SF0044 - Long-term care reform.
|
2001 |
State of Wyoming |
01LSO-0167.E1 ENGROSSED |
SENATE FILE NO. SF0044
Long-term care reform.
Sponsored by: Joint Labor, Health and Social Services
Interim Committee
A BILL
for
1 AN ACT relating to
long-term care reform; requiring the
2
department of health to determine adjustments to its base
3
formula for Medicaid reimbursement to nursing care
4
facilities; authorizing the department of health to conduct
5
a case mix study for Medicaid reimbursement to nursing care
6
facilities; requiring a report; authorizing the department
7
to apply for and implement a Medicaid waiver for
8
reimbursement to assisted living facilities as specified;
9
requiring the department to expand the home and community
10 based waiver as specified;
increasing funding for the
11 personal needs allowance under
Medicaid and the state
12 supplemental security income
program; eliminating a
13 restriction on the state
supplemental security income
14 program; specifying long-term care
topics to be studied;
15 providing appropriations; and
providing for an effective
16 date.
Page 1
1
2 Be It Enacted by the Legislature of the State of Wyoming:
3
4 Section 1. W.S. 42-2-103(d) is amended to read:
5
6 42-2-103. Provision of assistance and
services;
7 duties
of department; burial assistance; state supplemental
8
security income program.
9
10 (d) The
department shall administer a state
11 supplemental security income program
entitling any
12 individual receiving payments under
the federal
13 supplemental security income program
with no other income
14 during any one (1) calendar month,
to a payment for each
15 month the condition exists. The monthly payment under this
16 subsection shall be established by
the legislature within
17 the department's biennial budget
appropriation, which shall
18 not be less than the required
payment under applicable
19 federal law. An individual residing in a nursing home is 20
not eligible for the payment under this subsection.
21
23
Page 2
1 (a) The
department of health shall contract with a
2
private entity to determine adjustments to its base
3
prospective payment system formula for reimbursement of
4
nursing care facilities licensed under W.S. 35-2-901 et
5
seq., taking into consideration capital costs, operating
6
costs and health care costs of the nursing care facility.
7
8 (b) The
department of health shall conduct a study to
9
determine if the prospective payment system for
10 reimbursement to nursing care
facilities shall be replaced
11 by a case mix system of
reimbursement. The department shall
12 report to the joint labor, health
and social services
13 interim committee no later than
November 1, 2001 with
14 recommendations. The study shall:
15
16 (i) Establish a
methodology and criteria for
17 conducting the study, including the
continuation of the use
18 of forms and reports required of
nursing care facilities
19 under the prospective payment
system;
20
21 (ii) Explore
means to reduce or eliminate
22 incentives for nursing care facilities
to refuse or limit
23 admission of high acuity care
patients;
24
Page 3
1 (iii) Examine
what auditing procedures and
2
frequency will be necessary to ensure nursing care
3
facilities comply with the Medicaid reimbursement system;
4
5 (iv) Include in
the report required under this
6
subsection proposed penalties for violations by nursing
7
care facilities;
8
9 (v) Include a cost comparison of:
10
11 (A) The
prospective payment system of
12 reimbursement, as implemented in the
fiscal year beginning
13 July 1, 2001;
14
15 (B) The
prospective payment system of
16 reimbursement, as adjusted under
subsection (a) of this
17 section; and
18
19 (C) The case
mix system of reimbursement,
20 as studied under this subsection.
21
22 (c) There is
appropriated two million two hundred
23 five thousand dollars ($2,205,000.00)
to the department of
24 health to implement the services
specified in subsection
Page 4
1 (d)
of this section in the fiscal year beginning July 1,
2
2001, as follows:
3
4 (i) Eight
hundred twenty-four thousand sixty-
5
three dollars ($824,063.00) is appropriated from the
6
general fund; and
7
8 (ii) One million
three hundred eighty thousand
9
nine hundred thirty-seven dollars ($1,380,937.00) is
10 appropriated from federal funds.
11
12 (d) Subject to
approval by the secretary of the
13 United States department of health
and human services of an
14 expansion of the long term care home
and community based
15 waiver, the department of health
shall use the
16 appropriation authorized under
subsection (c) of this
17 section to expand services under the
long term care home
18 and community based waiver authorized
under W.S.
