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1 “(2) With respect to any period for which a hospital 2 has an agreement under section 1861 (bb), in order to allo3 cate routine costs between hospital and long-term care serv4 ices, the total reimbursement for routine services received 5 from all classes of long-term care patients, including title 6 XVIII, title XIX, and private pay patients, shall be subī tracted from the hospital total routine costs before calcula

8 tions are made to determine title XIX reimbursement for

9 routine hospital services.”.

10 (c) The amendments made by this section shall be11 come effective on the date on which final regulations, promul12 gated by the Secretary to implement the amendments, are 13 issued; and those regulations shall be issued not later than 14. the first day of the sixth calendar month following the month

15. in which this Act is enacted.

16 REIMBURSEMENT RATES UNDER MEDICAID FOR SKILLED

17

NURSING AND INTERMEDIATE CARE FACILITIES

18 Sec. 21. Section 1902 (a) (13) (E) of the Social Se19 curity Act is amended by inserting “(and which may, at the 20 option of the State, include a reasonable profit for the facil21 ity in the form of: (a) fixed per diem amounts or, (b) 22 incentive payments related to efficient performance, or (c) 23.: a rate of return on net cquity)” immediately after “cost

24 related basis".

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i MEDICAID CERTIFICATION AND APPROVAL OF SKILLED

.2

NURSING AND INTERMEDIATE CARE FACILITIES

3

SÉC. 22. (a) Section 1910 of the Social Security Act is

4 amended to read:

5 "CERTIFICATION AND APPROVAL OF SKILLED NURSING AND

6

INTERMEDIATE CARE FACILITIES

7

"SEC. 1910. (a) The Secretary shall make an agree

8 'ment with any State which is willing and able to do so

9 whereby the State health agency or other appropriate State 10 or local agencies (whichever are utilized by the Secretary

11 pursuant to section 1864 (a)) will be utilized to recommend

12 to him whether an institution in the State qualifies as a

13 skilled nursing facility (for purposes of section 1902 (a)

(28)) or an intermediate care facility (for purposes of sec14

tion 1905 (c)). 15

“(b) The Secretary shall advise the State agency ad16

ministering the medical assistance plan of his approval or 17

disapproval of any institution certified to him as a qualified 18

skilled nursing or intermediate care facility for purposes of 19

section 1902 (a) (28) and specify for each institution the 20

period (not to exceed twelve months) for which approval is 21

granted, except that the Secretary may extend that term 22 for

up to two months, where the health and safety of patients 23

will not be jeopardized, if he finds that an extension is 24

necessary to prevent irreparable harm to the facility or 25

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1 hardship to the facility's patients or if he finds it impracti2 cable within the twelve-month period to determine whether 3 the facility is complying with the provisions of this title and 4 applicable regulations. The State agency may upon approval 5 of the Secretary enter into an agreement with any skilled 6 nursing or intermediate care facility for the specified approval

7 period.

8

"(c) The Secretary may cancel approval of any skilled 9 nursing or intermediate care facility at any time if he finds 10 that a facility fails to meet the requirements contained in 11 section 1902 (a) (28) or section 1905 (c), or if he finds 12 grounds for termination of his agreement with the facility 13 pursuant to section 1866 (b). In that event the Secretary 14 shall notify the State agency and the skilled nursing or inter15 mediate care facility that approval of eligibility of the facility 16 to participate in the programs established by this title and 17 title XVIII shall be terminated at a time specified by the 18 Secretary. The approval of eligibility of any such facility to 19 participate in the programs may not be reinstated unless the 20 Secretary finds that the reason for termination has been re

moved and there is reasonable assurance that it will not

21

22

recur.

23

“ (d) Effective July 1, 1978, no payment may be made 24 to any State under this title for skilled nursing or intermedi25 ate care facility services furnished by any facility

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1

2

“(1) which does not have in effect an agreement with the State agency pursuant to subsection (b), or

“(2) whose approval of eligibility to participate in the programs established by this title or title XVIII

3

4

5

6

7

has been terminated by the Secretary and has not been reinstated, except that payment may be made for up to thirty days for skilled nursing or intermediate care facility services furnished to any eligible individual who was admitted to the facility prior to the effective date of

8

9

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the termination.".

11 “(e) Any skilled nursing facility or intermediate care 12 facility which is dissatisfied with any determination by the 13 Secretary that it no longer qualifies as a skilled nursing 14 facility or intermediate care facility for purposes of this 15 title shall be entitled to a hearing by the Secretary to the 16 same extent as is provided in section 205 (b) and to judicial 17 review of the Secretary's final decision after such hearing as 18 is provided in section 205 (g). Any agreement between such

19 facility and the State agency shall remain in effect until the

20 period for filing a request for a hearing has expired or, if a 21 request has been filed, until a decision has been made by the 22 Secretary: Provided, however, That the agreement shall 23 not be extended if the Secretary makes a written determina24 tion, specifying the reasons therefor, that the continuation 25 of provider status constitutes an immediate and serious

50

1 threat to the health and safety of patients, and if the Secre2 tary certifies that the facility has been notified of its defi

3 ciencies and has failed to correct them.”.

4 (b) Section 1869 (c) of the Social Security Act is 5 amended by adding at the end the following sentence: "If 6 the Secretary's determination terminates a provider with an 7 existing agreement pursuant to section 1866 (b) (2), or if g. that determination consists of a refusal to renew an existing 9 provider agreement, the provider's agreement shall remain in 10 effect until the period for filing a request for a hearing has 11 expired or, if a request has been filed, until a final decision 12 has been made by the Secretary: Provided, however, That 13 the agreement shall not be extended if the Secretary makes a 14 written determination, specifying the reasons therefor, that 15 the continuation of provider status constitutes an immediate 16 and serious threat to the health and safety of patients and if 17 the Secretary certifies that the provider has been notified 18 of such deficiencies and has failed to correct them.”. 19 (c) The amendments made by this section shall be20 come effective on the date on which final regulations, promul21 gated by the Secretary to implement the amendments, are

22 issued; and those regulations shall be issued not later than

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