1. Senate Bill 101 Mark A. Leeds, Director Long Term Care and Community Support Services Department of Health and Mental Hygiene Maryland Medicaid Advisory Committee Meeting September 27, 2007

2. What does Senate Bill 101 say? Impose a quality assessment not greater than 2% of revenue on certain nursing facilities in Maryland Facilities will pay the quality assessment based upon their non-Medicare days of care Funds generated by the assessment will be used to improve Medicaid reimbursements for nursing homes and restore reimbursement levels that were reduced for cost containment purposes in Fiscal Years 2006 and 2007

3. Who is exempt from the Quality Assessment? Continuing care retirement communities Nursing homes with fewer than 45 beds

4. Time frame for Quality Assessment Takes effect the first day of the State fiscal quarter during which Maryland’s proposal is approved by CMS In effect through June 30, 2012

5. Plan for Revenue Generated under Quality Assessment Increase ceilings, efficiency incentives, and capital payments that had been reduced for cost containment Improve reimbursement for:  Other- the- counter drugs  Negative pressure wound therapy  Power wheel chairs  Bariatric beds

6. Impact on Nursing Facilities 198 licensed nursing facilities will realize a net increase in reimbursement 15 facilities will realize a net loss (i.e., increased Medicaid rates will not totally offset the amount of the assessment they must pay)

7. Status of Quality Assessment A non-uniform assessment is being proposed, with those facilities with the greatest Medicaid volume paying a reduced per diem assessment Submitted an outline of proposal to CMS for informal review Currently awaiting feedback

8. Provision Regarding Pay for Performance Beginning July 1, 2008, a portion of revenues generated from the Quality Assessment shall be distributed to nursing facilities based on accountability measures indicating:  Quality of care and/or,  A commitment to quality of care

9. Development of Measures of Quality Care Accountability measures shall be developed in consultation with nursing home industry and other stakeholders

10. Measures of Quality Care Quality incentive will incorporate elements based on:  OHCQ findings  Consumer satisfaction  Staffing Must be objective, measurable, and have a correlation to residents’ quality of care