(a) Definitions.  The following words and terms, when used in this Section, have the following meaning, unless the context clearly indicates otherwise:

• (1) "Nursing Facility and Intermediate Care Facility for the mentally retarded" means any home, establishment, or institution or any portion thereof, licensed by the State Department of Health as defined in Section 1-1902 of Title 63 of the Oklahoma Statutes.
• (2) "Quality of Care Fee" means the fee assessment created for the purpose of quality care enhancements pursuant to Section 2002 of Title 56 of the Oklahoma Statutes upon each nursing facility and intermediate care facility for the mentally retarded licensed in this State.
• (3) "Quality of Care Fund" means a revolving fund established in the State Treasury pursuant to Section 2002 of Title 56 of the Oklahoma Statutes.
• (4) "Quality of Care Report" means the monthly report developed by the Oklahoma Health Care Authority to document the staffing ratios, total patient gross receipts, total patient days, and minimum wage compliance for specified staff for each nursing facility and intermediate care facility for the mentally retarded licensed in the State.
• (5) "Staffing ratios" means the minimum direct-care-staff-to-resident ratios pursuant to Section 1-1925.2 of Title 63 of the Oklahoma Statutes and pursuant to OAC 310:675-1 et seq.
• (6) "Peak In-House Resident Count" means the maximum number of in-house residents at any point in time during the applicable shift.
• (7) "Staff Hours worked by Shift" means the number of hours worked during the applicable shift by direct-care staff.
• (8) "Direct-Care Staff" means any nursing or therapy staff who provides direct, hands-on care to residents in a nursing facility and intermediate care facility for the mentally retarded pursuant to Section 1-1925.2 of Title 63 of the Oklahoma Statues, pursuant to OAC 310:675-1 et seq., and as defined in subsection (c) of this Section.
• (9) "Major Fraction Thereof" is defined as an additional threshold for direct-care-staff-to-resident ratios at which another direct-care staff person(s) is required due to the peak in-house resident count exceeding one-half of the minimum direct-care-staff-to-resident ratio pursuant to Section 1-1925.2 of Title 63 of the Oklahoma Statutes.
• (10) "Minimum wage" means the amount paid per hour to specified staff pursuant to Section 5022.1 of Title 63 of the Oklahoma Statutes.
• (11) "Specified staff" means the employee positions listed in the Oklahoma Statutes under Section 5022.1 of Title 63 and as defined in subsection (d) of this Section.
• (12) "Total Patient Days" means the monthly patient days that are compensable for the current monthly Quality of Care Report.
• (13) "Total Gross Receipts" means all cash received in the current Quality of Care Report month for services rendered to all residents in the facility.  Receipts should include all Medicaid, Medicare, Private Pay and Insurance including receipts for items not in the normal per diem rate.  Charitable contributions received by the nursing facility are not included.
• (14) "Service rate" means the minimum direct-care-staff-to-resident rate pursuant to Section 1-1925.2 of Title 63 of Oklahoma Statutes and pursuant to OAC 310:675-1 et seq.

(b) Quality of care fund assessments.

