The bill amends Section 40-8-19 of the General Laws in Chapter 40-8, titled "Medical Assistance," to reform the payment rates for nursing facilities by shifting from a price-based methodology for Medicaid reimbursement to a cost-based methodology. This change aims to ensure that reimbursement rates are reasonable and adequate to cover the costs incurred by efficiently operated facilities. The executive office of health and human services is tasked with developing a new reimbursement structure that includes components such as direct-care rates adjusted for resident acuity, indirect-care rates, and a fair-rental value system. Additionally, the bill mandates a comprehensive re-evaluation of Medicaid rates every three years starting October 1, 2025, to reflect current costs and patient acuity levels.

The bill also emphasizes the allocation of rate increases resulting from an inflation index, mandating that 80% of these increases be dedicated to enhancing compensation for eligible direct-care workers. Nursing facilities are required to submit annual certifications to the executive office of health and human services by July 31, detailing compliance with inflation index provisions related to employee compensation. Non-compliance will result in a clawback and a 25% penalty on unspent or improperly spent funds. The bill outlines a four-year transition plan for implementing these rate reforms, ensuring that no facility receives less reimbursement for direct-care costs than prior to the bill's passage, with specific limits on per diem rate changes during the transition period. Overall, the act aims to improve care standards in nursing facilities while ensuring fair compensation for direct-care staff.

Statutes affected:
5144: 40-8-19