Oklahoma § 56-1011.5 - Nursing facility incentive reimbursement rate plan

§ 56-1011.5. Nursing facility incentive reimbursement rate plan

A. 1. The Oklahoma Health Care Authority shall develop an

incentive reimbursement rate plan for nursing facilities focused on

improving resident outcomes and resident quality of life.

2. Under the current rate methodology, the Authority shall

reserve Five Dollars ($5.00) per patient day designated for the

quality assurance component that nursing facilities can earn for

improvement or performance achievement of resident-centered outcomes

metrics. To fund the quality assurance component, Two Dollars

($2.00) shall be deducted from each nursing facility's per diem

rate, and matched with Three Dollars ($3.00) per day funded by the

Authority. Payments to nursing facilities that achieve specific

metrics shall be treated as an "add back" to their net reimbursement

per diem. Dollar values assigned to each metric shall be determined

so that an average of the five-dollar-quality incentive is made to

qualifying nursing facilities.

3. Pay-for-performance payments may be earned quarterly and

based on facility-specific performance achievement of four equallyweighted, Long-Stay Quality Measures as defined by the Centers for

Medicare and Medicaid Services (CMS).

4. Contracted Medicaid long-term care providers may earn

payment by achieving either five percent (5%) relative improvement

each quarter from baseline or by achieving the National Average

Benchmark or better for each individual quality metric.

5. Pursuant to federal Medicaid approval, any funds that remain

as a result of providers failing to meet the quality assurance

metrics shall be pooled and redistributed to those who achieve the

quality assurance metrics each quarter. If federal approval is not

received, any remaining funds shall be deposited in the Nursing

Facility Quality of Care Fund authorized in Section 2002 of this

title.

6. The Authority shall establish an advisory group with

consumer, provider and state agency representation to recommend

quality measures to be included in the pay-for-performance program

and to provide feedback on program performance and recommendations

for improvement. The quality measures shall be reviewed annually

Oklahoma Statutes - Title 56. Poor Persons

and shall be subject to change every three (3) years through the

agency's promulgation of rules. The Authority shall insure

adherence to the following criteria in determining the quality

measures:

a.

provides direct benefit to resident care outcomes,

b.

applies to long-stay residents, and

c.

addresses a need for quality improvement using the

Centers for Medicare and Medicaid Services (CMS)

ranking for Oklahoma.

7. The Authority shall begin the pay-for-performance program

focusing on improving the following CMS nursing home quality

measures:

a.

percentage of long-stay, high-risk residents with

pressure ulcers,

b.

percentage of long-stay residents who lose too much

weight,

c.

percentage of long-stay residents with a urinary tract

infection, and

d.

percentage of long-stay residents who got an

antipsychotic medication.

B. The Oklahoma Health Care Authority shall negotiate with the

Centers for Medicare and Medicaid Services to include the authority

to base provider reimbursement rates for nursing facilities on the

criteria specified in subsection A of this section.

C. The Oklahoma Health Care Authority shall audit the program

to ensure transparency and integrity.

D. The Oklahoma Health Care Authority shall provide an annual

report of the incentive reimbursement rate plan to the Governor, the

Speaker of the House of Representatives, and the President Pro

Tempore of the Senate by December 31 of each year. The report shall

include, but not be limited to, an analysis of the previous fiscal

year including incentive payments, ratings, and notable trends.

Added by Laws 2006, c. 315, § 5, emerg. eff. June 9, 2006. Amended

by Laws 2010, c. 310, § 1, eff. Nov. 1, 2010; Laws 2019, c. 489, §

1, eff. Oct. 1, 2019.