• (1) The Oklahoma Health Care Authority (OHCA) was mandated by the Oklahoma Legislature to assess a monthly service fee to each Licensed Nursing Facility in the State.  The fee is assessed on a per patient day basis.  The amount of the fee is uniform for each facility type.  The fee is determined as six percent (6%) of the average total gross receipts divided by the total days for each facility type.
• (2) In determination of the fee for the time period beginning October 1, 2000, a survey was mailed to each licensed nursing facility requesting calendar year 1999 Total Patient Days, Gross Revenues and Contractual Allowances and Discounts.  This data is used to determine the amount of the fee to be assessed for the period of 10-01-00 through 06-30-01.  The fee is determined by totaling the "annualized" gross revenue and dividing by the "annualized" total days of service.  "Annualized" means that the surveys received that do not cover the whole year of 1999 are divided by the total number of days that are covered and multiplied by 365.
• (3) The fee for subsequent State Fiscal Years is determined by using the monthly gross receipts and census reports for the six month period October 1 through March 31 of the prior fiscal year, annualizing those figures, and then determining the fee as defined above.  As per 56 O.S. Section 202, as amended, the fees are frozen at the amount in effect at July 1, 2004.  Also, the fee will be monitored to never surpass the federal maximum of 5.5%.
• (4) Monthly reports of Gross Receipts and Census are included in the monthly Quality of Care Report.  The data required includes, but is not limited to, the Total Gross Receipts and Total Patient Days for the current monthly report.
• (5) The method of collection is as follows:
  • (A) The Oklahoma Health Care Authority assesses each facility monthly based on the reported patient days from the Quality of Care Report filed two months prior to the month of the fee assessment billing.  As defined in this subsection, the total assessment is the fee times the total days of service.  The Oklahoma Health Care Authority notifies the facility of its assessment by the end of the month of the Quality of Care Report submission date.
  • (B) Payment is due to the Oklahoma Health Care Authority by the 15^th of the following month.  Failure to pay the amount by the 15^th or failure to have the payment mailing postmarked by the 13^th will result in a debt to the State of Oklahoma and is subject to penalties of 10% of the amount and interest of 1.25% per month.  The Quality of Care Fee must be submitted no later than the 15^th of the month.  If the 15^th falls upon a holiday or weekend (Saturday-Sunday), the fee is due by 5 p.m. (Central Standard Time) of the following business day (Monday-Friday).
  • (C) The monthly assessment including applicable penalties and interest must be paid regardless of any appeals action requested by the facility.  If a provider fails to pay the Authority the assessment within the time frames noted on the second invoice to the provider, the assessment, applicable penalty, and interest will be deducted from the facility=s payment.  Any change in payment amount resulting from an appeals decision will be adjusted in future payments.  Adjustments to prior months' reported amounts for gross receipts or patient days may be made by filing an amended part C of the Quality of Care Report.
  • (D) The Quality of Care fee assessments excluding penalties and interest are an allowable cost for Oklahoma Health Care Authority Cost Reporting purposes.
  • (E) The Quality of Care fund which contains assessments collected excluding penalties and interest as described in this subsection and any interest attributable to investment of any money in the fund must be deposited in a revolving fund established in the State Treasury.  The funds will be used pursuant to Section 2002 of Title 56 of the Oklahoma Statutes.

(c) Quality of care direct-care-staff-to resident-ratios.

• (1) Effective September 1, 2000, all nursing facilities and intermediate care facilities for the mentally retarded (ICFs/MR) subject to the Nursing Home Care Act, in addition to other state and federal staffing requirements, must maintain the minimum direct-care-staff-to-resident ratios or direct-care service rates as cited in Section 1-1925.2 of Title 63 of the Oklahoma Statutes and pursuant to OAC 310:675-1 et seq.
• (2) For purposes of staff-to-resident ratios, direct-care staff are limited to the following employee positions:
  • (A) Registered Nurse
  • (B) Licensed Practical Nurse
  • (C) Nurse Aide
  • (D) Certified Medication Aide
  • (E) Qualified Mental Retardation Professional (ICFs/MR only)
  • (F) Physical Therapist
  • (G) Occupational Therapist
  • (H) Respiratory Therapist
  • (I) Speech Therapist
  • (J) Therapy Aide/Assistant
  • (K) Social Services Director/Social Worker
  • (L) Other Social Services Staff
  • (M) Activities Director
  • (N) Other Activities Staff
  • (O) Combined Social Services/Activities
• (3) Prior to September 1, 2003, activity and social services staff who did not provide direct, hands-on care may be included in the direct-care-staff-to-resident ratio in any shift or direct-care service rates.  On and after September 1, 2003, such persons are not included in the direct-care-staff-to-resident ratio or direct-care service rates.
• (4) In any shift when the direct-care-staff-to-resident ratio computation results in a major fraction thereof, direct-care staff is rounded to the next higher whole number.
• (5) To document and report compliance with the provisions of this subsection, nursing facilities and intermediate care facilities for the mentally retarded must submit the monthly Quality of Care Report pursuant to subsection (e) of this Section.

