{"data":{"id":"us-ok/okla.-stat.-tit.-63-63-1-1925.2","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 63, § 63-1-1925.2","heading":"Reimbursements from Nursing Facility Quality of Care","body":"Fund - Staffing ratios - Name and title posting - Rule promulgation\n\n- Appeal - Nursing Facility Funding Advisory Committee.\n\nA. The Oklahoma Health Care Authority shall fully recalculate\n\nand reimburse nursing facilities and Intermediate Care Facilities\n\nfor Individuals with Intellectual Disabilities (ICFs/IID) from the\n\nNursing Facility Quality of Care Fund beginning October 1, 2000, the\n\naverage actual, audited costs reflected in previously submitted cost\n\nreports for the cost-reporting period that began July 1, 1998, and\n\nended June 30, 1999, inflated by the federally published\n\ninflationary factors for the two (2) years appropriate to reflect\n\npresent-day costs at the midpoint of the July 1, 2000, through June\n\n30, 2001, rate year.\n\n1. The recalculations provided for in this subsection shall be\n\nconsistent for both nursing facilities and Intermediate Care\n\nFacilities for Individuals with Intellectual Disabilities\n\n(ICFs/IID).\n\n2. The recalculated reimbursement rate shall be implemented\n\nSeptember 1, 2000.\n\nB. 1. From September 1, 2000, through August 31, 2001, all\n\nnursing facilities subject to the Nursing Home Care Act, in addition\n\nto other state and federal requirements related to the staffing of\n\nnursing facilities, shall maintain the following minimum direct-\n\ncare-staff-to-resident ratios:\n\na. from 7:00 a.m. to 3:00 p.m., one direct-care staff to\n\nevery eight residents, or major fraction thereof,\n\nb. from 3:00 p.m. to 11:00 p.m., one direct-care staff to\n\nevery twelve residents, or major fraction thereof, and\n\nc. from 11:00 p.m. to 7:00 a.m., one direct-care staff to\n\nevery seventeen residents, or major fraction thereof.\n\n2. From September 1, 2001, through August 31, 2003, nursing\n\nfacilities subject to the Nursing Home Care Act and Intermediate\n\nCare Facilities for Individuals with Intellectual Disabilities\n\n(ICFs/IID) with seventeen or more beds shall maintain, in addition\n\nto other state and federal requirements related to the staffing of\n\nnursing facilities, the following minimum direct-care-staff-to-\n\nresident ratios:\n\na. from 7:00 a.m. to 3:00 p.m., one direct-care staff to\n\nevery seven residents, or major fraction thereof,\n\nb. from 3:00 p.m. to 11:00 p.m., one direct-care staff to\n\nevery ten residents, or major fraction thereof, and\n\nc. from 11:00 p.m. to 7:00 a.m., one direct-care staff to\n\nevery seventeen residents, or major fraction thereof.\n\n3. On and after October 1, 2019, nursing facilities subject to\n\nthe Nursing Home Care Act and Intermediate Care Facilities for\n\nIndividuals with Intellectual Disabilities (ICFs/IID) with seventeen\n\nor more beds shall maintain, in addition to other state and federal\n\nrequirements related to the staffing of nursing facilities, the\n\nfollowing minimum direct-care-staff-to-resident ratios:\n\na. from 7:00 a.m. to 3:00 p.m., one direct-care staff to\n\nevery six residents, or major fraction thereof,\n\nb. from 3:00 p.m. to 11:00 p.m., one direct-care staff to\n\nevery eight residents, or major fraction thereof, and\n\nc. from 11:00 p.m. to 7:00 a.m., one direct-care staff to\n\nevery fifteen residents, or major fraction thereof.\n\n4. Effective immediately, facilities shall have the option of\n\nvarying the starting times for the eight-hour shifts by one (1) hour\n\nbefore or one (1) hour after the times designated in this section\n\nwithout overlapping shifts.\n\n5. a. On and after January 1, 2020, a facility may implement\n\ntwenty-four-hour-based staff scheduling; provided,\n\nhowever, such facility shall continue to maintain a\n\ndirect-care service rate of at least two and nine\n\ntenths (2.9) hours of direct-care service per resident\n\nper day, the same to be calculated based on average\n\ndirect care staff maintained over a twenty-four-hour\n\nperiod.