SF0044 - Long-term care reform.
|
2001 |
State of Wyoming |
01LSO-0167 |
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
not eligible for
the payment under this subsection.
21
23
Page 2
1 (a) Effective
immediately, there is appropriated
2
fifteen thousand dollars ($15,000.00) to the department of
3
health as follows:
4
5 (i) Seven
thousand five hundred dollars
6 ($7,500.00)
is appropriated from the general fund; and
7
8 (ii) Seven
thousand five hundred dollars
9
($7,500.00) is appropriated from federal funds.
10
11 (b) The
appropriation authorized under subsection (a)
12 of this section shall be used by the
department of health,
13 to contract with a private entity to
determine adjustments
14 to its base prospective payment system
formula for
15 reimbursement of nursing care facilities
licensed under
16 W.S. 35-2-901 et seq., taking into consideration
capital
17 costs, operating costs and health care costs
of the nursing
18 care facility.
19
20 (c) Effective
immediately, there is appropriated
21 fifty thousand dollars ($50,000.00) to the
department of
22 health as follows:
23
Page 3
1 (i) Twenty-five
thousand dollars ($25,000.00) is
2
appropriated from the general fund; and
3
4 (ii) Twenty-five
thousand dollars ($25,000.00)
5 is
appropriated from federal funds.
6
7 (d) The
appropriation authorized under subsection (c)
8 of
this section shall be used by the department of health
9 to
conduct a study to determine if the prospective payment
10 system for reimbursement to nursing care
facilities shall
11 be replaced by a case mix system of
reimbursement. The
12 department shall report to the joint labor,
health and
13 social services interim committee no later
than November 1,
14 2001 with 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 4
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
(b) of this
17 section; and
18
19 (C) The case
mix system of reimbursement,
20 as studied under this subsection.
21
22 (e) 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 5
1 (f)
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 (f) 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
(e) 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 (e) 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 6
1
2 (g) 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
(h) 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 (h) 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 7
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 (j) There is
appropriated four hundred eighty-two
10 thousand dollars ($482,000.00) to the
department of health,
11 office on aging, for the fiscal year
beginning July 1, 2001
12 to allow an increase in the personal needs
allowance from
13 thirty dollars ($30.00) per month to fifty
dollars ($50.00)
14 per month for recipients of nursing
facilities services
15 under the Wyoming Medical Assistance and
Services Act and
16 to establish a personal needs allowance of
fifty dollars
17 ($50.00) per month for recipients of
benefits under the
18 state supplemental security income program
while residents
19 of nursing homes, as follows:
20
21 (i) Two hundred
three thousand one hundred
22 thirty-five dollars ($203,135.00) is
appropriated from the
23 general fund; and
24
Page 8
1 (ii) Two hundred
seventy-eight thousand eight
2
hundred sixty-five dollars ($278,865.00) is appropriated
3
from federal funds.
4
5 Section 3.
6
7 (a) The joint
labor, health and social services
8
interim committee shall continue a study of long-term
9
health care as required under 1999 Wyoming Session Laws,
10 Chapter 20, section 2. In addition, the
committee shall
11 review the continuum of care including:
12
13 (i) A review of
existing Wyoming long-term
14 health care programs;
15
16 (ii) A review of
all relevant Medicaid optional
17 programs;
18
19 (iii) Consideration
of possible inclusion of
20 additional Medicaid optional programs to
Wyoming's
21 continuum of long-term care;
22
23 (iv) Consideration
of possible implications of
24 the United States Supreme Court decision in Olmstead v.
Page 9
1 L.C., 000 U.S. 98-536 (1999) for the long-term
care market
2 in
Wyoming;
3
4 (v) Consideration
of support for the development
5 of
a one-point entry into the long-term care system in
6
Wyoming.
7
8 Section 4. This act is
effective immediately upon
9
completion of all acts necessary for a bill to become law
10 as provided by Article 4, Section 8 of the
Wyoming
11 Constitution.
12
13 (END)
Page 10