30, 2006,
operations component rate, shall be adjusted for economic trends and
conditions as provided in RCW 74.46.431(7)(b).
(5)
Sec. 17 RCW 74.46.835 and 1998 c 322 s 46 are each amended to
read as follows:
(1) Payment for direct care at the pilot nursing facility in King
county designed to meet the service needs of residents living with
AIDS, as defined in RCW 70.24.017, and as specifically authorized for
this purpose under chapter 9, Laws of 1989 1st ex. sess., shall be
exempt from case mix methods of rate determination set forth in this
chapter and shall be exempt from the direct care metropolitan
statistical area peer group cost limitation set forth in this chapter.
(2) Direct care component rates at the AIDS pilot facility shall be
based on direct care reported costs at the pilot facility, utilizing
the same ((three-year,)) rate-setting cycle prescribed for other
nursing facilities, and as supported by a staffing benchmark based upon
a department-approved acuity measurement system.
(3) The provisions of RCW 74.46.421 and all other rate-setting
principles, cost lids, and limits, including settlement as provided in
RCW 74.46.165 shall apply to the AIDS pilot facility.
(4) This section applies only to the AIDS pilot nursing facility.
Sec. 18 RCW 74.46.800 and 1998 c 322 s 42 are each amended to
read as follows:
(1) The department shall have authority to adopt, amend, and
rescind such administrative rules and definitions as it deems necessary
to carry out the policies and purposes of this chapter and to resolve
issues and develop procedures ((that it deems necessary)) to implement,
update, and improve ((the case mix elements of)) the nursing facility
medicaid payment system.
(2) Nothing in this chapter shall be construed to require the
department to adopt or employ any calculations, steps, tests,
methodologies, alternate methodologies, indexes, formulas, mathematical
or statistical models, concepts, or procedures for medicaid rate
setting or payment that are not expressly called for in this chapter.
NEW SECTION. Sec. 19 The following acts or parts of acts are
each repealed:
(1) RCW 74.46.030 (Principles of reporting requirements) and 1980
c 177 s 3;
(2) RCW 74.46.040 (Due dates for cost reports) and 1998 c 322 s 3,
1985 c 361 s 4, 1983 1st ex.s. c 67 s 1, & 1980 c 177 s 4;
(3) RCW 74.46.050 (Improperly completed or late cost report--Fines -- Adverse rate actions -- Rules) and 1998 c 322 s 4, 1985 c 361 s 5,
& 1980 c 177 s 5;
(4) RCW 74.46.060 (Completing cost reports and maintaining records)
and 1998 c 322 s 5, 1985 c 361 s 6, 1983 1st ex.s. c 67 s 2, & 1980 c
177 s 6;
(5) RCW 74.46.080 (Requirements for retention of records by the
contractor) and 1998 c 322 s 6, 1985 c 361 s 7, 1983 1st ex.s. c 67 s
3, & 1980 c 177 s 8;
(6) RCW 74.46.090 (Retention of cost reports and resident
assessment information by the department) and 1998 c 322 s 7, 1985 c
361 s 8, & 1980 c 177 s 9;
(7) RCW 74.46.100 (Purposes of department audits--Examination--Incomplete or incorrect reports -- Contractor's duties -- Access to
facility -- Fines -- Adverse rate actions) and 1998 c 322 s 8, 1985 c 361
s 9, 1983 1st ex.s. c 67 s 4, & 1980 c 177 s 10;
(8) RCW 74.46.155 (Reconciliation of medicaid resident days to
billed days and medicaid payments -- Payments due -- Accrued interest--Withholding funds) and 1998 c 322 s 9;
(9) RCW 74.46.165 (Proposed settlement report -- Payment refunds--Overpayments -- Determination of unused rate funds -- Total and component
payment rates) and 2001 1st sp.s. c 8 s 2 & 1998 c 322 s 10;
(10) RCW 74.46.190 (Principles of allowable costs) and 1998 c 322
s 11, 1995 1st sp.s. c 18 s 96, 1983 1st ex.s. c 67 s 12, & 1980 c 177
s 19;
(11) RCW 74.46.200 (Offset of miscellaneous revenues) and 1980 c
177 s 20;
(12) RCW 74.46.220 (Payments to related organizations -- Limits--Documentation) and 1998 c 322 s 12 & 1980 c 177 s 22;
(13) RCW 74.46.230 (Initial cost of operation) and 1998 c 322 s 13,
1993 sp.s. c 13 s 3, & 1980 c 177 s 23;
(14) RCW 74.46.240 (Education and training) and 1980 c 177 s 24;
(15) RCW 74.46.250 (Owner or relative -- Compensation) and 1980 c 177
s 25;
