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• 2024 General Session
• H.B. 503

H.B. 503 Nursing Care Facility Amendments

• Bill Text
• Status
• Hearings/Debate

Bill Sponsor: Rep. Burton, Jefferson S.

Floor Sponsor: Sen. McKell, Michael K.

• Substitute Sponsor: Rep. Burton, Jefferson S.

• Drafting Attorney: Greg Gunn
• Fiscal Analyst: Russell T. Frandsen

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• Bill Text
  • Introduced
  • Enrolled

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• Other Versions
  • H.B. 503
    Substitute Sponsor:
    

    • Introduced
    • Fiscal Note
    • House Transmittal Letter 1
    • Senate Transmittal Letter 1
  • H.B. 503 1st Substitute (Not Adopted)
    Substitute Sponsor: Burton, J.
    

    • Text
    • Fiscal Note
    • HB0503 comparison

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• Related Documents
  • Fiscal Note
  • HB0503 comparison

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• Information
  • Last Action: 14 Mar 2024, Governor Signed
  • Last Location: Lieutenant Governor's office for filing

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• Similar Bills
  • Veterans and Military Affairs
  • Medicaid
  • Nurses
  • Nursing Homes
  • Skilled Nursing Facilities

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Enrolled

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H.B. 503

4 26B-3-311 26B-3-313

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NURSING CARE FACILITY AMENDMENTS 2024 GENERAL SESSION STATE OF UTAH Chief Sponsor: Jefferson S. Burton Senate Sponsor: Michael K. McKell

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LONG TITLE

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General Description:

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This bill amends Medicaid provisions impacting nursing care facilities.

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Highlighted Provisions:

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This bill:

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▸allows a state-owned veterans nursing care facility to obtain a one-time approval for up

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to five total Medicaid certified beds, without the facility first proving bed capacity

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insufficiency or financial viability; and

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▸limits the transfer or sale of Medicaid certified beds in certain conditions.

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Money Appropriated in this Bill:

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None

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Other Special Clauses:

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None

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Utah Code Sections Affected:

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AMENDS:

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26B-3-311, as renumbered and amended by Laws of Utah 2023, Chapter 306

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26B-3-313, as renumbered and amended by Laws of Utah 2023, Chapter 306

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Be it enacted by the Legislature of the state of Utah:

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Section 1, Section 26B-3-311 is amended to read:

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26B-3-311. Authorization to renew, transfer, or increase Medicaid certified

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programs -- Reimbursement methodology.

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(1) (a)The division may renew Medicaid certification of a certified program if the

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program, without lapse in service to Medicaid recipients, has its nursing care facility

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program certified by the division at the same physical facility as long as the licensed

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and certified bed capacity at the facility has not been expanded, unless the director

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has approved additional beds in accordance with Subsection (5).

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(b)The division may renew Medicaid certification of a nursing care facility program

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that is not currently certified if:

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(i)since the day on which the program last operated with Medicaid certification:

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(A)the physical facility where the program operated has functioned solely and

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continuously as a nursing care facility; and

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(B)the owner of the program has not, under this section or Section 26B-3-313,

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transferred to another nursing care facility program the license for any of the

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Medicaid beds in the program; and

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(ii)except as provided in Subsection 26B-3-310(4), the number of beds granted

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renewed Medicaid certification does not exceed the number of beds certified at the

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time the program last operated with Medicaid certification, excluding a period of

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time where the program operated with temporary certification under Subsection

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26B-3-312 (3).

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(2) (a)The division may issue a Medicaid certification for a new nursing care facility

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program if a current owner of the Medicaid certified program transfers its ownership

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of the Medicaid certification to the new nursing care facility program and the new

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nursing care facility program meets all of the following conditions:

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(i)the new nursing care facility program operates at the same physical facility as the

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previous Medicaid certified program;

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(ii)the new nursing care facility program gives a written assurance to the director in

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accordance with Subsection (4);

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(iii)the new nursing care facility program receives the Medicaid certification within

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one year of the date the previously certified program ceased to provide medical

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assistance to a Medicaid recipient; and

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(iv)the licensed and certified bed capacity at the facility has not been expanded,

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unless the director has approved additional beds in accordance with Subsection (5).

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(b)A nursing care facility program that receives Medicaid certification under the

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provisions of Subsection (2)(a) does not assume the Medicaid liabilities of the

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previous nursing care facility program if the new nursing care facility program:

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(i)is not owned in whole or in part by the previous nursing care facility program; or

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(ii)is not a successor in interest of the previous nursing care facility program.