19 42-4-103(a)(xvii) to not more than
one hundred fifty (150)
20 additional qualified individuals.
The appropriation under
21 subsection (c) of this section for
the services authorized
22 by this subsection is in addition to
the appropriation for
23 similar services authorized by 2000
Wyoming Session Laws,
24 Chapter 76.
Page 5
1
2 (e) There is
appropriated two million two hundred
3
eighty-eight thousand dollars ($2,288,000.00) to the
4
department of health to implement the program specified in
5
subsection (f) of this section in the fiscal year beginning
6
July 1, 2001, as follows:
7
8 (i) Eight
hundred fifty-five thousand eighty-
9
three dollars ($855,083.00) is appropriated from the
10 general fund; and
11
12 (ii) One million
four hundred thirty-two
13 thousand nine hundred seventeen
dollars ($1,432,917.00) is
14 appropriated from federal funds.
15
16 (f) Effective
immediately, the department shall apply
17 to the secretary of the United
States department of health
18 and human services for approval of a
waiver authorizing the
19 department to conduct a pilot
project in the fiscal year
20 beginning July 1, 2001 to reimburse
assisted living care
21 services for not more than one
hundred (100) qualified
22 individuals in the state. Subject to
approval of the
23 waiver, the department shall,
beginning July 1, 2001,
24 determine eligibility for the
available funds in the pilot
Page 6
1 project
authorized under this subsection by using the LT101
2
pre-admission screening and review form and the same
3
threshold scores from the pre-admission screening as are
4
used to determine eligibility for reimbursement for nursing
5
facilities services. The department shall amend its rules
6
and regulations as necessary to implement the program
7
provided for in this subsection.
8
9 (g) There is
appropriated four hundred fifty thousand
10 dollars ($450,000.00) to the
department of health, office
11 on aging, and thirty-two thousand
dollars ($32,000.00) to
12 the department of family services, for the fiscal year
13 beginning July 1, 2001 to allow an
increase in the personal
14 needs allowance from thirty dollars
($30.00) per month to
15 fifty dollars ($50.00) per month for
recipients of nursing
16 facilities services under the
Wyoming Medical Assistance
17 and Services Act and to establish a
personal needs
18 allowance of fifty dollars ($50.00)
per month for
19 recipients of benefits under the state
supplemental
20 security income program while
residents of nursing homes,
21 as follows:
22
23 (i) Two hundred
three thousand one hundred
24 thirty-five dollars ($203,135.00) is
appropriated from the
Page 7
1 general
fund,
with one hundred seventy-one thousand one
2
hundred thirty-five dollars ($171,135.00) allocated to the
3
department of health, office on aging, and thirty-two
4
thousand dollars ($32,000.00) to the department of family
5
services; and
6
7 (ii) Two hundred
seventy-eight thousand eight
8
hundred sixty-five dollars ($278,865.00) is appropriated
9
from federal funds.
10
11 Section 3.
12
13 (a) The joint
labor, health and social services
14 interim committee shall continue a
study of long-term
15 health care as required under 1999
Wyoming Session Laws,
16 Chapter 20, section 2. In addition,
the committee shall
17 review the continuum of care
including:
18
19 (i) A review of
existing Wyoming long-term
20 health care programs;
21
22 (ii) A review of
all relevant Medicaid optional
23 programs;
24
Page 8
1 (iii) Consideration
of possible inclusion of
2
additional Medicaid optional programs to Wyoming's
3
continuum of long-term care;
4
5 (iv) Consideration
of possible implications of
6
the United States Supreme Court decision in Olmstead
v.
7
L.C., 000 U.S. 98-536 (1999) for
the long-term care market
8
in Wyoming;
9
10 (v) Consideration
of support for the development
11 of a one-point entry into the
long-term care system in
12 Wyoming;
13
14 (vi) A study of
appropriate staffing levels at
15 long term health care facilities.
16
17 Section
4. This act is effective immediately upon
18 completion of all acts necessary for
a bill to become law
19 as provided by Article 4, Section 8
of the Wyoming
20 Constitution.
21
22 (END)
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