\n\nb. At no time shall direct-care staffing ratios in a\n\nfacility with twenty-four-hour-based staff-scheduling\n\nprivileges fall below one direct-care staff to every\nto maintain a\n\ndirect-care service rate of at least two and nine\n\ntenths (2.9) hours of direct-care service per resident\n\nper day, the same to be calculated based on average\n\ndirect care staff maintained over a twenty-four-hour\n\nperiod.\n\nb. At no time shall direct-care staffing ratios in a\n\nfacility with twenty-four-hour-based staff-scheduling\n\nprivileges fall below one direct-care staff to every\n\nfifteen residents or major fraction thereof, and at\n\nleast two direct-care staff shall be on duty and awake\n\nat all times.\n\nc. As used in this paragraph, \"twenty-four-hour-based-\n\nscheduling\" means maintaining:\n\n(1) a direct-care-staff-to-resident ratio based on\n\noverall hours of direct-care service per resident\n\nper day rate of not less than two and ninety one-\n\nhundredths (2.90) hours per day,\n\n(2) a direct-care-staff-to-resident ratio of at least\n\none direct-care staff person on duty to every\n\nfifteen residents or major fraction thereof at\n\nall times, and\n\n(3) at least two direct-care staff persons on duty\n\nand awake at all times.\n\n6. a. On and after January 1, 2004, the State Department of\n\nHealth shall require a facility to maintain the shift-\n\nbased, staff-to-resident ratios provided in paragraph\n\n3 of this subsection if the facility has been\n\ndetermined by the Department to be deficient with\n\nregard to:\n\n(1) the provisions of paragraph 3 of this subsection,\n\n(2) fraudulent reporting of staffing on the Quality\n\nof Care Report, or\n\n(3) a complaint or survey investigation that has\n\ndetermined substandard quality of care as a\n\nresult of insufficient staffing.\n\nb. The Department shall require a facility described in\n\nsubparagraph a of this paragraph to achieve and\n\nmaintain the shift-based, staff-to-resident ratios\n\nprovided in paragraph 3 of this subsection for a\n\nminimum of three (3) months before being considered\n\neligible to implement twenty-four-hour-based staff\n\nscheduling as defined in subparagraph c of paragraph 5\n\nof this subsection.\n\nc. Upon a subsequent determination by the Department that\n\nthe facility has achieved and maintained for at least\n\nthree (3) months the shift-based, staff-to-resident\n\nratios described in paragraph 3 of this subsection,\n\nand has corrected any deficiency described in\n\nsubparagraph a of this paragraph, the Department shall\n\nnotify the facility of its eligibility to implement\n\ntwenty-four-hour-based staff-scheduling privileges.\n\n7. a. For facilities that utilize twenty-four-hour-based\n\nstaff-scheduling privileges, the Department shall\n\nmonitor and evaluate facility compliance with the\n\ntwenty-four-hour-based staff-scheduling staffing\n\nprovisions of paragraph 5 of this subsection through\n\nreviews of monthly staffing reports, results of\n\ncomplaint investigations and inspections.\n\nb. If the Department identifies any quality-of-care\n\nproblems related to insufficient staffing in such\n\nfacility, the Department shall issue a directed plan\n\nof correction to the facility found to be out of\n\ncompliance with the provisions of this subsection.\n\nc. In a directed plan of correction, the Department shall\n\nrequire a facility described in subparagraph b of this\n\nparagraph to maintain shift-based, staff-to-resident\n\nratios for the following periods of time:\n\n(1) the first determination shall require that shift-\n\nbased, staff-to-resident ratios be maintained\n\nuntil full compliance is achieved,\n\n(2) the second determination within a two-year period\n\nshall require that shift-based, staff-to-resident\n\nratios be maintained for a minimum period of\n\ntwelve (12) months, and\ning periods of time:\n\n(1) the first determination shall require that shift-\n\nbased, staff-to-resident ratios be maintained\n\nuntil full compliance is achieved,\n\n(2) the second determination within a two-year period\n\nshall require that shift-based, staff-to-resident\n\nratios be maintained for a minimum period of\n\ntwelve (12) months, and\n\n(3) the third determination within a two-year period\n\nshall require that shift-based, staff-to-resident\n\nratios be maintained. The facility may apply for\n\npermission to use twenty-four-hour staffing\n\nmethodology after two (2) years.