HOUSE BILL NO. 1240 103RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE OVERCAST.
2787H.01I JOSEPH ENGLER, Chief Clerk
AN ACT To repeal sections 197.300, 197.305, 197.310, 197.311, 197.312, 197.315, 197.316, 197.318, 197.320, 197.325, 197.326, 197.327, 197.330, 197.335, 197.340, 197.345, 197.355, 197.357, 197.366, 197.367, 197.705, 198.530, 208.169, and 208.225, RSMo, and to enact in lieu thereof four new sections relating to certificates of need.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Sections 197.300, 197.305, 197.310, 197.311, 197.312, 197.315, 197.316, 2 197.318, 197.320, 197.325, 197.326, 197.327, 197.330, 197.335, 197.340, 197.345, 197.355, 3 197.357, 197.366, 197.367, 197.705, 198.530, 208.169, and 208.225, RSMo, are repealed and 4 four new sections enacted in lieu thereof, to be known as sections 197.705, 198.530, 208.169, 5 and 208.225, to read as follows: 197.705. 1. For purposes of this section, the term "health care facilities" means: 2 (1) Facilities licensed under chapter 198; 3 (2) Long-term care beds in a hospital as described in subdivision (3) of 4 subsection 1 of section 198.012; and 5 (3) Long-term care hospitals or beds in a long-term care hospital meeting the 6 requirements described in 42 CFR 412.23(e). 7 2. All hospitals, as defined in section 197.020, and health care facilities[, defined in 8 sections 197.020 and 197.305,] shall require all personnel providing services in such facilities 9 to wear identification badges while acting within the scope of their employment. The 10 identification badges of all personnel shall prominently display the licensure status of such 11 personnel.
EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language. HB 1240 2
198.530. 1. For purposes of this section, the term "continuing care retirement 2 community" means a community that provides at the same site or location independent 3 housing, long-term health care, and other services to older persons not related by blood 4 or marriage to the owner or operator of the community under an agreement effective 5 for the life of the person or a specified period of time in excess of one year that 6 guarantees or provides priority access to on-site health-related long-term care services 7 when needed. 8 2. If an enrollee in a managed care organization is also a resident in a long-term care 9 facility licensed pursuant to chapter 198, or a continuing care retirement community[, as 10 defined in section 197.305], such enrollee's managed care organization shall provide the 11 enrollee with the option of receiving the covered service in the long-term care facility which 12 serves as the enrollee's primary residence. For purposes of this section, "managed care 13 organization" means any organization that offers any health plan certified by the department 14 of health and senior services designed to provide incentives to medical care providers to 15 manage the cost and use of care associated with claims, including, but not limited to, a health 16 maintenance organization and preferred provider organization. The resident enrollee's 17 managed care organization shall reimburse the resident facility for those services which 18 would otherwise be covered by the managed care organization if the following conditions 19 apply: 20 (1) The facility is willing and able to provide the services to the resident; and 21 (2) The facility and those health care professionals delivering services to residents 22 pursuant to this section meet the licensing and training standards as prescribed by law; and 23 (3) The facility is certified through Medicare; and 24 (4) The facility and those health care professionals delivering services to residents 25 pursuant to this section agree to abide by the terms and conditions of the health carrier's 26 contracts with similar providers, abide by patient protection standards and requirements 27 imposed by state or federal law for plan enrollees and meet the quality standards established 28 by the health carrier for similar providers. 29 [2.] 3. The managed care organization shall reimburse the resident facility at a rate of 30 reimbursement not less than the Medicare allowable rate pursuant to Medicare rules and 31 regulations. 32 [3.] 4. The services in subsection [1] 2 of this section shall include, but are not limited 33 to, skilled nursing care, rehabilitative and other therapy services, and postacute care, as 34 needed. Nothing in this section shall limit the managed care organization from utilizing 35 contracted providers to deliver the services in the enrollee's resident facility. 36 [4.] 5. A resident facility shall not prohibit a health carrier's participating providers 37 from providing covered benefits to an enrollee in the resident facility. A resident facility or HB 1240 3
38 health care professional shall not impose any charges on an enrollee for any service that is 39 ancillary to, a component of, or in support of the services provided under this section when 40 the services are provided by a health carrier's participating provider, or otherwise create a 41 disincentive for the use of the health carrier's participating providers. Any violation of the 42 requirements of this subsection by the resident facility shall be considered abuse or neglect of 43 the resident enrollee. 208.169. [1.] Notwithstanding other provisions of this chapter, including but not 2 limited to sections 208.152, 208.153, 208.159 and 208.162[: 3 (1) There shall be no revisions to a facility's reimbursement rate for providing nursing 4 care services under this chapter upon a change in ownership, management control, operation, 5 stock, leasehold interests by whatever form for any facility previously licensed or certified for 6 participation in the Medicaid program. Increased costs for the successor owner, management 7 or leaseholder that result from such a change shall not be recognized for purposes of 8 reimbursement; 9 (2) In the case of a newly built facility or part thereof which is less than two years of 10 age and enters the Title XIX program under this chapter after July 1, 1983, a reimbursement 11 rate shall be assigned based on the lesser of projected estimated operating costs or one 12 hundred ten percent of the median