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1 STATE OF OKLAHOMA
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2 1st Session of the 60th Legislature (2025)
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3 SENATE BILL 947 By: Rosino
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6 AS INTRODUCED
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7 An Act relating to long-term care; amending 56 O.S.
7 2021, Section 2002, which relates to the Nursing
8 Facilities Quality of Care Fee; updating statutory
8 language; amending 63 O.S. 2021, Section 1-2216, as
9 amended by Section 17, Chapter 339, O.S.L. 2024 (63
9 O.S. Supp. 2024, Section 1-2216), which relates to
10 the Oklahoma State Council on Aging and Adult
10 Protective Services; updating statutory language; and
11 declaring an emergency.
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14 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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15 SECTION 1. AMENDATORY 56 O.S. 2021, Section 2002, is
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16 amended to read as follows:
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17 Section 2002. A. For the purpose of providing quality care
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18 enhancements, the Oklahoma Health Care Authority is authorized to
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19 and shall assess a Nursing Facilities Quality of Care Fee pursuant
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20 to this section upon each nursing facility licensed in this state.
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21 Facilities operated by the Oklahoma Department of Veterans Affairs
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22 shall be exempt from this fee. Quality of care enhancements
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23 include, but are not limited to, the purposes specified in this
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24 section.
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1 B. As a basis for determining the Nursing Facilities Quality of
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2 Care Fee assessed upon each licensed nursing facility, the Authority
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3 shall calculate a uniform per-patient day rate. The rate shall be
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4 calculated by dividing six percent (6%) of the total annual patient
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5 gross receipts of all licensed nursing facilities in this state by
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6 the total number of patient days for all licensed nursing facilities
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7 in this state. The result shall be the per-patient day rate.
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8 Beginning July 15, 2004, the Nursing Facilities Quality of Care Fee
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9 shall not be increased unless specifically authorized by the
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10 Legislature.
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11 C. Pursuant to any approved Medicaid waiver and pursuant to
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12 subsection N of this section, the Nursing Facilities Quality of Care
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13 Fee shall not exceed the amount or rate allowed by federal law for
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14 nursing home licensed bed days.
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15 D. The Nursing Facilities Quality of Care Fee owed by a
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16 licensed nursing facility shall be calculated by the Authority by
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17 adding the daily patient census of a licensed nursing facility, as
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18 reported by the facility for each day of the month, and by
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19 multiplying the ensuing figure by the per-patient day rate
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20 determined pursuant to the provisions of subsection B of this
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21 section.
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22 E. Each licensed nursing facility which is assessed the Nursing
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23 Facilities Quality of Care Fee shall be required to file a report on
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24 a monthly basis with the Authority detailing the daily patient
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1 census and patient gross receipts at such time and in such manner as
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2 required by the Authority.
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3 F. 1. The Nursing Facilities Quality of Care Fee for a
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4 licensed nursing facility for the period beginning October 1, 2000,
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5 shall be determined using the daily patient census and annual
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6 patient gross receipts figures reported to the Authority for the
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7 calendar year 1999 upon forms supplied by the Authority.
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8 2. Annually the Nursing Facilities Quality of Care Fee shall be
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9 determined by:
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10 a. using the daily patient census and patient gross
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11 receipts reports received by the Authority for the
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12 most recent available twelve (12) months, and
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13 b. annualizing those figures.
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14 Each year thereafter, the annualization of the Nursing
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15 Facilities Quality of Care Fee specified in this paragraph shall be
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16 subject to the limitation in subsection B of this section unless the
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17 provision of subsection C of this section is met.
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18 G. The payment of the Nursing Facilities Quality of Care Fee by
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19 licensed nursing facilities shall be an allowable cost for Medicaid
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20 reimbursement purposes.
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21 H. 1. There is hereby created in the State Treasury a
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22 revolving fund to be designated the "Nursing Facility Quality of
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23 Care Fund".
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1 2. The fund shall be a continuing fund, not subject to fiscal
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2 year limitations, and shall consist of:
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3 a. all monies received by the Authority pursuant to this
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4 section and otherwise specified or authorized by law,
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5 b. monies received by the Authority due to federal
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6 financial participation pursuant to Title XIX of the
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7 Social Security Act, and
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8 c. interest attributable to investment of money in the
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9 fund.
