Bill Text: OR HB2056 | 2013 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Relating to long term care facilities; prescribing an effective date; providing for revenue raising that requires approval by a three-fifths majority.

Spectrum: Unknown

Status: (Failed) 2013-07-08 - In committee upon adjournment. [HB2056 Detail]

Download: Oregon-2013-HB2056-Amended.html

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     77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session

HA to HB 2056

LC 376/HB 2056-1

                       HOUSE AMENDMENTS TO
                         HOUSE BILL 2056

                   By COMMITTEE ON HEALTH CARE

                             April 2

  On page 1 of the printed bill, line 3, delete the second ' and'
and before the period insert '; and providing for revenue raising
that requires approval by a three-fifths majority'.
  Delete lines 20 through 24 and insert:
  ' (3) It is the goal of the Legislative Assembly that the long
term care facility bed capacity in Oregon be reduced by 1,500
beds by December 31, 2015, except for bed capacity in nursing
facilities operated by the Department of Veterans' Affairs and
facilities that either applied to the Oregon Health Authority for
a certificate of need between August 1, 2011, and December 1,
2012, or submitted a letter of intent under ORS 442.315 (7)
between January 15, 2013, and January 31, 2013.'.
  In line 27, after 'facility's' insert 'entire'.
  On page 2, line 6, after 'facility's' insert 'entire'.
  After line 29, insert:
  ' (11) The Director of Human Services or the director's
designee, in consultation with the Long Term Care Ombudsman,
shall engage in regional planning necessary to promote the safety
and dignity of residents living in a long term care facility that
surrenders its license under this section.'.
  On page 5, line 1, before the period insert ', or submitted a
letter of intent under ORS 442.315 (7) between January 15, 2013,
and January 31, 2013'.
  On page 7, line 31, delete 'person' and insert 'long term care
facility'.
  In line 39, delete 'percentage' and insert 'percentile'.
  Delete lines 41 through 45.
  On page 8, delete lines 1 through 13 and insert:
  ' (b) For the period beginning July 1, 2013, and ending June
30, 2016, the department shall reimburse costs at a rate not
lower than the 63rd percentile of rebased allowable costs for
that period.
  ' (c) For each three-month period beginning on or after July 1,
2016, in which the reduction in bed capacity in
Medicaid-certified long term care facilities is less than the
goal established in section 2 of this 2013 Act, the department
shall reimburse costs at a rate not lower than the percentile of
allowable costs according to the following schedule:
  ' (A) 62nd percentile for a reduction of 1,350 or more beds.
  ' (B) 61st percentile for a reduction of 1,200 or more beds but
less than 1,350 beds.
  ' (C) 60th percentile for a reduction of 1,050 or more beds but
less than 1,200 beds.
  ' (D) 59th percentile for a reduction of 900 or more beds but
less than 1,050 beds.
  ' (E) 58th percentile for a reduction of 750 or more beds but
less than 900 beds.
  ' (F) 57th percentile for a reduction of 600 or more beds but
less than 750 beds.