rate for the facility's class to include urban and rural 13 categories for each level of care including ICF only and SNF/ICF. The rates set under this 14 provision shall be effective for a period of twelve months from the effective date of the 15 provider agreement at which time the rate for the future year shall be set in accordance with 16 reported costs of the facility recognized under the reimbursement plan and as provided in 17 subdivisions (3) and (4) of this subsection. Rates set under this section may in no case exceed 18 the maximum ceiling amounts in effect under the reimbursement regulation; 19 (3) Reimbursement for capital related expenses for newly built facilities entering the 20 Title XIX program after March 18, 1983, shall be calculated as the building and building 21 equipment rate, movable equipment rate, land rate, and working capital rate. 22 (a) The building and building equipment rate will be the lower of: 23 a. Actual acquisition costs, which is the original cost to construct or acquire the 24 building, not to exceed the costs as determined in section 197.357; or 25 b. Reasonable construction or acquisition cost computed by applying the regional 26 Dodge Construction Index for 1981 with a trend factor, if necessary, or another current 27 construction cost measure multiplied by one hundred eight percent as an allowance for fees 28 authorized as architectural or legal not included in the Dodge Index Value, multiplied by the 29 square footage of the facility not to exceed three hundred twenty-five square feet per bed, 30 multiplied by the ratio of forty minus the actual years of the age of the facility divided by HB 1240 4
31 forty; and multiplied by a return rate of twelve percent; and divided by ninety-three percent of 32 the facility's total available beds times three hundred sixty-five days. 33 (b) The maximum movable equipment rate will be fifty-three cents per bed day. 34 (c) The maximum allowable land area is defined as five acres for a facility with one 35 hundred or less beds and one additional acre for each additional one hundred beds or fraction 36 thereof for a facility with one hundred one or more beds. 37 (d) The land rate will be calculated as: 38 a. For facilities with land areas at or below the maximum allowable land area, 39 multiply the acquisition cost of the land by the return rate of twelve percent, divide by ninety- 40 three percent of the facility's total available beds times three hundred sixty-five days. 41 b. For facilities with land areas greater than the maximum allowable land area, divide 42 the acquisition cost of the land by the total acres, multiply by the maximum allowable land 43 area, multiply by the return rate of twelve percent, divide by ninety-three percent of the 44 facility's total available beds times three hundred sixty-five days. 45 (e) The maximum working capital rate will be twenty cents per day; 46 (4) If a provider does not provide the actual acquisition cost to determine a 47 reimbursement rate under subparagraph a. of paragraph (a) of subdivision (3) of subsection 1 48 of this section, the sum of the building and building equipment rate, movable equipment rate, 49 land rate, and working capital rate shall be set at a reimbursement rate of six dollars; 50 (5)] , for each state fiscal year a negotiated trend factor shall be applied to each 51 facility's Title XIX per diem reimbursement rate. The trend factor shall be determined 52 through negotiations between the department and the affected providers and is intended to 53 hold the providers harmless against increase in cost. In no circumstances shall the negotiated 54 trend factor to be applied to state funds exceed the health care finance administration market 55 basket price index for that year. The provisions of this subdivision shall apply to fiscal year 56 1996 and thereafter. 57 [2. The provisions of subdivisions (1), (2), (3), and (4) of subsection 1 of this section 58 shall remain in effect until July 1, 1989, unless otherwise provided by law.] 208.225. 1. To implement fully the provisions of section 208.152, the MO HealthNet 2 division shall calculate the Medicaid per diem reimbursement rates of each nursing home 3 participating in the Medicaid program as a provider of nursing home services based on its 4 costs reported in the Title XIX cost report filed with the MO HealthNet division for its fiscal 5 year as provided in subsection 2 of this section. 6 2. The recalculation of Medicaid rates to all Missouri facilities will be performed as 7 follows: effective July 1, 2004, the department of social services shall use the Medicaid cost 8 report containing adjusted costs for the facility fiscal year ending in 2001 and redetermine the 9 allowable per-patient day costs for each facility. The department shall recalculate the class HB 1240 5
10 ceilings in the patient care, one hundred twenty percent of the median; ancillary, one hundred 11 twenty percent of the median; and administration, one hundred ten percent of the median cost 12 centers. Each facility shall receive as a rate increase one-third of the amount that is unpaid 13 based on the recalculated cost determination. 14 3. (1) For purposes of this subsection, the term "capital expenditures" means 15 expenditures by or on behalf of a facility that, under generally accepted accounting 16 principles, are not properly chargeable as an expense of operation and maintenance. 17 (2) Any intermediate care facility or skilled nursing facility, as such terms are defined 18 in section 198.006, participating in MO HealthNet that incurs total capital expenditures[, as 19 such term is defined in section 197.305,] in excess of two thousand dollars per bed shall be 20 entitled to obtain from the MO HealthNet division a recalculation of its Medicaid per diem 21 reimbursement rate based on its additional capital costs or all costs incurred during the facility 22 fiscal year during which such capital expenditures were made. Such recalculated 23 reimbursement rate shall become effective and payable when granted by the MO 24 HealthNet division as of the date of application for a rate adjustment. [197.300. Sections 197.300 to 197.366 shall be known as the 2 "Missouri Certificate of Need Law".]
