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A BILL TO BE ENTITLED
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AN ACT
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relating to the creation and administration of a quality assurance |
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fee for nursing facilities; providing an administrative penalty. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 242, Health and Safety Code, is amended |
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by adding Subchapter P to read as follows: |
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SUBCHAPTER P. QUALITY ASSURANCE FEE |
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Sec. 242.701. DEFINITIONS. In this subchapter: |
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(1) "Commission" means the Health and Human Services |
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Commission. |
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(2) "Department" means the Department of Aging and |
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Disability Services. |
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(3) "Executive commissioner" means the executive |
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commissioner of the Health and Human Services Commission. |
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(4) "Gross receipts" means money paid as compensation |
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for services provided to residents, including client |
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participation. The term does not include charitable contributions |
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to an institution. |
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Sec. 242.702. APPLICABILITY. This subchapter does not |
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apply to: |
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(1) a state-owned veterans' nursing facility; or |
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(2) an entity that provides on a single campus a |
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combination of services, which may include independent living |
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services, licensed assisted living services, or licensed nursing |
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facility care services, and: |
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(A) that operates under a continuing care |
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retirement community certificate of authority issued by the Texas |
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Department of Insurance; or |
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(B) in which, during the previous 12 months, the |
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combined patient days of service provided to independent living and |
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assisted living residents, excluding services provided to persons |
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occupying facility beds in a licensed nursing facility, exceeded |
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the patient days of service provided to nursing facility residents. |
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Sec. 242.703. COMPUTING QUALITY ASSURANCE FEE. (a) A |
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quality assurance fee is imposed on each institution subject to |
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this subchapter for which a license fee must be paid under Section |
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242.034. The quality assurance fee: |
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(1) is an amount established under Subsection (b) |
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multiplied by the number of patient days as determined in |
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accordance with Section 242.704; |
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(2) is payable monthly; and |
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(3) is in addition to other fees imposed under this |
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chapter. |
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(b) The commission shall establish a quality assurance fee |
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for each patient day in an amount that will produce annual revenues |
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of not more than 5.5 percent of the institution's total annual gross |
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receipts in this state. The fee is subject to adjustment as |
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necessary. The amount of the quality assurance fee may vary |
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according to the number of patient days provided by an institution |
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as necessary to obtain a waiver under federal regulations at 42 |
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C.F.R. Section 433.68(e). |
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(c) The amount of the quality assurance fee must be |
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determined using patient days and gross receipts: |
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(1) reported to the commission or to the department at |
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the direction of the commission; and |
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(2) covering a period of at least six months. |
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(d) The quality assurance fee is an allowable cost for |
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reimbursement under the state Medicaid program. |
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(e) A nursing facility may not list the quality assurance |
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fee as a separate charge on a patient's or resident's billing |
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statement or otherwise directly or indirectly attempt to charge the |
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quality assurance fee to a patient or resident. |
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Sec. 242.704. PATIENT DAYS. For each calendar day, an |
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institution shall determine the number of patient days by adding |
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the following: |
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(1) the number of patients occupying an institution |
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bed immediately before midnight of that day plus the number of |
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patients admitted that day less the number of patients discharged |
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that day, except that a patient is included in the count under this |
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subdivision if: |
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(A) the patient is admitted and discharged on the |
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same day; or |
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(B) the patient is discharged that day because of |
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the patient's death; and |
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(2) the number of beds that are on hold that day and |
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that have been placed on hold for a period not to exceed three |
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consecutive calendar days during which a patient is: |
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(A) in the hospital; or |
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(B) on therapeutic home leave. |
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Sec. 242.705. REPORTING AND COLLECTION. (a) The |
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commission or the department as directed by the executive |
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commissioner shall collect the quality assurance fee. |
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(b) Each institution shall, not later than the 25th day |
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after the last day of a month: |
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(1) file with the commission a report stating the |
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total patient days for the month; and |
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(2) pay the quality assurance fee. |
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Sec. 242.706. RULES; ADMINISTRATIVE PENALTY. (a) The |
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executive commissioner shall adopt rules for the administration of |
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this subchapter, including rules related to the imposition and |
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collection of the quality assurance fee. |
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(b) The executive commissioner may adopt rules granting |
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exceptions from the quality assurance fee, including an exception |
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for units of service reimbursed through Medicare Part A, if the |
