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(Parenthesis ( ) Indicate Expenditure Decreases)

Duplicates/Conflicts with/Companion to/Relates to

SOURCES OF INFORMATION

LFC files

SUMMARY

Synopsis of HFl#1 Amendment

House Floor Amendment #1 to the House Business and Industry Committee substitute for House Bill 138 does the following:

1. On page 1, lines 11 and 12, strikes language to now read' "Increased quality care in nursing facilities through reimbursement or payment".

2. On page 2, line 4, after the word "complaints", strikes the words "quality services" and inserts in lieu thereof, "alleging a nursing facility is".

3. Makes changes in two place to strike the word, "home's" and inserts instead, "facility (s)".

Synopsis of HBIC Substitute

House Business and Industry Committee substitute for House Bill 138 provides for the recoupment of money paid to nursing facilities for insufficient or poor quality service. Section 1 of the bill is a definitions section and defines "nursing facility", "patient", and "responsible party". Subsection B describes the process that state agencies must follow when responding to complaints about nursing facilities. Subsection C. establishes the criteria that the Human services Department must follow when establishing new Medicaid rates based on performance and quality care issues. Finally, Subsection D speaks to hearing provisions and due process requirements.

Significant Issues

Payment to nursing facilities based on the provision of quality services is unique to this industry. At this time it is uncertain if the federal Medicaid agency will allow the state to establish payment mechanisms different than their own requirements.

FISCAL IMPLICATIONS

Establishment of a new payment process will require significant resources to implement. There are questions about how a facility would bill the Human Services Department for payment of the delivery of quality based services.

ADMINISTRATIVE IMPLICATIONS

Administration of a program such as the one contemplated by this legislation would not be more difficult to administer than the present system which is cumbersome and costly.

TECHNICAL ISSUES

Agreement with the federal government is necessary to implement this type of system.

MB/njw:gm