(16) RCW 74.46.270 (Disclosure and approval or rejection of cost
allocation) and 1998 c 322 s 14, 1983 1st ex.s. c 67 s 13, & 1980 c 177
s 27;
(17) RCW 74.46.280 (Management fees, agreements -- Limitation on
scope of services) and 1998 c 322 s 15, 1993 sp.s. c 13 s 4, & 1980 c
177 s 28;
(18) RCW 74.46.290 (Expense for construction interest) and 1980 c
177 s 29;
(19) RCW 74.46.300 (Operating leases of office equipment--Rules)
and 1998 c 322 s 16 & 1980 c 177 s 30;
(20) RCW 74.46.310 (Capitalization) and 1983 1st ex.s. c 67 s 16 &
1980 c 177 s 31;
(21) RCW 74.46.320 (Depreciation expense) and 1980 c 177 s 32;
(22) RCW 74.46.330 (Depreciable assets) and 1980 c 177 s 33;
(23) RCW 74.46.340 (Land, improvements -- Depreciation) and 1980 c
177 s 34;
(24) RCW 74.46.350 (Methods of depreciation) and 1999 c 353 s 13 &
1980 c 177 s 35;
(25) RCW 74.46.360 (Cost basis of land and depreciation base of
depreciable assets) and 1999 c 353 s 2, 1997 c 277 s 1, 1991 sp.s. c 8
s 18, & 1989 c 372 s 14;
(26) RCW 74.46.370 (Lives of assets) and 1999 c 353 s 14, 1997 c
277 s 2, & 1980 c 177 s 37;
(27) RCW 74.46.380 (Depreciable assets) and 1993 sp.s. c 13 s 5,
1991 sp.s. c 8 s 12, & 1980 c 177 s 38;
(28) RCW 74.46.390 (Gains and losses upon replacement of
depreciable assets) and 1980 c 177 s 39;
(29) RCW 74.46.410 (Unallowable costs) and 2007 c 508 s 1, 2001 1st
sp.s. c 8 s 3, 1998 c 322 s 17, 1995 1st sp.s. c 18 s 97, 1993 sp.s. c
13 s 6, 1991 sp.s. c 8 s 15, 1989 c 372 s 2, 1986 c 175 s 3, 1983 1st
ex.s. c 67 s 17, & 1980 c 177 s 41;
(30) RCW 74.46.445 (Contractors -- Rate adjustments) and 1999 c 353
s 15;
(31) RCW 74.46.533 (Combined and estimated rebased rates--Determination -- Hold harmless provision) and 2007 c 508 s 6;
(32) RCW 74.46.600 (Billing period) and 1980 c 177 s 60;
(33) RCW 74.46.610 (Billing procedure -- Rules) and 1998 c 322 s 32,
1983 1st ex.s. c 67 s 33, & 1980 c 177 s 61;
(34) RCW 74.46.620 (Payment) and 1998 c 322 s 33 & 1980 c 177 s 62;
(35) RCW 74.46.625 (Supplemental payments) and 1999 c 392 s 1;
(36) RCW 74.46.630 (Charges to patients) and 1998 c 322 s 34 & 1980
c 177 s 63;
(37) RCW 74.46.640 (Suspension of payments) and 1998 c 322 s 35,
1995 1st sp.s. c 18 s 112, 1983 1st ex.s. c 67 s 34, & 1980 c 177 s 64;
(38) RCW 74.46.650 (Termination of payments) and 1998 c 322 s 36 &
1980 c 177 s 65;
(39) RCW 74.46.660 (Conditions of participation) and 1998 c 322 s
37, 1992 c 215 s 1, 1991 sp.s. c 8 s 13, & 1980 c 177 s 66;
(40) RCW 74.46.680 (Change of ownership -- Assignment of department's
contract) and 1998 c 322 s 38, 1985 c 361 s 2, & 1980 c 177 s 68;
(41) RCW 74.46.690 (Change of ownership -- Final reports -- Settlement)
and 1998 c 322 s 39, 1995 1st sp.s. c 18 s 113, 1985 c 361 s 3, 1983
1st ex.s. c 67 s 36, & 1980 c 177 s 69;
(42) RCW 74.46.700 (Resident personal funds -- Records -- Rules) and
1991 sp.s. c 8 s 19 & 1980 c 177 s 70;
(43) RCW 74.46.711 (Resident personal funds -- Conveyance upon death
of resident) and 2001 1st sp.s. c 8 s 14 & 1995 1st sp.s. c 18 s 69;
(44) RCW 74.46.770 (Contractor appeals -- Challenges of laws, rules,
or contract provisions -- Challenge based on federal law) and 1998 c 322
s 40, 1995 1st sp.s. c 18 s 114, 1983 1st ex.s. c 67 s 39, & 1980 c 177
s 77;
(45) RCW 74.46.780 (Appeals or exception procedure) and 1998 c 322
s 41, 1995 1st sp.s. c 18 s 115, 1989 c 175 s 159, 1983 1st ex.s. c 67
s 40, & 1980 c 177 s 78;
(46) RCW 74.46.790 (Denial, suspension, or revocation of license or
provisional license -- Penalties) and 1980 c 177 s 79;
(47) RCW 74.46.820 (Public disclosure) and 2005 c 274 s 356, 1998
c 322 s 43, 1985 c 361 s 14, 1983 1st ex.s. c 67 s 41, & 1980 c 177 s
82;
(48) RCW 74.46.900 (Severability -- 1980 c 177) and 1980 c 177 s 93;
(49) RCW 74.46.901 (Effective dates -- 1983 1st ex.s. c 67; 1980 c
177) and 1983 1st ex.s. c 67 s 49, 1981 1st ex.s. c 2 s 10, & 1980 c
177 s 94;
(50) RCW 74.46.902 (Section captions -- 1980 c 177) and 1980 c 177 s
89;
(51) RCW 74.46.905 (Severability -- 1983 1st ex.s. c 67) and 1983 1st
ex.s. c 67 s 43; and
(52) RCW 74.46.906 (Effective date -- 1998 c 322 §§ 1-37, 40-49, and
52-54) and 1998 c 322 s 55.