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H.B. 482 Enrolled

             1     

LONG-TERM CARE FACILITY - MEDICAID

             2     
CERTIFICATION FOR BED CAPACITY AMENDMENTS

             3     
2011 GENERAL SESSION

             4     
STATE OF UTAH

             5     
Chief Sponsor: Eric K. Hutchings

             6     
Senate Sponsor: Luz Robles

             7     
             8      LONG TITLE
             9      General Description:
             10          This bill amends provisions of the Medical Assistance Act regarding Medicaid
             11      certification of nursing care facility programs.
             12      Highlighted Provisions:
             13          This bill:
             14          .    allows the Division of Healthcare Financing within the Department of Health, under
             15      certain conditions, to renew Medicaid certification of a nursing care facility not
             16      currently certified; and
             17          .    makes technical changes.
             18      Money Appropriated in this Bill:
             19          None
             20      Other Special Clauses:
             21          None
             22      Utah Code Sections Affected:
             23      AMENDS:
             24          26-18-503, as last amended by Laws of Utah 2008, Chapter 347
             25     
             26      Be it enacted by the Legislature of the state of Utah:
             27          Section 1. Section 26-18-503 is amended to read:
             28           26-18-503. Authorization to renew, transfer, or increase Medicaid certified
             29      programs -- Reimbursement methodology.


             30          (1) (a) The division may renew Medicaid certification of a certified program if the
             31      program, without lapse in service to Medicaid recipients, has its nursing care facility program
             32      certified by the division at the same physical facility as long as the licensed and certified bed
             33      capacity at the facility has not been expanded, unless the director has approved additional beds
             34      in accordance with Subsection (5).
             35          (b) The division may renew Medicaid certification of a nursing care facility program
             36      that is not currently certified if:
             37          (i) since the day on which the program last operated with Medicaid certification:
             38          (A) the physical facility where the program operated has functioned solely and
             39      continuously as a nursing care facility; and
             40          (B) the owner of the program has not, under this section or Section 26-18-505 ,
             41      transferred to another nursing care facility program the license for any of the Medicaid beds in
             42      the program; and
             43          (ii) the number of beds granted renewed Medicaid certification does not exceed the
             44      number of beds certified at the time the program last operated with Medicaid certification,
             45      excluding a period of time where the program operated with temporary certification under
             46      Subsection 26-18-504 (4).
             47          (2) (a) The division may issue a Medicaid certification for a new nursing care facility
             48      program if a current owner of the Medicaid certified program transfers its ownership of the
             49      Medicaid certification to the new nursing care facility program and the new nursing care
             50      facility program meets all of the following conditions:
             51          (i) the new nursing care facility program operates at the same physical facility as the
             52      previous Medicaid certified program;
             53          (ii) the new nursing care facility program gives a written assurance to the director in
             54      accordance with Subsection (4);
             55          (iii) the new nursing care facility program receives the Medicaid certification within
             56      one year of the date the previously certified program ceased to provide medical assistance to a
             57      Medicaid recipient; and


             58          (iv) the licensed and certified bed capacity at the facility has not been expanded, unless
             59      the director has approved additional beds in accordance with Subsection (5).
             60          (b) A nursing care facility program that receives Medicaid certification under the
             61      provisions of Subsection (2)(a) does not assume the Medicaid liabilities of the previous nursing
             62      care facility program if the new nursing care facility program:
             63          (i) is not owned in whole or in part by the previous nursing care facility program; or
             64          (ii) is not a successor in interest of the previous nursing care facility program.
             65          (3) The division may issue a Medicaid certification to a nursing care facility program
             66      that was previously a certified program but now resides in a new or renovated physical facility
             67      if the nursing care facility program meets all of the following:
             68          (a) the nursing care facility program met all applicable requirements for Medicaid
             69      certification at the time of closure;
             70          (b) the new or renovated physical facility is in the same county or within a five-mile
             71      radius of the original physical facility;
             72          (c) the time between which the certified program ceased to operate in the original
             73      facility and will begin to operate in the new physical facility is not more than three years;
             74          (d) if Subsection (3)(c) applies, the certified program notifies the department within 90
             75      days after ceasing operations in its original facility, of its intent to retain its Medicaid
             76      certification;
             77          (e) the provider gives written assurance to the director in accordance with Subsection
             78      (4) that no third party has a legitimate claim to operate a certified program at the previous
             79      physical facility; and
             80          (f) the bed capacity in the physical facility has not been expanded unless the director
             81      has approved additional beds in accordance with Subsection (5).
             82          (4) (a) The entity requesting Medicaid certification under Subsections (2) and (3) must
             83      give written assurances satisfactory to the director or his designee that:
             84          (i) no third party has a legitimate claim to operate the certified program;
             85          (ii) the requesting entity agrees to defend and indemnify the department against any


