Whereas , The deferred operation of this act would tend to defeat its purpose, which is to provide forthwith for nursing facility Medicaid rates for fiscal year 2004, therefore it is hereby declared to be an emergency law, necessary for the immediate preservation of the public convenience.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
SECTION 1. Notwithstanding any general or special law to the contrary, in fiscal year 2004, the division of health care finance and policy shall establish nursing facility Medicaid rates, payable out of the Health Care Quality Improvement Trust Fund, established under section 2EEE of chapter 29 of the General Laws, effective July 1, 2003 through June 30, 2004 that cumulatively total $288,500,000 more than the annual payment rates established by the division under the rates in effect as of June 30, 2002. The division shall adjust per diem rates to reflect any reductions in medicaid utilization. Payments from the fund shall be allocated in the following manner in fiscal year 2004:
(1) effective July 1, 2003, an annual amount of $99,000,000 in the aggregate to fund the use of 2000 base year cost information for rate determination purposes;
(2) effective July 1, 2003, an annual amount of $122,500,000 for enhanced payment rates to nursing homes;
(3) effective July 1, 2003, an annual amount of $50,000,000 to fund a rate add-on for wages, hours and benefits and related employee costs of direct care staff of nursing homes. As a condition for such rate add-on, the division of health care finance and policy shall require that each nursing home document to the division that such funds are spent only on direct care staff by increasing the wages, hours and benefits of direct care staff, increasing the facility's staff-to-patient ratio, or by demonstrably improving the facility's recruitment and retention of nursing staff to provide quality care, which shall include expenditure of funds for nursing facilities which document actual nursing spending that is higher than the median nursing cost per management minute in the base year used to calculate Medicaid nursing facility rates. A facility's direct care staff shall include any and all nursing personnel including registered nurses, licensed practical nurses, and certified nurses' aides hired by the facility from any temporary nursing agency or nursing pool registered with the department of public health. The division shall credit wage increases that are over and above any previously collectively bargained for wage increases. In monitoring compliance for this rate add-on, the division's regulations shall adjust any spending compliance test to reflect any Medicaid nursing facility payment reductions, including, but not limited to, rate reductions imposed on or after October 1, 2002. The expenditure of these funds shall be subject to audit by the division in consultation with the department of public health and the division of medical assistance. In implementing this act, the division shall consult with the Nursing Home Advisory Council;
(4) effective July 1, 2003, an annual amount of $17,000,000 to fund rate adjustments for reasonable capital expenditures by nursing homes, giving priority to nursing homes located or constructed in under-bedded areas as determined by the division of medical assistance, in consultation with the division of health care finance and policy, that meet quality standards established by the division of medical assistance in conjunction with the department of public health and the division of health care finance and policy for the purposes of encouraging the upgrading and maintenance of quality of care in nursing homes, and to fund rate adjustments to eligible nursing homes that meet utilization standards established by the division of medical assistance in consultation with the division of health care finance and policy for the purpose of reducing unnecessary nursing home admissions and facilitating the return of nursing home residents to non-institutional settings;
(5) $300,000 for the purposes of an audit of funds distributed pursuant to clause (3). The division of health care finance and policy, in consultation with the department of public health and with the assistance of the division of medical assistance, shall establish penalties sufficient to deter non-compliance to be imposed against any facility that expends any or all monies in violation of clause (3), including but not limited to recoupment, assessment of fines or interest. The division shall report to the house and senate committees on ways and means not later than October 1, 2004 a preliminary analysis of funds expended pursuant to that clause in fiscal year 2004 and a description and timeline for auditing of these funds;
(7) an amount sufficient to implement section 622 of chapter 151 of the acts of 1996.
SECTION 2. The comptroller shall transfer from the Health Care Security Trust Fund to the Health Care Quality Improvement Trust Fund, on the first business day of each quarter, the amount indicated by the divisions of health care finance and policy and medical assistance to provide the appropriate rate increases to nursing homes and payment of dispensing fees to pharmacies.
SECTION 3. The division of medical assistance shall seek a waiver from the uniformity provisions of 42 U.S.C. 1396(w)(b) to mitigate the impact of the user fee on non-profit continuing care retirement communities and non-profit residential care facilities, but any facility included in the waiver calculation shall be established as a non-profit entity.
SECTION 4. As a condition of receiving any of the funds allocated in this act, all participating nursing homes shall, for the purposes of a medical leave of absence for Medicaid eligible residents, ensure that the bed in the facility occupied by said resident before the hospitalization shall be available upon the return of said resident from an inpatient acute hospital stay for a period of not less than 10 days.