Okla. Stat. tit. 56, § 56-2002

A. For the purpose of providing quality care enhancements, the

Oklahoma Health Care Authority is authorized to and shall assess a

Nursing Facilities Quality of Care Fee pursuant to this section upon

each nursing facility licensed in this state. Facilities operated

by the Oklahoma Department of Veterans Affairs shall be exempt from

this fee. Quality of care enhancements include, but are not limited

to, the purposes specified in this section.

B. As a basis for determining the Nursing Facilities Quality of

Care Fee assessed upon each licensed nursing facility, the Authority

shall calculate a uniform per-patient day rate. The rate shall be

calculated by dividing six percent (6%) of the total annual patient

gross receipts of all licensed nursing facilities in this state by

the total number of patient days for all licensed nursing facilities

in this state. The result shall be the per-patient day rate.

Beginning July 15, 2004, the Nursing Facilities Quality of Care Fee

shall not be increased unless specifically authorized by the

Legislature.

C. Pursuant to any approved Medicaid waiver and pursuant to

subsection N of this section, the Nursing Facilities Quality of Care

Fee shall not exceed the amount or rate allowed by federal law for

nursing home licensed bed days.

D. The Nursing Facilities Quality of Care Fee owed by a

licensed nursing facility shall be calculated by the Authority by

adding the daily patient census of a licensed nursing facility, as

reported by the facility for each day of the month, and by

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multiplying the ensuing figure by the per-patient day rate

determined pursuant to the provisions of subsection B of this

section.

E. Each licensed nursing facility which is assessed the Nursing

Facilities Quality of Care Fee shall be required to file a report on

a monthly basis with the Authority detailing the daily patient

census and patient gross receipts at such time and in such manner as

required by the Authority.

F. 1. The Nursing Facilities Quality of Care Fee for a

licensed nursing facility for the period beginning October 1, 2000,

shall be determined using the daily patient census and annual

patient gross receipts figures reported to the Authority for the

calendar year 1999 upon forms supplied by the Authority.

2. Annually the Nursing Facilities Quality of Care Fee shall be

determined by:

a. using the daily patient census and patient gross

receipts reports received by the Authority for the

most recent available twelve (12) months, and

b. annualizing those figures.

Each year thereafter, the annualization of the Nursing

Facilities Quality of Care Fee specified in this paragraph shall be

subject to the limitation in subsection B of this section unless the

provision of subsection C of this section is met.

G. The payment of the Nursing Facilities Quality of Care Fee by

licensed nursing facilities shall be an allowable cost for Medicaid

reimbursement purposes.

H. 1. There is hereby created in the State Treasury a

revolving fund to be designated the “Nursing Facility Quality of

Care Fund”.

2. The fund shall be a continuing fund, not subject to fiscal

year limitations, and shall consist of:

a. all monies received by the Authority pursuant to this

section and otherwise specified or authorized by law,

b. monies received by the Authority due to federal

financial participation pursuant to Title XIX of the

Social Security Act, and

c. interest attributable to investment of money in the

fund.

3. All monies accruing to the credit of the fund are hereby

appropriated and shall be budgeted and expended by the Authority

for:

a. reimbursement of the additional costs paid to

Medicaid-certified nursing facilities for purposes

specified by Sections 1-1925.2 and 5022.2 of Title 63

of the Oklahoma Statutes,

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b. reimbursement of the Medicaid rate increases for
g to the credit of the fund are hereby

appropriated and shall be budgeted and expended by the Authority

for:

a. reimbursement of the additional costs paid to

Medicaid-certified nursing facilities for purposes

specified by Sections 1-1925.2 and 5022.2 of Title 63

of the Oklahoma Statutes,

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b. reimbursement of the Medicaid rate increases for

intermediate care facilities for individuals with

intellectual disabilities (ICFs/IID),

c. nonemergency transportation services for Medicaid-

eligible nursing home clients,

d. eyeglass and denture services for Medicaid-eligible

nursing home clients,

e. fifteen ombudsmen employed by the Office of the

Attorney General,

f. ten additional nursing facility inspectors employed by

the State Department of Health,

g. pharmacy and other Medicaid services to qualified

Medicare beneficiaries whose incomes are at or below

one hundred percent (100%) of the federal poverty

level; provided however, pharmacy benefits authorized

for such qualified Medicare beneficiaries shall be

suspended if the federal government subsequently

extends pharmacy benefits to this population,

h. costs incurred by the Authority in the administration

of the provisions of this section and any programs

created pursuant to this section,

i. durable medical equipment and supplies services for

Medicaid-eligible elderly adults, and

j. personal needs allowance increases for residents of

nursing homes and Intermediate Care Facilities for

Individuals with Intellectual Disabilities (ICFs/IID)

from Thirty Dollars ($30.00) to Fifty Dollars ($50.00)

per month per resident.

4. Expenditures from the fund shall be made upon warrants

issued by the State Treasurer against claims filed as prescribed by

law with the Director of the Office of Management and Enterprise

Services for approval and payment.

5. The fund and the programs specified in this section funded

by revenues collected from the Nursing Facilities Quality of Care

Fee pursuant to this section are exempt from budgetary cuts,

reductions, or eliminations.

