SB-1037, As Passed Senate, December 20, 2018

HOUSE SUBSTITUTE FOR

SENATE BILL NO. 1037

A bill to amend 1939 PA 280, entitled

"The social welfare act,"

(MCL 400.1 to 400.119b) by adding section 111n.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

Sec. 111n. (1) If the department issues a new interpretation

of existing Medicaid provider policy directly affecting nursing

facility Medicaid cost reports, that change in policy must have a

prospective effective date. A policy may have a retrospective

effective date as part of a state plan amendment approval or waiver

approval, or if required by state law, federal law, or judicial

ruling.

(2) By July 1, 2019, but no later than October 1, 2019, the

department shall revise the Medicaid nonavailable bed plan policy

to allow a nursing facility to remove beds from service for up to 5

years. As part of the revised nonavailable bed plan policy, all of

the following apply:

(a) A nursing facility is not required to remove all beds from

a room.

(b) The beds placed in a nonavailable bed plan may be from

noncontiguous rooms.

be utilized during the period when the nursing facility has a bed

in the nonavailable bed plan, but the square footage associated

with each nonavailable bed is nonreimbursable on the Medicaid cost

report.

(3) The department shall establish a process to automatically

change the program enrollment type and managed care enrollment

status in the community health automated Medicaid processing system

(CHAMPS) immediately when a filing has been made by a health

maintenance organization to disenroll a nursing facility resident

from a health maintenance organization and the resident has

completed 45 days of skilled care at a nursing facility. The

department may utilize a filing to disenroll a nursing facility

resident from a health maintenance organization, admission and

discharge data entered by a nursing facility in CHAMPS, or

automated admission, discharge, and transfer transactions to verify

the 45-day limit.

(4) Within 60 days after receipt of a request from a nursing

facility, the department shall perform a secondary review of a

denied rate exception, including, but not limited to, rate relief,

or application of a classwide average rate. The secondary review

must be performed by department staff who are separate from the

department staff who performed the initial review determination.

(5) The department shall offer a quarterly meeting and invite

appropriate nursing facility stakeholders. Appropriate stakeholders

shall include at least 1 representative from each nursing facility

provider trade association, the state long-term care ombudsman, and

any other representatives. Individuals who participate in these

quarterly meetings, in conjunction with the department, may

designate advisory workgroups to develop recommendations on the

discussion topics that should include, at a minimum, the following:

(a) Seeking quality improvement to the cost report audit and

settlement process, including clarification to process-related

policies and protocols that include, but are not limited to, the

following:

(i) Improving the auditors' and providers' quality and

preparedness.

(ii) Enhanced communication between applicable parties such as

department staff, consultants, and providers.

(iii) Improving Medicaid providers' ability to provide

auditable documentation on a timely basis.

(b) Promoting transparency between providers and department

staff, including, but not limited to, applying regulations and

policy in an accurate, consistent, and timely manner and evaluating

changes that have been implemented to resolve any identified

problems and concerns.

Enacting section 1. This amendatory act takes effect 180 days