  ' (G) 56th percentile for a reduction of 450 or more beds but
less than 600 beds.
  ' (H) 55th percentile for a reduction of 300 or more beds but
less than 450 beds.
  ' (I) 54th percentile for a reduction of 150 or more beds but
less than 300 beds.
  ' (J) 53rd percentile for a reduction of 1 to 49 beds.
  ' (7) A reduction in the percentile of allowable costs
reimbursed under subsection (6) of this section is not subject to
ORS 410.555.'.
  Delete lines 19 through 45 and delete pages 9 through 12.
  On page 13, delete lines 1 through 22 and insert:
  '  { +  SECTION 9. + } ORS 442.015, as amended by section 3 of
this 2013 Act, is amended to read:
  ' 442.015. As used in ORS chapter 441 and this chapter, unless
the context requires otherwise:
  ' (1) 'Acquire' or 'acquisition' means obtaining equipment,
supplies, components or facilities by any means, including
purchase, capital or operating lease, rental or donation, with
intention of using such equipment, supplies, components or
facilities to provide health services in Oregon. When equipment
or other materials are obtained outside of this state,
acquisition is considered to occur when the equipment or other
materials begin to be used in Oregon for the provision of health
services or when such services are offered for use in Oregon.
  ' (2) 'Affected persons' has the same meaning as given to '
party' in ORS 183.310.
  ' (3)(a) 'Ambulatory surgical center' means a facility or
portion of a facility that operates exclusively for the purpose
of providing surgical services to patients who do not require
hospitalization and for whom the expected duration of services
does not exceed 24 hours following admission.
  ' (b) 'Ambulatory surgical center' does not mean:
  ' (A) Individual or group practice offices of private
physicians or dentists that do not contain a distinct area used
for outpatient surgical treatment on a regular and organized
basis, or that only provide surgery routinely provided in a
physician's or dentist's office using local anesthesia or
conscious sedation; or
  ' (B) A portion of a licensed hospital designated for
outpatient surgical treatment.
  ' (4) 'Develop' means to undertake those activities that on
their completion will result in the offer of a new institutional
health service or the incurring of a financial obligation, as
defined under applicable state law, in relation to the offering
of such a health service.
  '  { - (5) 'Essential long term care facility' means an
individual long term care facility that serves predominantly
rural and frontier communities, as designated by the Office of
Rural Health, and meets other criteria established by the
Department of Human Services by rule. - }
  '  { - (6) - }  { +  (5) + } 'Expenditure' or 'capital
expenditure' means the actual expenditure, an obligation to an
expenditure, lease or similar arrangement in lieu of an
expenditure, and the reasonable value of a donation or grant in
lieu of an expenditure but not including any interest thereon.
  '  { - (7) - }  { +  (6) + } 'Freestanding birthing center'
means a facility licensed for the primary purpose of performing
low risk deliveries.
  '  { - (8) - }  { +  (7) + } 'Governmental unit' means the
state, or any county, municipality or other political
subdivision, or any related department, division, board or other
agency.
  '  { - (9) - }  { +  (8) + } 'Gross revenue' means the sum of
daily hospital service charges, ambulatory service charges,
ancillary service charges and other operating revenue. 'Gross
revenue' does not include contributions, donations, legacies or
bequests made to a hospital without restriction by the donors.
  '  { - (10)(a) - }  { +  (9)(a) + } 'Health care facility'
means:
  ' (A) A hospital;
  ' (B) A long term care facility;
  ' (C) An ambulatory surgical center;
  ' (D) A freestanding birthing center; or
  ' (E) An outpatient renal dialysis center.
  ' (b) 'Health care facility' does not mean:
  ' (A) A residential facility licensed by the Department of
Human Services or the Oregon Health Authority under ORS 443.415;
  ' (B) An establishment furnishing primarily domiciliary care as
described in ORS 443.205;
  ' (C) A residential facility licensed or approved under the
rules of the Department of Corrections;
  ' (D) Facilities established by ORS 430.335 for treatment of
substance abuse disorders; or
  ' (E) Community mental health programs or community
developmental disabilities programs established under ORS
430.620.
  '  { - (11) - }  { +  (10) + } 'Health maintenance
organization' or 'HMO ' means a public organization or a private
organization organized under the laws of any state that:
  ' (a) Is a qualified HMO under section 1310 (d) of the U.S.
Public Health Services Act; or
  ' (b)(A) Provides or otherwise makes available to enrolled
participants health care services, including at least the
following basic health care services:
  ' (i) Usual physician services;
  ' (ii) Hospitalization;
  ' (iii) Laboratory;
  ' (iv) X-ray;
  ' (v) Emergency and preventive services; and
  ' (vi) Out-of-area coverage;
  ' (B) Is compensated, except for copayments, for the provision
of the basic health care services listed in subparagraph (A) of