6. The Medicaid rate increases for intermediate care facilities

for individuals with intellectual disabilities (ICFs/IID) shall not

exceed the net Medicaid rate increase for nursing facilities

including, but not limited to, the Medicaid rate increase for which

Medicaid-certified nursing facilities are eligible due to the

Nursing Facilities Quality of Care Fee less the portion of that

increase attributable to treating the Nursing Facilities Quality of

Care Fee as an allowable cost.

7. The reimbursement rate for nursing facilities shall be made

in accordance with Oklahoma’s Medicaid reimbursement rate

methodology and the provisions of this section.

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8. No nursing facility shall be guaranteed, expressly or

otherwise, that any additional costs reimbursed to the facility will

equal or exceed the amount of the Nursing Facilities Quality of Care

Fee paid by the nursing facility.

I. 1. In the event that federal financial participation

pursuant to Title XIX of the Social Security Act is not available to

the Oklahoma Medicaid program, for purposes of matching expenditures

from the Nursing Facility Quality of Care Fund at the approved

federal medical assistance percentage for the applicable fiscal

year, the Nursing Facilities Quality of Care Fee shall be null and

void as of the date of the nonavailability of such federal funding,

through and during any period of nonavailability.

2. In the event of an invalidation of this section by any court

of last resort under circumstances not covered in subsection J of

this section, the Nursing Facilities Quality of Care Fee shall be

null and void as of the effective date of that invalidation.

3. In the event that the Nursing Facilities Quality of Care Fee

is determined to be null and void for any of the reasons enumerated
lity.

2. In the event of an invalidation of this section by any court

of last resort under circumstances not covered in subsection J of

this section, the Nursing Facilities Quality of Care Fee shall be

null and void as of the effective date of that invalidation.

3. In the event that the Nursing Facilities Quality of Care Fee

is determined to be null and void for any of the reasons enumerated

in this subsection, any Nursing Facilities Quality of Care Fee

assessed and collected for any periods after such invalidation shall

be returned in full within sixty (60) days by the Authority to the

nursing facility from which it was collected.

J. 1. If any provision of this section or the application

thereof shall be adjudged to be invalid by any court of last resort,

such judgment shall not affect, impair or invalidate the provisions

of the section, but shall be confined in its operation to the

provision thereof directly involved in the controversy in which such

judgment was rendered. The applicability of such provision to other

persons or circumstances shall not be affected thereby.

2. This subsection shall not apply to any judgment that affects

the rate of the Nursing Facilities Quality of Care Fee, its

applicability to all licensed nursing homes in the state, the usage

of the fee for the purposes prescribed in this section, or the

ability of the Authority to obtain full federal participation to

match its expenditures of the proceeds of the fee.

K. The Authority shall promulgate rules for the implementation

and enforcement of the Nursing Facilities Quality of Care Fee

established by this section.

L. The Authority shall provide for administrative penalties in

the event nursing facilities fail to:

1. Submit the Quality of Care Fee;

2. Submit the fee in a timely manner;

3. Submit reports as required by this section; or

4. Submit reports timely.

M. As used in this section:

1. “Nursing facility” means any home, establishment or

institution, or any portion thereof, licensed by the State

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Department of Health as defined in Section 1-1902 of Title 63 of the

Oklahoma Statutes;

2. “Medicaid” means the medical assistance program established

in Title XIX of the federal Social Security Act and administered in

this state by the Authority;

3. “Patient gross revenues” means gross revenues received in

compensation for services provided to residents of nursing

facilities including, but not limited to, client participation. The

term “patient gross revenues” shall not include amounts received by

nursing facilities as charitable contributions; and

4. “Additional costs paid to Medicaid-certified nursing

facilities under Oklahoma’s Medicaid reimbursement methodology”

means both state and federal Medicaid expenditures including, but

not limited to, funds in excess of the aggregate amounts that would

otherwise have been paid to Medicaid-certified nursing facilities

under the Medicaid reimbursement methodology which have been updated

for inflationary, economic, and regulatory trends and which are in

effect immediately prior to the inception of the Nursing Facilities

Quality of Care Fee.

N. 1. As per any approved federal Medicaid waiver, the

assessment rate subject to the provision of subsection C of this

section is to remain the same as those rates that were in effect

prior to January 1, 2012, for all state-licensed continuum of care

facilities.

2. Any facilities that made application to the State Department

of Health to become a licensed continuum of care facility no later

than January 1, 2012, shall be assessed at the same rate as those

facilities assessed pursuant to paragraph 1 of this subsection;

provided, that any facility making the application shall receive the

license on or before September 1, 2012. Any facility that fails to

receive such license from the State Department of Health by
t

of Health to become a licensed continuum of care facility no later

than January 1, 2012, shall be assessed at the same rate as those

facilities assessed pursuant to paragraph 1 of this subsection;

provided, that any facility making the application shall receive the

license on or before September 1, 2012. Any facility that fails to

receive such license from the State Department of Health by

September 1, 2012, shall be assessed at the rate established by

subsection C of this section subsequent to September 1, 2012.

O. If any provision of this section, or the application

thereof, is determined by any controlling federal agency, or any

court of last resort to prevent the state from obtaining federal

financial participation in the state’s Medicaid program, such

provision shall be deemed null and void as of the date of the

nonavailability of such federal funding and through and during any

period of nonavailability. All other provisions of the bill shall

remain valid and enforceable.