Under present law, the total aggregated amount of assessments for all nursing facilities from July 1, 2022, through June 30, 2023, is 4.75 percent of the net patient service revenue; present law also establishes how the annual assessment amount is to be determined. Each nursing facility has an annual assessment amount that is determined as follows:
(1) Any licensed nursing home that is licensed on July 1, 2022, for 50 beds or fewer pays an assessment rate equal to 3 percent of net patient service revenue, divided by all non-medicare days. The facility must pay the per diem rate for each of its non-medicare days;
(2) Any licensed nursing home that on July 1, 2022, operates as part of a continuing care retirement community pays assessment rate equal to 3 percent of net patient service revenue, divided by all non-medicare days. The facility must pay the per diem rate for each of its non-medicare days;
(3) Any licensed nursing home that is licensed on July 1, 2022, and provided 40,000 or greater medicaid patient days for the 12 months ending December 31 of the prior year pays an assessment rate equal to 2.5 percent of net patient service revenue divided by all non-medicare patient days. The facility must pay the per diem rate for each of its non-medicare days;
(4) Any new nursing home facility that is initially licensed and commences operations after July 1, 2022, pays in FY 2022-2023 a prorated assessment equal to $2,225 per licensed bed per year, prorated to accrue from the date the nursing facility became certified to participate in TennCare. The change in ownership of an existing licensed facility does not meet the requirements of (4);
(5) Any licensed nursing home not meeting the criteria of (1)-(4) pays an equal per facility annual assessment amount at such amount as is necessary to ensure that the total aggregated amount of assessment for all nursing facilities from July 1, 2022, through June 30, 2023, equals 4.75 percent of the net patient service revenue, when such total aggregated assessment amount is established on July 1 of each year;
(6) Any excess collections of per facility annual assessments above the targeted 4.75 percent of the net patient service revenue are retained in the nursing home assessment trust fund account. Should actual collections of per facility annual assessments not equal the targeted 4.75 percent of the net patient service revenue, any shortfall may be made up from funds in the nursing home assessment trust fund account, or from other appropriations to the TennCare program; and
(7) Any facility that ceases to be licensed by the health facilities commission is not required to pay assessment fees accruing after the date of its licensure termination.
This bill:
(1) Extends the nursing home annual assessment fee to June 30, 2024;
(2) Increases the total aggregated amount of assessments for all nursing facilities from July 1, 2023, through June 30, 2024, to an amount equal to 6 percent (instead of 4.75 percent) of the net patient service revenue;
(3) Reduces the assessment rate for a nursing home that is licensed on July 1, 2023, for 50 beds or fewer from 3 percent to 2.75 percent;
(4) Sets the assessment rate for a licensed nursing home that on July 1, 2023, either operates as part of a continuing care retirement community or is certified only to provide medicare skilled nursing facility services, at 2.75 percent;
(5) Sets the assessment rate for a nursing home that is licensed on July 1, 2023, and provided 35,000 or greater medicaid patient days for the 12 months ending December 31 of the prior year at 2.75 percent;
(6) Maintains the assessment rate for a new nursing home facility that is initially licensed and commences operations on or after July 1, 2023, at a prorated assessment equal to $2,225 per licensed bed per year, prorated to accrue from the date the nursing facility became certified to participate in TennCare; and
(7) Increases the assessment rate for a licensed nursing home not meeting the criteria of subdivisions (3)-(6) from 4.75 percent to 6 percent.
ON APRIL 3, 2023, THE HOUSE ADOPTED AMENDMENT #1 AND PASSED HOUSE BILL 493, AS AMENDED.
AMENDMENT #1 makes the following changes to this bill:
(1) Creates an exception to the allowance of one mid-year adjustment that may be established prior to January 1 by the bureau, which states that the bureau may modify the amount of the annual assessment for each nursing facility established by this bill if such modification is necessary to comply with federal regulations; and
(2) Provides that the assessment rate for a new nursing home facility that is initially licensed and commences operations on or after July 1, 2023, at a prorated assessment equal to $2,225 per licensed bed per year, is prorated to accrue from the date the nursing facility became licensed, rather than the date the nursing facility became certified to participate in TennCare.

Statutes affected:
Introduced: 71-5-1002(h)(1), 71-5-1002, 71-5-1003, 71-5-1010(a), 71-5-1010