Oklahoma Administrative Code
Title 317 - Oklahoma Health Care Authority
Chapter 30 - Medical Providers-Fee for Service
Subchapter 5 - Individual Providers and Specialties
Part 9 - LONG-TERM CARE FACILITIES
Section 317:30-5-131.2 - Quality of care fund requirements and report
Universal Citation: OK Admin Code 317:30-5-131.2
Current through Vol. 42, No. 1, September 16, 2024
(a) Definitions. The following words and terms, when used in this Section, have the following meaning, unless the context clearly indicates otherwise:
(1)
"Annualize" means that the calculations, including, for example,
total patient days, gross revenue, or contractual allowances and discounts, is
divided by the total number of applicable days in the relevant time period.
(2)
"Direct-Care
Staff" means any nursing or therapy staff who provides direct, hands-on
care to residents in a nursing facility and intermediate care facility for
individuals with intellectual disabilities pursuant to Section
1-1925.2
of Title 63 of the Oklahoma Statutes, pursuant to OAC 310:675-1 et seq., and as
defined in subsection (c) of this Section.
(3)
"Major Fraction Thereof"
means an additional threshold for direct-care-staff-to-resident ratios at which
another direct-care staff person(s) is required due to the peak in-house
resident count exceeding one-half of the minimum direct-care-staff-to-resident
ratio pursuant to Section
1-1925.2
of Title 63 of the Oklahoma Statutes.
(4)
"Nursing Facility and Intermediate
Care Facility for Individuals with Intellectual Disabilities" means any
home, establishment, or institution or any portion thereof, licensed by the
Oklahoma State Department of Health (OSDH) as defined in Section
1-1902 of
Title 63 of the Oklahoma Statutes.
(5)
"Peak In-House Resident
Count" means the maximum number of in-house residents at any point in
time during the applicable shift.
(6)
"Quality of Care Fee" means
the fee assessment created for the purpose of quality care enhancements
pursuant to Section
2002
of Title 56 of the Oklahoma Statutes upon each nursing facility and
intermediate care facility for individuals with intellectual disabilities
licensed in this state.
(7)
"Quality of Care Fund" means a revolving fund established in the
State Treasury pursuant to Section
2002
of Title 56 of the Oklahoma Statutes.
(8)
"Quality of Care Report"
means the monthly report developed by the Oklahoma Health Care Authority (OHCA)
to document the staffing ratios, total patient gross receipts, total patient
days, and minimum wage compliance for specified staff for each nursing facility
and intermediate care facility for individuals with intellectual disabilities
licensed in the state.
(9)
"Service Rate" means the minimum direct-care-staff-to-resident
rate pursuant to Section
1-1925.2
of Title 63 of Oklahoma Statutes and pursuant to OAC 310:675-1 et seq.
(10)
"Staff Hours Worked by
Shift" means the number of hours worked during the applicable shift by
direct-care staff.
(11)
"Staffing Ratios" means the minimum direct-care-staff-to-resident
ratios pursuant to Section
1-1925.2
of Title 63 of the Oklahoma Statutes and pursuant to OAC 310:675-1 et seq.
(12)
"Total Gross
Receipts" means all cash received in the current Quality of Care Report
month for services rendered to all residents in the facility. Receipts should
include all Medicaid, Medicare, private pay, and insurance including receipts
for items not in the normal per diem rate. Charitable contributions received by
the nursing facility are not included.
(13)
"Total Patient Days" means
the monthly patient days that are compensable for the current monthly Quality
of Care Report.
(b) Quality of care fund assessments.
(1) The OHCA was mandated by the Oklahoma
Legislature to assess a monthly service fee to each licensed nursing facility
in the state. The fee is assessed on a per patient day basis. The amount of the
fee is uniform for each facility type. The fee is determined as six percent
(6%) of the average total gross receipts divided by the total days for each
facility type.
(2) Annually, the
Nursing Facilities Quality of Care Fee shall be determined by using the daily
patient census and patient gross receipts report received by the OHCA for the
most recent available twelve months and annualizing those figures. Also, the
fee will be monitored to never surpass the federal maximum.
(3) The fee is authorized through the
Medicaid State Plan and by the Centers for Medicare and Medicaid Services
regarding waiver of uniformity requirements related to the fee.
(4) Monthly reports of Gross Receipts and
Census are included in the monthly Quality of Care Report. The data required
includes, but is not limited to, the Total Gross Receipts and Total Patient
Days for the current monthly report.