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10 3. All monies accruing to the credit of the fund are hereby
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11 appropriated and shall be budgeted and expended by the Authority
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12 for:
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13 a. reimbursement of the additional costs paid to
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14 Medicaid-certified nursing facilities for purposes
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15 specified by Sections 1-1925.2 and 5022.2 of Title 63
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16 of the Oklahoma Statutes,
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17 b. reimbursement of the Medicaid rate increases for
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18 intermediate care facilities for individuals with
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19 intellectual disabilities (ICFs/IID),
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20 c. nonemergency transportation services for Medicaid-
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21 eligible nursing home clients,
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22 d. eyeglass and denture services for Medicaid-eligible
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23 nursing home clients,
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1 e. fifteen ombudsmen employed by the Department of Human
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2 Services Office of the Attorney General,
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3 f. ten additional nursing facility inspectors employed by
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4 the State Department of Health,
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5 g. pharmacy and other Medicaid services to qualified
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6 Medicare beneficiaries whose incomes are at or below
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7 one hundred percent (100%) of the federal poverty
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8 level; provided however, pharmacy benefits authorized
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9 for such qualified Medicare beneficiaries shall be
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10 suspended if the federal government subsequently
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11 extends pharmacy benefits to this population,
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12 h. costs incurred by the Authority in the administration
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13 of the provisions of this section and any programs
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14 created pursuant to this section,
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15 i. durable medical equipment and supplies services for
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16 Medicaid-eligible elderly adults, and
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17 j. personal needs allowance increases for residents of
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18 nursing homes and Intermediate Care Facilities for
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19 Individuals with Intellectual Disabilities (ICFs/IID)
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20 from Thirty Dollars ($30.00) to Fifty Dollars ($50.00)
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21 per month per resident.
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22 4. Expenditures from the fund shall be made upon warrants
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23 issued by the State Treasurer against claims filed as prescribed by
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1 law with the Director of the Office of Management and Enterprise
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2 Services for approval and payment.
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3 5. The fund and the programs specified in this section funded
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4 by revenues collected from the Nursing Facilities Quality of Care
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5 Fee pursuant to this section are exempt from budgetary cuts,
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6 reductions, or eliminations.
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7 6. The Medicaid rate increases for intermediate care facilities
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8 for individuals with intellectual disabilities (ICFs/IID) shall not
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9 exceed the net Medicaid rate increase for nursing facilities
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10 including, but not limited to, the Medicaid rate increase for which
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11 Medicaid-certified nursing facilities are eligible due to the
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12 Nursing Facilities Quality of Care Fee less the portion of that
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13 increase attributable to treating the Nursing Facilities Quality of
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14 Care Fee as an allowable cost.
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15 7. The reimbursement rate for nursing facilities shall be made
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16 in accordance with Oklahoma's Medicaid reimbursement rate
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17 methodology and the provisions of this section.
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18 8. No nursing facility shall be guaranteed, expressly or
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19 otherwise, that any additional costs reimbursed to the facility will
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20 equal or exceed the amount of the Nursing Facilities Quality of Care
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21 Fee paid by the nursing facility.
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22 I. 1. In the event that federal financial participation
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23 pursuant to Title XIX of the Social Security Act is not available to
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24 the Oklahoma Medicaid program, for purposes of matching expenditures
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1 from the Nursing Facility Quality of Care Fund at the approved
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2 federal medical assistance percentage for the applicable fiscal
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3 year, the Nursing Facilities Quality of Care Fee shall be null and
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4 void as of the date of the nonavailability of such federal funding,
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5 through and during any period of nonavailability.
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6 2. In the event of an invalidation of this section by any court
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7 of last resort under circumstances not covered in subsection J of
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8 this section, the Nursing Facilities Quality of Care Fee shall be
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9 null and void as of the effective date of that invalidation.
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10 3. In the event that the Nursing Facilities Quality of Care Fee
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11 is determined to be null and void for any of the reasons enumerated
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12 in this subsection, any Nursing Facilities Quality of Care Fee
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13 assessed and collected for any periods after such invalidation shall
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14 be returned in full within sixty (60) days by the Authority to the
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15 nursing facility from which it was collected.
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16 J. 1. If any provision of this section or the application
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17 thereof shall be adjudged to be invalid by any court of last resort,
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18 such judgment shall not affect, impair or invalidate the provisions
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19 of the section, but shall be confined in its operation to the
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20 provision thereof directly involved in the controversy in which such
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21 judgment was rendered. The applicability of such provision to other
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22 persons or circumstances shall not be affected thereby.
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23 2. This subsection shall not apply to any judgment that affects
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24 the rate of the Nursing Facilities Quality of Care Fee, its
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1 applicability to all licensed nursing homes in the state, the usage
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2 of the fee for the purposes prescribed in this section, or the
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3 ability of the Authority to obtain full federal participation to
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4 match its expenditures of the proceeds of the fee.
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5 K. The Authority shall promulgate rules for the implementation
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6 and enforcement of the Nursing Facilities Quality of Care Fee
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7 established by this section.
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8 L. The Authority shall provide for administrative penalties in
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9 the event nursing facilities fail to:
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10 1. Submit the Quality of Care Fee;
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11 2. Submit the fee in a timely manner;
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12 3. Submit reports as required by this section; or
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13 4. Submit reports timely.