this paragraph to enrolled participants on a predetermined
periodic rate basis; and
  ' (C) Provides physicians' services primarily directly through
physicians who are either employees or partners of such
organization, or through arrangements with individual physicians
or one or more groups of physicians organized on a group practice
or individual practice basis.
  '  { - (12) - }  { +  (11) + } 'Health services' means
clinically related diagnostic, treatment or rehabilitative
services, and includes alcohol, drug or controlled substance
abuse and mental health services that may be provided either
directly or indirectly on an inpatient or ambulatory patient
basis.
  '  { - (13) - }  { +  (12) + } 'Hospital' means:
  ' (a) A facility with an organized medical staff and a
permanent building that is capable of providing 24-hour inpatient
care to two or more individuals who have an illness or injury and
that provides at least the following health services:
  ' (A) Medical;
  ' (B) Nursing;
  ' (C) Laboratory;
  ' (D) Pharmacy; and
  ' (E) Dietary; or
  ' (b) A special inpatient care facility as that term is defined
by the authority by rule.
  '  { - (14) - }  { +  (13) + } 'Institutional health services'
means health services provided in or through health care
facilities and includes the entities in or through which such
services are provided.
  '  { - (15) - }  { +  (14) + } 'Intermediate care facility'
means a facility that provides, on a regular basis,
health-related care and services to individuals who do not
require the degree of care and treatment that a hospital or
skilled nursing facility is designed to provide, but who because
of their mental or physical condition require care and services
above the level of room and board that can be made available to
them only through institutional facilities.
  '  { - (16) - }  { +  (15) + } 'Long term care facility' means
a facility with permanent facilities that include inpatient beds,
providing medical services, including nursing services but
excluding surgical procedures except as may be permitted by the
rules of the Director of Human Services, to provide treatment for
two or more unrelated patients. 'Long term care facility'
includes skilled nursing facilities and intermediate care
facilities but may not be construed to include facilities
licensed and operated pursuant to ORS 443.400 to 443.455.
  '  { - (17) - }  { +  (16) + } 'New hospital' means a facility
that did not offer hospital services on a regular basis within
its service area within the prior 12-month period and is
initiating or proposing to initiate such services. 'New hospital'
also includes any replacement of an existing hospital that
involves a substantial increase or change in the services
offered.
  '  { - (18) - }  { +  (17) + } 'New skilled nursing or
intermediate care service or facility' means a service or
facility that did not offer long term care services on a regular
basis by or through the facility within the prior 12-month period
and is initiating or proposing to initiate such services. 'New
skilled nursing or intermediate care service or facility' also
includes the rebuilding of a long term care facility, the
relocation of buildings that are a part of a long term care
facility, the relocation of long term care beds from one facility
to another or an increase in the number of beds of more than 10
or 10 percent of the bed capacity, whichever is the lesser,
within a two-year period   { - in a facility that applied for a
certificate of need between August 1, 2011, and December 1, 2012,
or submitted a letter of intent under ORS 442.315 (7) between
January 15, 2013, and January 31, 2013 - } .
  '  { - (19) - }  { +  (18) + } 'Offer' means that the health
care facility holds itself out as capable of providing, or as
having the means for the provision of, specified health services.
  '  { - (20) - }  { +  (19) + } 'Outpatient renal dialysis
facility' means a facility that provides renal dialysis services
directly to outpatients.
  '  { - (21) - }  { +  (20) + } 'Person' means an individual, a
trust or estate, a partnership, a corporation (including
associations, joint stock companies and insurance companies), a
state, or a political subdivision or instrumentality, including a
municipal corporation, of a state.
  '  { - (22) - }  { +  (21) + } 'Skilled nursing facility' means
a facility or a distinct part of a facility, that is primarily
engaged in providing to inpatients skilled nursing care and
related services for patients who require medical or nursing
care, or an institution that provides rehabilitation services for
the rehabilitation of individuals who are injured or sick or who
have disabilities.
  '  { +  SECTION 10. + } ORS 442.315, as amended by section 4 of
this 2013 Act, is amended to read:
  ' 442.315. (1) Any new hospital or new skilled nursing or
intermediate care service or facility not excluded pursuant to
ORS 441.065  { - , and any long term care facility for which a
license was surrendered under section 2 of this 2013 Act, - }
shall obtain a certificate of need from the Oregon Health
Authority prior to an offering or development.