\n\nC. Effective September 1, 2002, facilities shall post the names\n\nand titles of direct-care staff on duty each day in a conspicuous\n\nplace, including the name and title of the supervising nurse.\n\nD. The State Commissioner of Health shall promulgate rules\n\nprescribing staffing requirements for Intermediate Care Facilities\n\nfor Individuals with Intellectual Disabilities serving six or fewer\n\nclients (ICFs/IID-6) and for Intermediate Care Facilities for\n\nIndividuals with Intellectual Disabilities serving sixteen or fewer\n\nclients (ICFs/IID-16).\n\nE. Facilities shall have the right to appeal and to the\n\ninformal dispute resolution process with regard to penalties and\n\nsanctions imposed due to staffing noncompliance.\n\nF. 1. When the state Medicaid program reimbursement rate\n\nreflects the sum of Ninety-four Dollars and eleven cents ($94.11),\n\nplus the increases in actual audited costs over and above the actual\n\naudited costs reflected in the cost reports submitted for the most\n\ncurrent cost-reporting period and the costs estimated by the\n\nOklahoma Health Care Authority to increase the direct-care, flexible\n\nstaff-scheduling staffing level from two and eighty-six one-\n\nhundredths (2.86) hours per day per occupied bed to three and two-\n\ntenths (3.2) hours per day per occupied bed, all nursing facilities\n\nsubject to the provisions of the Nursing Home Care Act and\n\nIntermediate Care Facilities for Individuals with Intellectual\n\nDisabilities (ICFs/IID) with seventeen or more beds, in addition to\n\nother state and federal requirements related to the staffing of\n\nnursing facilities, shall maintain direct-care, flexible staff-\n\nscheduling staffing levels based on an overall three and two-tenths\n\n(3.2) hours per day per occupied bed.\n\n2. When the state Medicaid program reimbursement rate reflects\n\nthe sum of Ninety-four Dollars and eleven cents ($94.11), plus the\n\nincreases in actual audited costs over and above the actual audited\n\ncosts reflected in the cost reports submitted for the most current\n\ncost-reporting period and the costs estimated by the Oklahoma Health\n\nCare Authority to increase the direct-care flexible staff-scheduling\n\nstaffing level from three and two-tenths (3.2) hours per day per\n\noccupied bed to three and eight-tenths (3.8) hours per day per\n\noccupied bed, all nursing facilities subject to the provisions of\n\nthe Nursing Home Care Act and Intermediate Care Facilities for\n\nIndividuals with Intellectual Disabilities (ICFs/IID) with seventeen\n\nor more beds, in addition to other state and federal requirements\n\nrelated to the staffing of nursing facilities, shall maintain\n\ndirect-care, flexible staff-scheduling staffing levels based on an\n\noverall three and eight-tenths (3.8) hours per day per occupied bed.\n\n3. When the state Medicaid program reimbursement rate reflects\n\nthe sum of Ninety-four Dollars and eleven cents ($94.11), plus the\n\nincreases in actual audited costs over and above the actual audited\n\ncosts reflected in the cost reports submitted for the most current\n\ncost-reporting period and the costs estimated by the Oklahoma Health\n\nCare Authority to increase the direct-care, flexible staff-\n\nscheduling staffing level from three and eight-tenths (3.8) hours\n\nper day per occupied bed to four and one-tenth (4.1) hours per day\nncreases in actual audited costs over and above the actual audited\n\ncosts reflected in the cost reports submitted for the most current\n\ncost-reporting period and the costs estimated by the Oklahoma Health\n\nCare Authority to increase the direct-care, flexible staff-\n\nscheduling staffing level from three and eight-tenths (3.8) hours\n\nper day per occupied bed to four and one-tenth (4.1) hours per day\n\nper occupied bed, all nursing facilities subject to the provisions\n\nof the Nursing Home Care Act and Intermediate Care Facilities for\n\nIndividuals with Intellectual Disabilities (ICFs/IID) with seventeen\n\nor more beds, in addition to other state and federal requirements\n\nrelated to the staffing of nursing facilities, shall maintain\n\ndirect-care, flexible staff-scheduling staffing levels based on an\n\noverall four and one-tenth (4.1) hours per day per occupied bed.