[197.305. As used in sections 197.300 to 197.366, the following terms 2 mean: 3 (1) "Affected persons", the person proposing the development of a 4 new institutional health service, the public to be served, and health care 5 facilities within the service area in which the proposed new health care service 6 is to be developed; 7 (2) "Agency", the certificate of need program of the Missouri 8 department of health and senior services; 9 (3) "Capital expenditure", an expenditure by or on behalf of a health 10 care facility which, under generally accepted accounting principles, is not 11 properly chargeable as an expense of operation and maintenance; 12 (4) "Certificate of need", a written certificate issued by the committee 13 setting forth the committee's affirmative finding that a proposed project 14 sufficiently satisfies the criteria prescribed for such projects by sections 15 197.300 to 197.366; 16 (5) "Develop", to undertake those activities which on their completion 17 will result in the offering of a new institutional health service or the incurring 18 of a financial obligation in relation to the offering of such a service; 19 (6) "Expenditure minimum" shall mean: 20 (a) For beds in existing or proposed health care facilities licensed 21 pursuant to chapter 198 and long-term care beds in a hospital as described in 22 subdivision (3) of subsection 1 of section 198.012, six hundred thousand 23 dollars in the case of capital expenditures, or four hundred thousand dollars in 24 the case of major medical equipment, provided, however, that prior to January 25 1, 2003, the expenditure minimum for beds in such a facility and long-term HB 1240 6
26 care beds in a hospital described in section 198.012 shall be zero, subject to the 27 provisions of subsection 7 of section 197.318; 28 (b) For beds or equipment in a long-term care hospital meeting the 29 requirements described in 42 CFR, Section 412.23(e), the expenditure 30 minimum shall be zero; and 31 (c) For health care facilities, new institutional health services or beds 32 not described in paragraph (a) or (b) of this subdivision one million dollars in 33 the case of capital expenditures, excluding major medical equipment, and one 34 million dollars in the case of medical equipment; 35 (7) "Health service area", a geographic region appropriate for the 36 effective planning and development of health services, determined on the basis 37 of factors including population and the availability of resources, consisting of 38 a population of not less than five hundred thousand or more than three million; 39 (8) "Major medical equipment", medical equipment used for the 40 provision of medical and other health services; 41 (9) "New institutional health service": 42 (a) The development of a new health care facility costing in excess of 43 the applicable expenditure minimum; 44 (b) The acquisition, including acquisition by lease, of any health care 45 facility, or major medical equipment costing in excess of the expenditure 46 minimum; 47 (c) Any capital expenditure by or on behalf of a health care facility in 48 excess of the expenditure minimum; 49 (d) Predevelopment activities as defined in subdivision (12) hereof 50 costing in excess of one hundred fifty thousand dollars; 51 (e) Any change in licensed bed capacity of a health care facility 52 licensed under chapter 198 which increases the total number of beds by more 53 than ten or more than ten percent of total bed capacity, whichever is less, over 54 a two-year period, provided that any such health care facility seeking a 55 nonapplicability review for an increase in total beds or total bed capacity in an 56 amount less than described in this paragraph shall be eligible for such review 57 only if the facility has had no patient care class I deficiencies within the last 58 eighteen months and has maintained at least an eighty-five percent average 59 occupancy rate for the previous six quarters; 60 (f) Health services, excluding home health services, which are offered 61 in a health care facility and which were not offered on a regular basis in such 62 health care facility within the twelve-month period prior to the time such 63 services would be offered; 64 (g) A reallocation by an existing health care facility of licensed beds 65 among major types of service or reallocation of licensed beds from one 66 physical facility or site to another by more than ten beds or more than ten 67 percent of total licensed bed capacity, whichever is less, over a two-year 68 period; 69 (10) "Nonsubstantive projects", projects which do not involve the 70 addition, replacement, modernization or conversion of beds or the provision of 71 a new health service but which include a capital expenditure which exceeds 72 the expenditure minimum and are due to an act of God or a normal 73 consequence of maintaining health care services, facility or equipment; HB 1240 7
74 (11) "Person", any individual, trust, estate, partnership, corporation, 75 including associations and joint stock companies, state or political subdivision 76 or instrumentality thereof, including a municipal corporation; 77 (12) "Predevelopment activities", expenditures for architect