  ' (2) The authority shall adopt rules specifying criteria and
procedures for making decisions as to the need for the new
services or facilities.
  ' (3)(a) An applicant for a certificate of need shall apply to
the authority on forms provided for this purpose by authority
rule.
  ' (b) An applicant shall pay a fee prescribed as provided in
this section. Subject to the approval of the Oregon Department of
Administrative Services, the authority shall prescribe
application fees, based on the complexity and scope of the
proposed project.
  ' (4) The authority shall be the decision-making authority for
the purpose of certificates of need. The authority may establish
an expedited review process for an application for a certificate
of need to rebuild a long term care facility, relocate buildings
that are part of a long term care facility or relocate long term
care facility bed capacity from one long term care facility to
another. The authority shall issue a proposed order not later
than 120 days after the date a complete application for expedited
review is received by the authority.
  ' (5)(a) An applicant or any affected person who is
dissatisfied with the proposed decision of the authority is
entitled to an informal hearing in the course of review and
before a final decision is rendered.
  ' (b) Following a final decision being rendered by the
authority, an applicant or any affected person may request a
reconsideration hearing pursuant to ORS chapter 183.
  ' (c) In any proceeding brought by an affected person or an
applicant challenging an authority decision under this
subsection, the authority shall follow procedures consistent with
the provisions of ORS chapter 183 relating to a contested case.
  ' (6) Once a certificate of need has been issued, it may not be
revoked or rescinded unless it was acquired by fraud or deceit.
However, if the authority finds that a person is offering or
developing a project that is not within the scope of the
certificate of need, the authority may limit the project as
specified in the issued certificate of need or reconsider the
application. A certificate of need is not transferable.
  ' (7) Nothing in this section applies to any hospital, skilled
nursing or intermediate care service or facility that seeks to
replace equipment with equipment of similar basic technological
function or an upgrade that improves the quality or
cost-effectiveness of the service provided. Any person acquiring
such replacement or upgrade shall file a letter of intent for the
project in accordance with the rules of the authority if the
price of the replacement equipment or upgrade exceeds $1 million.
  ' (8) Except as required in subsection (1) of this section for
a new hospital or new skilled nursing or intermediate care
service or facility not operating as a Medicare swing bed
program, nothing in this section requires a rural hospital as
defined in ORS 442.470 (5)(a)(A) and (B) to obtain a certificate
of need.
  ' (9) Nothing in this section applies to basic health services,
but basic health services do not include:
  ' (a) Magnetic resonance imaging scanners;
  ' (b) Positron emission tomography scanners;
  ' (c) Cardiac catheterization equipment;
  ' (d) Megavoltage radiation therapy equipment;
  ' (e) Extracorporeal shock wave lithotriptors;
  ' (f) Neonatal intensive care;
  ' (g) Burn care;
  ' (h) Trauma care;
  ' (i) Inpatient psychiatric services;
  ' (j) Inpatient chemical dependency services;
  ' (k) Inpatient rehabilitation services;
  ' (L) Open heart surgery; or
  ' (m) Organ transplant services.
  ' (10) In addition to any other remedy provided by law,
whenever it appears that any person is engaged in, or is about to
engage in, any acts that constitute a violation of this section,
or any rule or order issued by the authority under this section,
the authority may institute proceedings in the circuit courts to
enforce obedience to such statute, rule or order by injunction or
by other processes, mandatory or otherwise.
  ' (11) As used in this section, 'basic health services' means
health services offered in or through a hospital licensed under
ORS chapter 441, except skilled nursing or intermediate care
nursing facilities or services and those services specified in
subsection (9) of this section.
  '  { +  SECTION 11. + } Section 24, chapter 736, Oregon Laws
2003, as amended by section 11, chapter 757, Oregon Laws 2005,
section 12, chapter 780, Oregon Laws 2007, and section 7 of this
2013 Act, is amended to read:
  '  { +  Sec. 24. + } (1) The Long Term Care Facility Quality
Assurance Fund is established in the State Treasury, separate and
distinct from the General Fund. Interest earned by the Long Term
Care Facility Quality Assurance Fund shall be credited to the
fund.
  ' (2) Amounts in the Long Term Care Facility Quality Assurance
Fund are continuously appropriated to the Department of Human
Services for the purposes of paying refunds due under section 20,
chapter 736, Oregon Laws 2003, and funding long term care
facilities, as defined in section 15, chapter 736, Oregon Laws
2003, that are a part of the Oregon Medicaid reimbursement
system.
  ' (3) Funds in the Long Term Care Facility Quality Assurance
Fund and the matching federal financial participation under Title
XIX of the Social Security Act may be used to fund
Medicaid-certified long term care facilities using only the
reimbursement methodology described in   { - subsections (4) and
(5) - }  { +  subsection (4) + } of this section to achieve a
rate of reimbursement greater than the rate in effect on June 30,
2003.
  ' (4) The reimbursement methodology used to make additional
payments to Medicaid-certified long term care facilities includes
but is not limited to:
  ' (a) Rebasing on July 1 of each year;
  ' (b) Continuing the use of the pediatric rate;
  ' (c) Continuing the use of the complex medical needs
additional payment; and
  ' (d) Discontinuing the use of the relationship percentage,
except when calculating the pediatric rate in paragraph (b) of
this subsection.
  '  { - (5) In addition to the reimbursement methodology
described in subsection (4) of this section, the department may
make additional payments of $9.75 per resident who receives
medical assistance to a long term care facility that purchased
long term care bed capacity under section 2 of this 2013 Act on
or after October 1, 2013, and on or before December 31, 2015. The
payments may be made for a period of four years from the date of
purchase.  The department may not make additional payments under
this section until the Medicaid-certified long term care facility
is found by the department to meet quality standards adopted by
the department by rule. - }
  '  { - (6)(a) - }  { +  (5)(a) + } The department shall
reimburse costs using the methodology described in
 { - subsections (4) and (5) - }  { +  subsection (4) + } of this
section at a rate not lower than a percentile of allowable costs
for the period for which the reimbursement is made.
  ' (b) For the period beginning July 1, 2013, and ending June
30, 2016, the department shall reimburse costs at a rate not