\n\n4. The Commissioner shall promulgate rules for shift-based,\n\nstaff-to-resident ratios for noncompliant facilities denoting the\n\nincremental increases reflected in direct-care, flexible staff-\n\nscheduling staffing levels.\n\n5. In the event that the state Medicaid program reimbursement\n\nrate for facilities subject to the Nursing Home Care Act, and\n\nIntermediate Care Facilities for Individuals with Intellectual\n\nDisabilities (ICFs/IID) having seventeen or more beds is reduced\n\nbelow actual audited costs, the requirements for staffing ratio\n\nlevels shall be adjusted to the appropriate levels provided in\n\nparagraphs 1 through 4 of this subsection.\n\nG. For purposes of this subsection:\n\n1. \"Direct-care staff\" means any nursing or therapy staff who\n\nprovides direct, hands-on care to residents in a nursing facility;\n\n2. Prior to September 1, 2003, activity and social services\n\nstaff who are not providing direct, hands-on care to residents may\n\nbe included in the direct-care-staff-to-resident ratio in any shift.\n\nOn and after September 1, 2003, such persons shall not be included\n\nin the direct-care-staff-to-resident ratio, regardless of their\n\nlicensure or certification status; and\n\n3. The administrator shall not be counted in the direct-care-\n\nstaff-to-resident ratio regardless of the administrator's licensure\n\nor certification status.\n\nH. 1. The Oklahoma Health Care Authority shall require all\n\nnursing facilities subject to the provisions of the Nursing Home\n\nCare Act and Intermediate Care Facilities for Individuals with\n\nIntellectual Disabilities (ICFs/IID) with seventeen or more beds to\n\nsubmit a monthly report on staffing ratios on a form that the\n\nAuthority shall develop.\n\n2. The report shall document the extent to which such\n\nfacilities are meeting or are failing to meet the minimum direct-\n\ncare-staff-to-resident ratios specified by this section. Such\n\nreport shall be available to the public upon request.\n\n3. The Authority may assess administrative penalties for the\n\nfailure of any facility to submit the report as required by the\n\nAuthority. Provided, however:\n\na. administrative penalties shall not accrue until the\n\nAuthority notifies the facility in writing that the\n\nreport was not timely submitted as required, and\n\nb. a minimum of a one-day penalty shall be assessed in\n\nall instances.\n\n4. Administrative penalties shall not be assessed for\n\ncomputational errors made in preparing the report.\n\n5. Monies collected from administrative penalties shall be\n\ndeposited in the Nursing Facility Quality of Care Fund and utilized\n\nfor the purposes specified in the Oklahoma Healthcare Initiative\n\nAct.\n\nI. 1. All entities regulated by this state that provide long-\n\nterm care services shall utilize a single assessment tool to\n\ndetermine client services needs. The tool shall be developed by the\n\nOklahoma Health Care Authority in consultation with the State\n\nDepartment of Health.\n\n2. a. The Oklahoma Nursing Facility Funding Advisory\n\nCommittee is hereby created and shall consist of the\n\nfollowing:\nI. 1. All entities regulated by this state that provide long-\n\nterm care services shall utilize a single assessment tool to\n\ndetermine client services needs. The tool shall be developed by the\n\nOklahoma Health Care Authority in consultation with the State\n\nDepartment of Health.\n\n2. a. The Oklahoma Nursing Facility Funding Advisory\n\nCommittee is hereby created and shall consist of the\n\nfollowing:\n\n(1) four members selected by the Oklahoma Association\n\nof Health Care Providers,\n\n(2) three members selected by the Oklahoma\n\nAssociation of Homes and Services for the Aging,\n\nand\n\n(3) two members selected by the State Council on\n\nAging.\n\nThe Chair shall be elected by the committee. No state\n\nemployees may be appointed to serve.