Senate Bill No. 904 seeks to enhance the reimbursement rate plan for nursing facilities under the Oklahoma Medicaid program, with a focus on improving resident outcomes and quality of life. The bill requires the Oklahoma Health Care Authority to create an incentive reimbursement rate plan that includes a quality assurance component, allocating $5.00 per patient day for facilities that meet specific long-stay quality measures. It introduces a tiered payment structure based on quality ratings, where facilities rated two stars receive 40% of the quality assurance component, escalating to 100% for five-star facilities. Additionally, the bill allows for an optional staff retention initiative that can provide up to $3.00 per Medicaid patient day for facilities meeting certain nursing staff retention criteria.

The legislation also amends staffing requirements for intermediate care facilities for individuals with intellectual disabilities (ICFs/IID) with seventeen or more beds, establishing a tiered staffing level based on Medicaid reimbursement rates. It mandates direct-care staffing levels to increase from 3.2 hours to 4.1 hours per day per occupied bed as reimbursement rates reflect cost increases. The bill requires the Oklahoma Health Care Authority to develop rules for staffing ratios, implement a monthly reporting system, and assess penalties for non-compliance, with penalties directed to the Nursing Facility Quality of Care Fund. Furthermore, it creates the Oklahoma Nursing Facility Funding Advisory Committee to develop a new methodology for Medicaid reimbursements based on direct care staffing expenditures and includes provisions for dementia training and a nursing facility cost-reporting system. The act is set to take effect on July 1, 2025, with an emergency clause for immediate implementation upon passage.