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(3)The division may issue a Medicaid certification to a nursing care facility program that

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was previously a certified program but now resides in a new or renovated physical

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facility if the nursing care facility program meets all of the following:

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(a)the nursing care facility program met all applicable requirements for Medicaid

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certification at the time of closure;

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(b)the new or renovated physical facility is in the same county or within a five-mile

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radius of the original physical facility;

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(c)the time between which the certified program ceased to operate in the original

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facility and will begin to operate in the new physical facility is not more than three

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years, unless:

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(i)an emergency is declared by the president of the United States or the governor,

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affecting the building or renovation of the physical facility;

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(ii)the director approves an exception to the three-year requirement for any nursing

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care facility program within the three-year requirement;

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(iii)the provider submits documentation supporting a request for an extension to the

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director that demonstrates a need for an extension; and

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(iv)the exception does not extend for more than two years beyond the three-year

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requirement;

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(d)if Subsection (3)(c) applies, the certified program notifies the department within 90

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days after ceasing operations in its original facility, of its intent to retain its Medicaid

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certification;

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(e)the provider gives written assurance to the director in accordance with Subsection (4)

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that no third party has a legitimate claim to operate a certified program at the

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previous physical facility; and

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(f)the bed capacity in the physical facility has not been expanded unless the director has

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approved additional beds in accordance with Subsection (5).

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(4) (a)The entity requesting Medicaid certification under Subsections (2) and (3) shall

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give written assurances satisfactory to the director or the director's designee that:

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(i)no third party has a legitimate claim to operate the certified program;

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(ii)the requesting entity agrees to defend and indemnify the department against any

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claims by a third party who may assert a right to operate the certified program; and

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(iii)if a third party is found, by final agency action of the department after exhaustion

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of all administrative and judicial appeal rights, to be entitled to operate a certified

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program at the physical facility the certified program shall voluntarily comply

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with Subsection (4)(b).

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(b)If a finding is made under the provisions of Subsection (4)(a)(iii):

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(i)the certified program shall immediately surrender its Medicaid certification and

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comply with division rules regarding billing for Medicaid and the provision of

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services to Medicaid patients; and

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(ii)the department shall transfer the surrendered Medicaid certification to the third

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party who prevailed under Subsection (4)(a)(iii).

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(5) (a)The director may approve additional nursing care facility programs for Medicaid

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certification, or additional beds for Medicaid certification within an existing nursing

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care facility program, if a nursing care facility or other interested party requests

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Medicaid certification for a nursing care facility program or additional beds within an

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existing nursing care facility program, and the nursing care facility program or other

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interested party complies with this section.

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(b) The Except as provided under Subsection (5)(e), a nursing care facility or other

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interested party requesting Medicaid certification for a nursing care facility program

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or additional beds within an existing nursing care facility program under Subsection

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(5)(a) shall submit to the director:

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(i)proof of the following as reasonable evidence that bed capacity provided by

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Medicaid certified programs within the county or group of counties impacted by

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the requested additional Medicaid certification is insufficient:

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(A)nursing care facility occupancy levels for all existing and proposed facilities

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will be at least 90% for the next three years;

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(B)current nursing care facility occupancy is 90% or more; or

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(C)there is no other nursing care facility within a 35-mile radius of the nursing

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care facility requesting the additional certification; and

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(ii)an independent analysis demonstrating that at projected occupancy rates the

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nursing care facility's after-tax net income is sufficient for the facility to be

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financially viable.

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(c)Any request for additional beds as part of a renovation project are limited to the

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maximum number of beds allowed in Subsection (7).

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(d)The director shall determine whether to issue additional Medicaid certification by

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considering:

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(i)whether bed capacity provided by certified programs within the county or group of

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counties impacted by the requested additional Medicaid certification is

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insufficient, based on the information submitted to the director under Subsection

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(5)(b);

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(ii)whether the county or group of counties impacted by the requested additional

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Medicaid certification is underserved by specialized or unique services that would

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be provided by the nursing care facility;

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(iii)whether any Medicaid certified beds are subject to a claim by a previous certified

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program that may reopen under the provisions of Subsections (2) and (3);

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(iv)how additional bed capacity should be added to the long-term care delivery

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system to best meet the needs of Medicaid recipients; and

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(v) (A)whether the existing certified programs within the county or group of

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counties have provided services of sufficient quality to merit at least a two-star

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rating in the Medicare Five-Star Quality Rating System over the previous

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three-year period; and

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(B)information obtained under Subsection (9) . ; and

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(vi) subject to Subsection (5)(e), for a state-owned veterans nursing care facility,

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whether the facility has previously been approved for a Medicaid certified bed

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increase under this Subsection (5).

