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Lawmakers advance bills allowing Medicaid reimbursement rate adjustments for care facilities

JEFFERSON CITY, Mo. — Measures aimed at encouraging nursing home facilities to invest in improvements are making their way through the General Assembly.

The identical measures would allow for nursing home facilities to have their Medicaid reimbursement rate readjusted following investment in patient care. One received unanimous approval from the Senate on April 18, and the House passed the other on April 29 in a 145-7 vote.

Sen. Mike Cunningham’s SB 11 and Rep. Jack Bondon’s HB 600 would enable intermediate care facilities or skilled nursing facilities to have Medicaid per diem reimbursement rate readjusted if they invest at least $2,000 per bed in improvements.  

“This is the right thing to do, both for seniors and for private investment in the state,” Bondon told the Missouri Times. “It is the right thing to do to hopefully correct a government-created imbalance in the system.”

In Missouri, Medicaid reimbursements rates range from $141 to $175 per patient per day. Once a rate is set there is no mechanism in state law for adjustment, which has resulted in the average reimbursement rate being $20 per day per person unfunded compared to actual costs.

Lacking the ability to update reimbursement rates has “disincentivized” facilities from updating and further investing in the facility itself. One supporter went as far as to say under the current process, facilities putting funds towards capital investments would be a financial detriment and could hurt patient care.

During the House perfection debate, Rep. Sheila Solon said the legislation would “level the playing field.”

Rep. Don Rone noted a nursing home in his district spent $1 million upgrading and rebuilding after it was destroyed. That nursing home’s rate is still at its original reimbursement rate while roughly 10 miles down the road a new facility was built with the new per diem rate.

Had this legislation been in effect, the facility that invested $1 million in its facility would have been able to apply to have its Medicaid reimbursement rate adjusted.

“I support this bill wholeheartedly because of the situation in my district,” said Rone.

A full resetting of the Medicaid per diem reimbursement rates would cost the state roughly $66 million, according to testimony provided during a House hearing.

The current proposal — adjustments in rates for facilities investing $2,000 per bed — is projected to cost the state between $1.68 million and $5.1 million in Fiscal Year 2022.