(5) The method of collection is as follows:
(A) The OHCA assesses each facility monthly
based on the reported patient days from the Quality of Care Report filed two
months prior to the month of the fee assessment billing. As defined in this
subsection, the total assessment is the fee times the total days of service.
The OHCA notifies the facility of its assessment by the end of the month of the
Quality of Care Report submission date.
(B) Payment is due to the OHCA by the 15
th of the following month. Failure to
pay the amount by the 15
th or failure to have the payment
mailing postmarked by the 13
th will result in a debt to the State
of Oklahoma and is subject to penalties of 10 percent (10%) of the amount and
interest of 1.25 percent (1.25%) per month. The Quality of Care Fee must be
submitted no later than the 15
th of the month. If the 15
th falls upon a holiday or weekend
(Saturday-Sunday), the fee is due by 5 p.m., Central Standard Time (CST), of
the following business day (Monday-Friday).
(C) The monthly assessment, including
applicable penalties and interest, must be paid regardless of any appeals
action requested by the facility. If a provider fails to pay the OHCA the
assessment within the time frames noted on the second invoice to the provider,
the assessment, applicable penalty, and interest will be deducted from the
facility's payment. Any change in payment amount resulting from an appeals
decision will be adjusted in future payments. Adjustments to prior months'
reported amounts for gross receipts or patient days may be made by filing an
amended part C of the Quality of Care Report.
(D) The Quality of Care fee assessments
excluding penalties and interest are an allowable cost for OHCA cost reporting
purposes.
(E) The Quality of Care
fund, which contains assessments collected including penalties and interest as
described in this subsection and any interest attributable to investment of any
money in the fund, must be deposited in a revolving fund established in the
State Treasury. The funds will be used pursuant to Section
2002
of Title 56 of the Oklahoma Statutes.
(c) Quality of care direct-care-staff-to resident-ratios.
(1) All nursing facilities and intermediate
care facilities for individuals with intellectual disabilities (ICFs/IID)
subject to the Nursing Home Care Act, in addition to other state and federal
staffing requirements, must maintain the minimum direct-care-staff-to-resident
ratios or direct-care service rates as cited in Section
1-1925.2
of Title 63 of the Oklahoma Statutes and pursuant to OAC 310:675-1 et seq.
(2) For purposes of
staff-to-resident ratios, direct-care staff are limited to the following
employee positions:
(A) Registered Nurse;
(B) Licensed Practical Nurse;
(C) Nurse Aide;
(D) Certified Medication Aide;
(E) Qualified Intellectual Disability
Professional (ICFs/IID only);
(F)
Physical Therapist;
(G)
Occupational Therapist;
(H)
Respiratory Therapist;
(I) Speech
Therapist; and
(J) Therapy
Aide/Assistant.
(3) The
hours of direct care rendered by persons filling non-direct care positions may
be used when those persons are certified and rendering direct care in the
positions listed in OAC 317:30-5-131.2(c)(2) when documented in the records and
time sheets of the facility.
(4) In
any shift when the direct-care-staff-to-resident ratio computation results in a
major fraction thereof, direct-care staff is rounded to the next higher whole
number.
(5) To document and report
compliance with the provisions of this subsection, nursing facilities and
ICFs/IID must submit the monthly Quality of Care Report pursuant to subsection
(e) of this Section.
(d) Quality of care reports. All nursing facilities and intermediate care facilities for individuals with intellectual disabilities must submit a monthly report developed by the OHCA, the Quality of Care Report, for the purposes of documenting the extent to which such facilities are compliant with the minimum direct-care-staff-to-resident ratios or direct-care service rates.
(1) The monthly report must be signed by the
preparer and by the owner, authorized corporate officer, or administrator of
the facility for verification and attestation that the reports were compiled in
accordance with this section.
(2)
The owner or authorized corporate officer of the facility must retain full
accountability for the report's accuracy and completeness regardless of report
submission method.
(3) Penalties
for false statements or misrepresentation made by or on behalf of the provider
are provided at
42
U.S.C. Section 1320a-7b.
(4) The Quality of Care Report must be
submitted by 5 p.m. (CST) on the 15
th of the following month. If the 15
th falls upon a holiday or a weekend
(Saturday-Sunday), the report is due by 5 p.m. (CST) of the following business
day (Monday - Friday).