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(e) For a state-owned veterans nursing care facility that has not previously been

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approved for a Medicaid certified bed increase under this Subsection (5):

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(i) the facility is exempt from the requirements under Subsection (5)(b); and

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(ii) the director may approve, for that facility location only, up to five total Medicaid

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certified beds.

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(6)The department shall adopt administrative rules in accordance with Title 63G, Chapter

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3, Utah Administrative Rulemaking Act, to adjust the Medicaid nursing care facility

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property reimbursement methodology to:

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(a)only pay that portion of the property component of rates, representing actual bed

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usage by Medicaid clients as a percentage of the greater of:

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(i)actual occupancy; or

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(ii) (A)for a nursing care facility other than a facility described in Subsection

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(6)(a)(ii)(B), 85% of total bed capacity; or

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(B)for a rural nursing care facility, 65% of total bed capacity; and

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(b)not allow for increases in reimbursement for property values without major

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renovation or replacement projects as defined by the department by rule.

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(7) (a)Except as provided in Subsection 26B-3-310(3), if a nursing care facility does not

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seek Medicaid certification for a bed under Subsections (1) through (6), the

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department shall, notwithstanding Subsections 26B-3-312(3)(a) and (b), grant

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Medicaid certification for additional beds in an existing Medicaid certified nursing

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care facility that has 90 or fewer licensed beds, including Medicaid certified beds, in

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the facility if:

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(i)the nursing care facility program was previously a certified program for all beds

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but now resides in a new facility or in a facility that underwent major renovations

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involving major structural changes, with 50% or greater facility square footage

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design changes, requiring review and approval by the department;

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(ii)the nursing care facility meets the quality of care regulations issued by CMS; and

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(iii)the total number of additional beds in the facility granted Medicaid certification

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under this section does not exceed 10% of the number of licensed beds in the

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facility.

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(b)The department may not revoke the Medicaid certification of a bed under this

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Subsection (7) as long as the provisions of Subsection (7)(a)(ii) are met.

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(8) (a)If a nursing care facility or other interested party indicates in its request for

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additional Medicaid certification under Subsection (5)(a) that the facility will offer

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specialized or unique services, but the facility does not offer those services after

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receiving additional Medicaid certification, the director shall revoke the additional

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Medicaid certification.

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(b)The nursing care facility program shall obtain Medicaid certification for any

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additional Medicaid beds approved under Subsection (5) or (7) within three years of

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the date of the director's approval, or the approval is void.

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(9) (a)If the director makes an initial determination that quality standards under

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Subsection (5)(d)(v) have not been met in a rural county or group of rural counties

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over the previous three-year period, the director shall, before approving certification

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of additional Medicaid beds in the rural county or group of counties:

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(i)notify the certified program that has not met the quality standards in Subsection

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(5)(d)(v) that the director intends to certify additional Medicaid beds under the

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provisions of Subsection (5)(d)(v); and

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(ii)consider additional information submitted to the director by the certified program

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in a rural county that has not met the quality standards under Subsection (5)(d)(v).

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(b)The notice under Subsection (9)(a) does not give the certified program that has not

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met the quality standards under Subsection (5)(d)(v), the right to legally challenge or

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appeal the director's decision to certify additional Medicaid beds under Subsection

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(5)(d)(v).

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Section 2, Section 26B-3-313 is amended to read:

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26B-3-313. Authorization to sell or transfer licensed Medicaid beds -- Duties of

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transferor -- Duties of transferee -- Duties of division.

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(1)This section provides a method to transfer or sell the license for a Medicaid bed from a

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nursing care facility program to another entity that is in addition to the authorization to

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transfer under Section 26B-3-311.

