990259                                                            No.  36
                    HOUSE APPROPRIATIONS BILL AMENDMENT
                                  HB5001

                               CHAMBER ACTION
           SENATE                     .                    HOUSE
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Representative(s): Bean
offered the following LATE FILED amendment:

In Section: 03 On Page: 070 Specific Appropriation:  242
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Explanation:
Reduces $55,000,000 from the General Revenue Fund and $72,639,824 from the 
Medical Care Trust Fund by limiting the Medicaid payments for nursing home 
Medicare Part A coinsurance and provides $55,000,000 from the General 
Revenue Fund and $72,639,824 from the Medical Care Trust Fund to re-base 
the operating and indirect patient care component targets and target rate 
class ceilings of the Medicaid nursing home per diem rates.
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        AGENCY FOR HEALTH CARE ADMINISTRATION
        Program: Health Care Services
        Medicaid Long Term Care

        In Section 03  On Page 070
242     Special Categories
        Nursing Home Care

At the end of existing proviso language, following Specific 
Appropriation 242, INSERT:

Funds in Specific Appropriation 242 reflect a reduction of $55,000,000 
from the General Revenue Fund and $72,639,824 from the Medical Care 
Trust Fund as a result of limiting the Medicaid payments for nursing 
home Medicare Part A coinsurance.  Medicaid will pay no portion of 
Medicare coinsurance when payment that Medicare has made for the service 
equals or exceeds what Medicaid would have paid if it had been the sole 
payer.  This provision shall be contingent upon federal approval of a 
 990259  Log:0055  JEP/JEP           04/10/07 07:21:23 PM  House  Page: 1


Medicaid State Plan amendment to limit Medicaid payments for nursing 
home Medicare Part A coinsurance.

From the funds in Specific Appropriation 242 $55,000,000 from the 
General Revenue Fund and $72,639,824 from the Medical Care Trust Fund 
are provided to re-base the operating and indirect patient care 
component targets and target rate class ceilings of the Medicaid nursing 
home per diem rate.  The operating and indirect patient care components 
of the per diem rate shall continue to be limited by the lower of the 
cost-based class ceiling, the target rate class ceiling, or the 
individual provider-specific target.  

The Title XIX Long-Term Care Reimbursement Plan shall be modified to:

Establish a target rate class ceiling floor equal to 90% of the 
cost-based class ceiling.

Establish an individual provider-specific target floor equal to 75% of 
the cost-based class ceiling.

Modify the inflation multiplier to equal 2.0 times inflation for the 
individual provider-specific target. (The inflation multiplier for the 
target rate class ceiling shall remain at 1.4 times inflation.)

Modify the calculation of the change of ownership target to equal the 
previous providers' operating and indirect patient care cost per diem 
(excluding incentives), plus 50 percent of the difference between the 
previous providers' per diem (excluding incentives) and the effective 
class ceiling and use an inflation multiplier of 2.0 times inflation. 

This provision shall be contingent upon federal approval of a Medicaid 
State Plan amendment to limit Medicaid payments for nursing home 
Medicare Part A coinsurance. 

Line item amendments are accepted as part of the amendatory process.  However, due to the necessity of using computerized systems this may entail a different placement within a budget entity or the renumbering of the specific appropriation items.



















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