Oklahoma One Step Closer to Boosting Medicaid Rates for Nursing Homes

Oklahoma moved one step closer to boosting Medicaid payments for skilled nursing facilities, with Senate Bill 280 ready to proceed to the Senate for final approval after some floor amendments.

Tulsa World first reported the news.

Oklahoma is proactively trying to bolster its Medicaid rate, which ranks among the lowest in the country. Several cities in the state even took the unusual step of holding nursing home licenses in the hopes of benefiting from the federal Nursing Facility Upper Payment Limit program, but those efforts failed earlier this year. As a result, the state’s nursing home industry has turned its attention to the Nursing Home Quality Assurance Initiative (NHQI), as embodied in Senate Bill 280.

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The NHQI would establish a pay-for-performance component based on improving on pressure ulcers, UTIs, use of antipsychotics, and weight loss among nursing home residents. It would bolster the state’s Medicaid rate, which was roughly $150 a day as of October 2018, by $23 a day. Five dollars of that amount would be dependent on meeting the quality metrics.

Facilities can earn that component when they make improvements quarter over quarter, or are at a level above the national average, Care Providers Oklahoma president and CEO Nico Gomez told SNN. The organization is the local branch of the American Health Care Association, a trade group representing nursing homes.

The nursing home industry and the state Medicaid agency disagree on how much more the agency would spend on nursing home care, Gomez said. But they agree that fully funding the NHQI will take $150 million in state funding this year.

The Senate has to decide whether to accept the House’s amendments to the bill and then to send it to the governor when the budget has been determined, Gomez explained. Budget negotiations are ongoing between the state legislature and governor, he said; once a budget agreement is reached, then the nursing home industry will know the final outcome of the NHQI, Gomez said.

Oklahoma isn’t alone in trying novel ways to boost its Medicaid funding for nursing homes: With razor-thin margins for operators and persistent underfunding at the state level, trade groups and other advocates have fought for quality-based Medicaid raises in Texas, Indiana, and elsewhere.

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