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commission obtains all waivers necessary under federal law, |
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including 42 C.F.R. Section 433.68(e). |
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(c) An administrative penalty assessed under this |
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subchapter in accordance with Section 242.066 may not exceed |
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one-half of the amount of the outstanding quality assurance fee or |
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$20,000, whichever is greater. |
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Sec. 242.707. NURSING HOME QUALITY ASSURANCE FEE ACCOUNT. |
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(a) The nursing home quality assurance fee account is a dedicated |
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account in the general revenue fund. Interest earned on money in |
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the account shall be credited to the account. |
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(b) The comptroller shall deposit money collected under |
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this subchapter to the credit of the account. |
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(c) Subject to legislative appropriation and this |
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subchapter, money in the account together with federal matching |
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money shall be used to support or maintain an increase in Medicaid |
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reimbursement for institutions. |
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Sec. 242.708. REIMBURSEMENT OF INSTITUTIONS. (a) Subject |
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to legislative appropriation, the commission may use money in the |
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nursing home quality assurance fee account, together with any |
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federal money available to match that money, to: |
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(1) offset the institution's allowable expenses under |
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the state Medicaid program; and |
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(2) increase reimbursement rates paid under the |
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Medicaid program to institutions. |
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(b) The commission shall devise the formula by which amounts |
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received under this subchapter increase the reimbursement rates |
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paid to institutions under the state Medicaid program. |
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Sec. 242.709. INVALIDITY; FEDERAL FUNDS. If any portion of |
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this subchapter is held invalid by a final order of a court that is |
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not subject to appeal, or if the commission determines that the |
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imposition of the fee and the expenditure as prescribed by this |
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subchapter of amounts collected will not entitle the state to |
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receive additional federal funds under the Medicaid program, the |
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commission shall stop collection of the quality assurance fee and, |
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not later than the 30th day after the date collection is stopped, |
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shall return to the institutions that paid the fees, in proportion |
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to the total amount paid by those institutions, any money deposited |
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to the credit of the nursing home quality assurance fee account but |
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not spent. |
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Sec. 242.710. REVISION IN CASE OF DISAPPROVAL. If the |
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Centers for Medicare and Medicaid Services disapproves the quality |
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assurance fee plan established under this subchapter, the |
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commission shall revise the associated state plan amendments and |
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waiver requests as necessary to comply with federal regulations |
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provided by 42 C.F.R. Section 433.68(e). The revisions must be |
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completed as soon as practicable after the date the commission |
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receives notice of the disapproval. |
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Sec. 242.711. AUTHORITY TO ACCOMPLISH PURPOSES OF |
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SUBCHAPTER. The executive commissioner by rule may adopt a |
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definition, a method of computation, or a rate that differs from |
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those expressly provided by or expressly authorized by this |
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subchapter to the extent the difference is necessary to accomplish |
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the purposes of this subchapter. |
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SECTION 2. (a) Notwithstanding Section 242.703, Health and |
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Safety Code, as added by this Act, the executive commissioner of the |
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Health and Human Services Commission shall establish the initial |
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quality assurance fee imposed under Subchapter P, Chapter 242, |
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Health and Safety Code, as added by this Act, based on available |
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revenue and patient day information. The initial quality assurance |
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fee established under this section remains in effect until the |
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Health and Human Services Commission obtains the information |
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necessary to set the fee under Section 242.703, Health and Safety |
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Code, as added by this Act. |
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(b) As soon as practicable after the effective date of this |
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Act, the executive commissioner of the Health and Human Services |
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Commission shall adopt rules as necessary to implement Subchapter |
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P, Chapter 242, Health and Safety Code, as added by this Act. |
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(c) If before implementing any provision of this Act a state |
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agency determines a waiver or authorization from a federal agency |
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is necessary for implementation of that provision, the agency |
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affected by the provision shall request the waiver or authorization |
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and may delay implementing that provision until the waiver or |
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authorization is granted. |
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SECTION 3. Notwithstanding any other provision of law, a |
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quality assurance fee may not be imposed under Section 242.703, |
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Health and Safety Code, as added by this Act, or collected under |
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Section 242.705, Health and Safety Code, as added by this Act, |
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until: |
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(1) the amendment to the state plan for Medicaid that |
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increases the rates paid to the nursing facilities for providing |
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services under the state Medicaid program is approved by the |
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Centers for Medicare and Medicaid Services or another applicable |
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federal government agency; and |
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(2) nursing facilities have been compensated |
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retroactively at the increased rate for services provided under the |
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state Medicaid program for the period beginning with the effective |
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date of this Act. |
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SECTION 4. This Act takes effect September 1, 2007. |