\n\nb. The purpose of the advisory committee will be to\n\ndevelop a new methodology for calculating state\n\nMedicaid program reimbursements to nursing facilities\n\nby implementing facility-specific rates based on\n\nexpenditures relating to direct care staffing. No\n\nnursing home will receive less than the current rate\n\nat the time of implementation of facility-specific\n\nrates pursuant to this subparagraph.\n\nc. The advisory committee shall be staffed and advised by\n\nthe Oklahoma Health Care Authority.\n\nd. The new methodology will be submitted for approval to\n\nthe Board of the Oklahoma Health Care Authority by\n\nJanuary 15, 2005, and shall be finalized by July 1,\n\n2005. The new methodology will apply only to new\n\nfunds that become available for Medicaid nursing\n\nfacility reimbursement after the methodology of this\n\nparagraph has been finalized. Existing funds paid to\n\nnursing homes will not be subject to the methodology\n\nof this paragraph. The methodology as outlined in\n\nthis paragraph will only be applied to any new funding\n\nfor nursing facilities appropriated above and beyond\n\nthe funding amounts effective on January 15, 2005.\n\ne. The new methodology shall divide the payment into two\n\ncomponents:\n\n(1) direct care which includes allowable costs for\n\nregistered nurses, licensed practical nurses,\n\ncertified medication aides and certified nurse\n\naides. The direct care component of the rate\n\nshall be a facility-specific rate, directly\n\nrelated to each facility's actual expenditures on\n\ndirect care, and\n\n(2) other costs.\n\nf. The Oklahoma Health Care Authority, in calculating the\n\nbase year prospective direct care rate component,\n\nshall use the following criteria:\n\n(1) to construct an array of facility per diem\n\nallowable expenditures on direct care, the\n\nAuthority shall use the most recent data\n\navailable. The limit on this array shall be no\n\nless than the ninetieth percentile,\n\n(2) each facility's direct care base-year component\n\nof the rate shall be the lesser of the facility's\n\nallowable expenditures on direct care or the\n\nlimit,\n\n(3) other rate components shall be determined by the\n\nOklahoma Nursing Facility Funding Advisory\n\nCommittee in accordance with federal regulations\n\nand requirements,\n\n(4) prior to July 1, 2020, the Authority shall seek\n\nfederal approval to calculate the upper payment\n\nlimit under the authority of CMS utilizing the\n\nMedicare equivalent payment rate, and\n\nonents shall be determined by the\n\nOklahoma Nursing Facility Funding Advisory\n\nCommittee in accordance with federal regulations\n\nand requirements,\n\n(4) prior to July 1, 2020, the Authority shall seek\n\nfederal approval to calculate the upper payment\n\nlimit under the authority of CMS utilizing the\n\nMedicare equivalent payment rate, and\n\n(5) if Medicaid payment rates to providers are\n\nadjusted, nursing home rates and Intermediate\n\nCare Facilities for Individuals with Intellectual\n\nDisabilities (ICFs/IID) rates shall not be\n\nadjusted less favorably than the average\n\npercentage-rate reduction or increase applicable\n\nto the majority of other provider groups.\n\ng. (1) Effective October 1, 2019, if sufficient funding\n\nis appropriated for a rate increase, a new\n\naverage rate for nursing facilities shall be\n\nestablished. The rate shall be equal to the\n\nstatewide average cost as derived from audited\n\ncost reports for SFY 2018, ending June 30, 2018,\n\nafter adjustment for inflation. After such new\n\naverage rate has been established, the facility\n\nspecific reimbursement rate shall be as follows:\n\n(a) amounts up to the existing base rate amount\n\nshall continue to be distributed as a part\n\nof the base rate in accordance with the\n\nexisting State Plan, and\n\n(b) to the extent the new rate exceeds the rate\n\neffective before the effective date of this\n\nact, fifty percent (50%) of the resulting\n\nincrease on October 1, 2019, shall be\n\nallocated toward an increase of the existing\n\nbase reimbursement rate and distributed\n\naccordingly. The remaining fifty percent\n\n(50%) of the increase shall be allocated in\n\naccordance with the currently approved 70/30\n\nreimbursement rate methodology as outlined\n\nin the existing State Plan.