lower than the 63rd percentile of rebased allowable costs for
that period.
  ' (c) For each three-month period beginning on or after July 1,
2016, in which the reduction in bed capacity in
Medicaid-certified long term care facilities is less than
 { - the goal established in section 2 of this 2013 Act - }  { +
1,500 in bed capacity statewide that existed on the effective
date of this 2013 Act + }, the department shall reimburse costs
at a rate not lower than the percentile of allowable costs
according to the following schedule:
  ' (A) 62nd percentile for a reduction of 1,350 or more beds.
  ' (B) 61st percentile for a reduction of 1,200 or more beds but
less than 1,350 beds.
  ' (C) 60th percentile for a reduction of 1,050 or more beds but
less than 1,200 beds.
  ' (D) 59th percentile for a reduction of 900 or more beds but
less than 1,050 beds.
  ' (E) 58th percentile for a reduction of 750 or more beds but
less than 900 beds.
  ' (F) 57th percentile for a reduction of 600 or more beds but
less than 750 beds.
  ' (G) 56th percentile for a reduction of 450 or more beds but
less than 600 beds.
  ' (H) 55th percentile for a reduction of 300 or more beds but
less than 450 beds.
  ' (I) 54th percentile for a reduction of 150 or more beds but
less than 300 beds.
  ' (J) 53rd percentile for a reduction of 1 to 149 beds.
  '  { - (7) - }  { +  (6) + } A reduction in the percentile
 { + ceiling + } of allowable costs reimbursed under subsection
 { - (6) - }  { +  (5) + } of this section is not subject to ORS
410.555.'.
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