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14 M. As used in this section:
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15 1. "Nursing facility" means any home, establishment or
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16 institution, or any portion thereof, licensed by the State
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17 Department of Health as defined in Section 1-1902 of Title 63 of the
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18 Oklahoma Statutes;
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19 2. "Medicaid" means the medical assistance program established
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20 in Title XIX of the federal Social Security Act and administered in
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21 this state by the Authority;
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22 3. "Patient gross revenues" means gross revenues received in
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23 compensation for services provided to residents of nursing
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24 facilities including, but not limited to, client participation. The
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1 term "patient gross revenues" shall not include amounts received by
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2 nursing facilities as charitable contributions; and
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3 4. "Additional costs paid to Medicaid-certified nursing
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4 facilities under Oklahoma's Medicaid reimbursement methodology"
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5 means both state and federal Medicaid expenditures including, but
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6 not limited to, funds in excess of the aggregate amounts that would
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7 otherwise have been paid to Medicaid-certified nursing facilities
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8 under the Medicaid reimbursement methodology which have been updated
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9 for inflationary, economic, and regulatory trends and which are in
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10 effect immediately prior to the inception of the Nursing Facilities
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11 Quality of Care Fee.
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12 N. 1. As per any approved federal Medicaid waiver, the
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13 assessment rate subject to the provision of subsection C of this
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14 section is to remain the same as those rates that were in effect
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15 prior to January 1, 2012, for all state-licensed continuum of care
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16 facilities.
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17 2. Any facilities that made application to the State Department
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18 of Health to become a licensed continuum of care facility no later
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19 than January 1, 2012, shall be assessed at the same rate as those
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20 facilities assessed pursuant to paragraph 1 of this subsection;
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21 provided, that any facility making the application shall receive the
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22 license on or before September 1, 2012. Any facility that fails to
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23 receive such license from the State Department of Health by
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1 September 1, 2012, shall be assessed at the rate established by
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2 subsection C of this section subsequent to September 1, 2012.
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3 O. If any provision of this section, or the application
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4 thereof, is determined by any controlling federal agency, or any
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5 court of last resort to prevent the state from obtaining federal
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6 financial participation in the state's Medicaid program, such
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7 provision shall be deemed null and void as of the date of the
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8 nonavailability of such federal funding and through and during any
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9 period of nonavailability. All other provisions of the bill shall
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10 remain valid and enforceable.
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11 SECTION 2. AMENDATORY 63 O.S. 2021, Section 1-2216, as
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12 amended by Section 17, Chapter 339, O.S.L. 2024 (63 O.S. Supp. 2024,
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13 Section 1-2216), is amended to read as follows:
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14 Section 1-2216. A. The Attorney General shall promulgate rules
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15 regarding:
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16 1. The powers and official duties of the State Long-Term Care
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17 Ombudsman consistent with applicable federal law and rules or as
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18 provided by the Long-Term Care Ombudsman Act;
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19 2. Minimum qualifications for persons to serve as
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20 representatives of the Office of the State Long-Term Care Ombudsman;
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21 3. Initial and continuing training requirements for ombudsman
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22 staff and volunteers which shall provide for a minimum of eighteen
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23 (18) hours of continuing education relevant to the care of the aging
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24 and disabled;
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1 4. The minimum number of visits that must be made by an
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2 ombudsman to the assigned facilities;
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3 5. The proper documentation and reporting of visits made to
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4 facilities by the ombudsman;
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5 6. Procedures to ensure that officers, employees, or other
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6 representatives of the Office are not subject to a conflict of
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7 interest which would impair their ability to carry out their
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8 official duties in an impartial manner; and
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9 7. The disclosure by the State Long-Term Care Ombudsman or area
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10 or local Ombudsman entities of files maintained by the State Long-
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11 Term Care Ombudsman Program. Such rules shall:
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12 a. provide that such files and records may be disclosed
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13 only at the discretion of the State Long-Term Care
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14 Ombudsman or the person designated by the State Long-
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15 Term Care Ombudsman to disclose the files and records,
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16 and
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17 b. prohibit the disclosure of the identity of any
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18 complainant or resident with respect to whom the
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19 Office maintains such files or records unless:
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20 (1) the complainant or resident, or the legal
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21 representative of the complainant or resident,
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22 consents to the disclosure and the consent is
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23 given in writing,
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1 (2) (a) the complainant or resident gives consent
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2 orally, and
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3 (b) the consent is documented contemporaneously
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4 in a writing made by a State Long-Term Care
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5 Ombudsman representative of the Office in
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6 accordance with such rules as the Attorney
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7 General shall promulgate, or
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8 (3) the disclosure is required by court order.
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9 B. The Oklahoma State Council on Aging and Adult Protective
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10 Services, established by the Attorney General Department of Human
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11 Services to review, monitor, and evaluate programs targeted to older
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12 persons, shall serve in an advisory capacity to the State Long-Term
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13 Care Ombudsman through establishment of a committee with equal
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14 provider and consumer representation.
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15 SECTION 3. It being immediately necessary for the preservation
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16 of the public peace, health or safety, an emergency is hereby
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17 declared to exist, by reason whereof this act shall take effect and
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18 be in full force from and after its passage and approval.
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