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(2) (a)A nursing care facility program may transfer or sell one or more of its licenses for

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Medicaid beds in accordance with Subsection (2)(b) if:

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(i)at the time of the transfer, and with respect to the license for the Medicaid bed that

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will be transferred, the nursing care facility program that will transfer the

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Medicaid license meets all applicable regulations for Medicaid certification;

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(ii)the nursing care facility program gives a written assurance, which is postmarked

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or has proof of delivery 30 days before the transfer, to the director and to the

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transferee in accordance with Subsection 26B-3-311(4);

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(iii)the nursing care facility program that will transfer the license for a Medicaid bed

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notifies the division in writing, which is postmarked or has proof of delivery 30

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days before the transfer, of:

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(A)the number of bed licenses that will be transferred;

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(B)the date of the transfer; and

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(C)the identity and location of the entity receiving the transferred licenses; and

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(iv)if the nursing care facility program for which the license will be transferred or

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purchased is located in an urban county with a nursing care facility average annual

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occupancy rate over the previous two years less than or equal to 75%, the nursing

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care facility program transferring or selling the license demonstrates to the

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satisfaction of the director that the sale or transfer:

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(A)will not result in an excessive number of Medicaid certified beds within the

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county or group of counties that would be impacted by the transfer or sale; and

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(B)best meets the needs of Medicaid recipients.

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(b)Except as provided in Subsection (2)(c), a nursing care facility program may transfer

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or sell one or more of its licenses for Medicaid beds to:

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(i)a nursing care facility program that has the same owner or successor in interest of

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the same owner;

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(ii)a nursing care facility program that has a different owner; or

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(iii)a related-party nonnursing-care-facility entity that wants to hold one or more of

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the licenses for a nursing care facility program not yet identified, as long as:

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(A)the licenses are subsequently transferred or sold to a nursing care facility

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program within three years; and

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(B)the nursing care facility program notifies the director of the transfer or sale in

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accordance with Subsection (2)(a)(iii).

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(c) A

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(c) (i) Subject to Subsection (2)(c)(ii), a nursing care facility program may not

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transfer or sell one or more of its licenses for Medicaid beds to an entity under

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Subsection (2)(b)(i), (ii), or (iii) that is located in a rural county unless the entity

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requests, and the director issues, Medicaid certification for the beds under

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Subsection 26B-3-311(5).

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(ii) A veterans nursing care facility that has been approved for a Medicaid certified

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bed increase under Subsection 26B-3-311(5) may not transfer or sell any of the

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veterans nursing care facility's Medicaid certified beds.

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(3)A nursing care facility program or entity under Subsection (2)(b)(i), (ii), or (iii) that

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receives or purchases a license for a Medicaid bed under Subsection (2)(b):

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(a)may receive a license for a Medicaid bed from more than one nursing care facility

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program;

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(b)shall give the division notice, which is postmarked or has proof of delivery within 14

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days of the nursing care facility program or entity seeking Medicaid certification of

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beds in the nursing care facility program or entity, of the total number of licenses for

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Medicaid beds that the entity received and who it received the licenses from;

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(c)may only seek Medicaid certification for the number of licensed beds in the nursing

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care facility program equal to the total number of licenses for Medicaid beds received

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by the entity;

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(d)does not have to demonstrate need or seek approval for the Medicaid licensed bed

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under Subsection 26B-3-311(5), except as provided in Subsections (2)(a)(iv) and

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(2)(c) ;

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(e)shall meet the standards for Medicaid certification other than those in Subsection

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26B-3-311 (5), including personnel, services, contracts, and licensing of facilities

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under Chapter 2, Part 2, Health Care Facility Licensing and Inspection; and

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(f)shall obtain Medicaid certification for the licensed Medicaid beds within three years

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of the date of transfer as documented under Subsection (2)(a)(iii)(B).

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(4) (a)When the division receives notice of a transfer of a license for a Medicaid bed

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under Subsection (2)(a)(iii)(A), the department shall reduce the number of licenses

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for Medicaid beds at the transferring nursing care facility:

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(i)equal to the number of licenses transferred; and

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(ii)effective on the date of the transfer as reported under Subsection (2)(a)(iii)(B).

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(b)For purposes of Section 26B-3-310, the division shall approve Medicaid certification

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for the receiving nursing care facility program or entity:

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(i)in accordance with the formula established in Subsection (3)(c); and

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(ii)if:

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(A)the nursing care facility seeks Medicaid certification for the transferred

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licenses within the time limit required by Subsection (3)(f); and

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(B)the nursing care facility program meets other requirements for Medicaid

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certification under Subsection (3)(e).

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(c)A license for a Medicaid bed may not be approved for Medicaid certification without

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meeting the requirements of Sections 26B-3-310 and 26B-3-311 if:

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(i)the license for a Medicaid bed is transferred under this section but the receiving

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entity does not obtain Medicaid certification for the licensed bed within the time

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required by Subsection (3)(f); or

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(ii)the license for a Medicaid bed is transferred under this section but the license is

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no longer eligible for Medicaid certification.

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Section 3. Effective date. This bill takes effect on May 1, 2024.