\n\n(2) Any subsequent rate increases, as determined\n\nbased on the provisions set forth in this\n\nsubparagraph, shall be allocated in accordance\n\nwith the currently approved 70/30 reimbursement\n\nrate methodology. The rate shall not exceed the\n\nupper payment limit established by the Medicare\n\nrate equivalent established by the federal CMS.\n\nh. Effective October 1, 2019, in coordination with the\n\nrate adjustments identified in the preceding section,\n\na portion of the funds shall be utilized as follows:\n\n(1) effective October 1, 2019, the Oklahoma Health\n\nCare Authority shall increase the personal needs\n\nallowance for residents of nursing homes and\n\nIntermediate Care Facilities for Individuals with\n\nIntellectual Disabilities (ICFs/IID) from Fifty\n\nDollars ($50.00) per month to Seventy-five\n\nDollars ($75.00) per month per resident. The\n\nincrease shall be funded by Medicaid nursing home\n\nproviders, by way of a reduction of eighty-two\n\ncents ($0.82) per day deducted from the base\n\nrate. Any additional cost shall be funded by the\n\nNursing Facility Quality of Care Fund, and\nFifty\n\nDollars ($50.00) per month to Seventy-five\n\nDollars ($75.00) per month per resident. The\n\nincrease shall be funded by Medicaid nursing home\n\nproviders, by way of a reduction of eighty-two\n\ncents ($0.82) per day deducted from the base\n\nrate. Any additional cost shall be funded by the\n\nNursing Facility Quality of Care Fund, and\n\n(2) effective January 1, 2020, all clinical employees\n\nworking in a licensed nursing facility shall be\n\nrequired to receive at least four (4) hours\n\nannually of Alzheimer's or dementia training, to\n\nbe provided and paid for by the facilities.\n\n3. The Department of Human Services shall expand its statewide\n\ntoll-free, Senior-Info Line for senior citizen services to include\n\nassistance with or information on long-term care services in this\n\nstate.\n\n4. The Oklahoma Health Care Authority shall develop a nursing\n\nfacility cost-reporting system that reflects the most current costs\n\nexperienced by nursing and specialized facilities. The Oklahoma\n\nHealth Care Authority shall utilize the most current cost report\n\ndata to estimate costs in determining daily per diem rates.\n\n5. The Oklahoma Health Care Authority shall provide access to\n\nthe detailed Medicaid payment audit adjustments and implement an\n\nappeal process for disputed payment audit adjustments to the\n\nprovider. Additionally, the Oklahoma Health Care Authority shall\n\nmake sufficient revisions to the nursing facility cost reporting\n\nforms and electronic data input system so as to clarify what\n\nexpenses are allowable and appropriate for inclusion in cost\n\ncalculations.\n\nJ. 1. When the state Medicaid program reimbursement rate\n\nreflects the sum of Ninety-four Dollars and eleven cents ($94.11),\n\nplus the increases in actual audited costs, over and above the\n\nactual audited costs reflected in the cost reports submitted for the\n\nmost current cost-reporting period, and the direct-care, flexible\n\nstaff-scheduling staffing level has been prospectively funded at\n\nfour and one-tenth (4.1) hours per day per occupied bed, the\n\nAuthority may apportion funds for the implementation of the\n\nprovisions of this section.\n\n2. The Authority shall make application to the United States\n\nCenters for Medicare and Medicaid Service for a waiver of the\n\nuniform requirement on health-care-related taxes as permitted by\n\nSection 433.72 of 42 C.F.R.\n\n3. Upon approval of the waiver, the Authority shall develop a\n\nprogram to implement the provisions of the waiver as it relates to\n\nall nursing facilities.","path":["OK Code","Title 63"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os63.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"2cb825206d5758f61f9d34fb20d0b101e2fa515378123e2346ad4e925423d7de","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-63-63-1-1925.1","next":"us-ok/okla.-stat.-tit.-63-63-1-1925.2a"},"notice":"GroundRules: Original legal text. Not legal advice."}