(5) The
Quality of Care Report will be made available in an electronic version for
uniform submission of the required data elements.
(6) Facilities must submit the monthly report
through the OHCA Provider Portal.
(7) Should a facility discover an error in
its submitted report for the previous month only, the facility must provide to
the Long-term Care Financial Management Unit written notification with
adequate, objective, and substantive documentation within five business days
following the submission deadline. Any documentation received after the five
business day period will not be considered in determining compliance and for
reporting purposes by the OHCA.
(8)
An initial administrative penalty of $150.00 is imposed upon the facility for
incomplete, unauthorized, or non-timely filing of the Quality of Care Report.
Additionally, a daily administrative penalty will begin upon the OHCA notifying
the facility in writing that the report was not complete or not timely
submitted as required. The $150.00 daily administrative penalty accrues for
each calendar day after the date the notification is received. The penalties
are deducted from the Medicaid facility's payment. For 100 percent (100%)
private pay facilities, the penalty amount(s) is included and collected in the
fee assessment billings process. Imposed penalties for incomplete reports or
non-timely filing are not considered for OHCA cost reporting
purposes.
(9) The Quality of Care
Report includes, but is not limited to, information pertaining to the necessary
reporting requirements in order to determine the facility's compliance with
subsections (b) and (c) of this Section. Such reported information includes,
but is not limited to: total gross receipts, patient days, available bed days,
direct care hours, Medicare days, Medicaid days, number of employees, monthly
resident census, and tenure of certified nursing assistants, nurses, directors
of nursing, and administrators.
(10) Audits may be performed to determine
compliance pursuant to subsections (b), and (c) of this Section.
Announced/unannounced on-site audits of reported information may also be
performed.
(11)
Direct-care-staff-to-resident information and on-site audit findings pursuant
to subsection (c), will be reported to the OSDH for their review in order to
determine "willful" non-compliance and assess penalties accordingly pursuant to
Title 63 Section
1-1912
through Section 1-1917 of the Oklahoma Statutes. The OSHD informs the OHCA of
all final penalties as required in order to deduct from the Medicaid facility's
payment. Imposed penalties are not considered for OHCA Cost Reporting purposes.
(12) Under OAC
317:2-1-2,
long-term care facility providers may appeal the administrative penalty
described in (b)(5)(B) and (d)(8) of this section.
(13) Facilities that have been authorized by
the OSDH to implement flexible staff scheduling must comply with OAC 310:675-1
et seq. The authorized facility is required to complete the flexible staff
scheduling section of Part A of the Quality of Care Report. The owner,
authorized corporate officer, or administrator of the facility must complete
the flexible staff scheduling signature block, acknowledging their OSDH
authorization for flexible staff scheduling.
Added at 17 Ok Reg 3509, eff 9-1-00 (emergency); Added at 18 Ok Reg 255, eff 11-21-00 (emergency); Added at 18 Ok Reg 780, eff 1-23-01 (emergency); Added at 18 Ok Reg 1130, eff 5-11-01 ; Amended at 19 Ok Reg 69, eff 9-1-01 (emergency); Amended at 19 Ok Reg 1067, eff 5-13-02 ; Amended at 20 Ok Reg 160, eff 9-26-02 (emergency); Amended at 20 Ok Reg 1216, eff 5-27-03 ; Amended at 20 Ok Reg 1928, eff 6-26-03 ; Amended at 22 Ok Reg 99, eff 4-1-04 (emergency); Amended at 22 Ok Reg 2467, eff 7-11-05 ; Amended at 23 Ok Reg 771, eff 3-9-06 (emergency); Amended at 23 Ok Reg 2440, eff 6-25-06 ; Amended at 24 Ok Reg 2821, eff 6-1-07 through 7-14-08 (emergency) 1 ; Amended at 25 Ok Reg 2668, eff 7-25-08 ; Amended at 30 Ok Reg 1195, eff 7-1-13
1 This emergency action expired on 7-14-08 before being superseded by a permanent action. Upon expiration of an emergency amendatory action, the last effective permanent text is reinstated. Therefore, on 7-15-08 (after the 7-14-08 expiration of the emergency action), the text of 317:30-5-131.2 reverted back to the permanent text that became effective 6-25-06, as was last published in the 2006 Edition of the OAC, and remained as such until amended again by permanent action on 7-25-08.
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