             86      claims by a third party who may assert a right to operate the certified program; and
             87          (iii) if a third party is found, by final agency action of the department after exhaustion
             88      of all administrative and judicial appeal rights, to be entitled to operate a certified program at
             89      the physical facility the certified program shall voluntarily comply with Subsection (4)(b).
             90          (b) If a finding is made under the provisions of Subsection (4)(a)(iii):
             91          (i) the certified program shall immediately surrender its Medicaid certification and
             92      comply with division rules regarding billing for Medicaid and the provision of services to
             93      Medicaid patients; and
             94          (ii) the department shall transfer the surrendered Medicaid certification to the third
             95      party who prevailed under Subsection (4)(a)(iii).
             96          (5) (a) As provided in Subsection 26-18-502 (2)(b), the director shall issue additional
             97      Medicaid certification when requested by a nursing care facility or other interested party if
             98      there is insufficient bed capacity with current certified programs in a service area. A
             99      determination of insufficient bed capacity shall be based on the nursing care facility or other
             100      interested party providing reasonable evidence of an inadequate number of beds in the county
             101      or group of counties impacted by the requested Medicaid certification based on:
             102          (i) current demographics which demonstrate nursing care facility occupancy levels of at
             103      least 90% for all existing and proposed facilities within a prospective three-year period;
             104          (ii) current nursing care facility occupancy levels of 90%; or
             105          (iii) no other nursing care facility within a 35-mile radius of the nursing care facility
             106      requesting the additional certification.
             107          (b) In addition to the requirements of Subsection (5)(a), a nursing care facility program
             108      must demonstrate by an independent analysis that the nursing care facility can financially
             109      support itself at an after tax break-even net income level based on projected occupancy levels.
             110          (c) When making a determination to certify additional beds or an additional nursing
             111      care facility program under Subsection (5)(a):
             112          (i) the director shall consider whether the nursing care facility will offer specialized or
             113      unique services that are underserved in a service area;


             114          (ii) the director shall consider whether any Medicaid certified beds are subject to a
             115      claim by a previous certified program that may reopen under the provisions of Subsections (2)
             116      and (3); and
             117          (iii) the director may consider how to add additional capacity to the long-term care
             118      delivery system to best meet the needs of Medicaid recipients.
             119          (6) The department shall adopt administrative rules in accordance with Title 63G,
             120      Chapter 3, Utah Administrative Rulemaking Act, to adjust the Medicaid nursing care facility
             121      property reimbursement methodology to:
             122          (a) beginning July 1, 2008, only pay that portion of the property component of rates,
             123      representing actual bed usage by Medicaid clients as a percentage of the greater of:
             124          (i) actual occupancy; or
             125          (ii) (A) for a nursing care facility other than a facility described in Subsection
             126      (6)(a)(ii)(B), 85% of total bed capacity; or
             127          (B) for a rural nursing care facility, 65% of total bed capacity; and
             128          (b) beginning July 1, 2008, not allow for increases in reimbursement for property
             129      values without major renovation or replacement projects as defined by the department by rule.


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