(d) Quality of care minimum wage for specified staff.  Effective November 1, 2000, all nursing facilities and private intermediate care facilities for the mentally retarded receiving Medicaid payments, in addition to other federal and state regulations, must pay specified staff not less than in the amount of $6.65 per hour.  Employee positions included for purposes of minimum wage for specified staff are as follows:

• (1) Registered Nurse
• (2) Licensed Practical Nurse
• (3) Nurse Aide
• (4) Certified Medication Aide
• (5) Other Social Service Staff
• (6) Other Activities Staff
• (7) Combined Social Services/Activities
• (8) Other Dietary Staff
• (9) Housekeeping Supervisor and Staff
• (10) Maintenance Supervisor and Staff
• (11) Laundry Supervisor and Staff

(e) Quality of care reports.  Effective September 1, 2000, all nursing facilities and intermediate care facilities for the mentally retarded must submit a monthly report developed by the Oklahoma Health Care Authority, the Quality of Care Report, for the purposes of documenting the extent to which such facilities are compliant with the minimum direct-care-staff-to-resident ratios or direct-care service rates.

• (1) The monthly report must be signed by the preparer and by the Owner, authorized Corporate Officer or Administrator of the facility for verification and attestation that the reports were compiled in accordance with this section.
• (2) The Owner or authorized Corporate Officer of the facility must retain full accountability for the report's accuracy and completeness regardless of report submission method.
• (3) Penalties for false statements or misrepresentation made by or on behalf of the provider are provided at 42 U.S.C. Section 1320a-7b which states, in part, "Whoever...(2) at any time knowingly and willfully makes or causes to be made any false statement of a material fact for use in determining rights to such benefit or payment...shall (i) in the case of such statement, representation, concealment, failure, or conversion by any person in connection with furnishing (by that person) of items or services for which payment is or may be made under this title (42 U.S.C. '1320 et seq.), be guilty of a felony and upon conviction thereof fined not more than $25,000 or imprisoned for not more than five years or both, or (ii) in the case of such a statement, representation, concealment, failure or conversion by any other person, be guilty of a misdemeanor and upon conviction thereof fined not more than $10,000 or imprisoned for not more than one year, or both."
• (4) The Quality of Care Report must be submitted by 5 p.m. (CST) on the 15^th of the following month.  If the 15^th falls upon a holiday or a weekend (Saturday-Sunday), the report is due by 5 p.m. (CST) of the following business day (Monday - Friday).
• (5) The Quality of Care Report will be made available in an electronic version for uniform submission of the required data elements.
• (6) Facilities must submit the monthly report either through electronic mail to the Opportunities for Living Life Division, Long Term Care Quality Initiatives Unit or send the monthly report in disk or paper format by certified mail and pursuant to subsection (e)(14) of this section.  The submission date is determined by the date and time recorded through electronic mail or the postmark date and the date recorded on the certified mail receipt.
• (7) Should a facility discover an error in its submitted report for the previous month only, the facility must provide to the Opportunities for Living Life Division, Long Term Care Quality Initiatives Unit written notification with adequate, objective and substantive documentation within five business days following the submission deadline.  Any documentation received after the five business day period will not be considered in determining compliance and for reporting purposes by the Oklahoma Health Care Authority.
• (8) An initial administrative penalty of $150.00 is imposed upon the facility for incomplete, unauthorized, or non-timely filing of the Quality of Care Report.  Additionally, a daily administrative penalty will begin upon the Authority notifying the facility in writing that the report was not complete or not timely submitted as required.  The $150.00 daily administrative penalty accrues for each calendar day after the date the notification is received.  The penalties are deducted from the Medicaid facility's payment.  For 100% private pay facilities, the penalty amount(s) is included and collected in the fee assessment billings process.  Imposed penalties for incomplete reports or non-timely filing are not considered for Oklahoma Health Care Authority Cost Reporting purposes.
• (9) The Quality of Care Report includes, but is not limited to, information pertaining to the necessary reporting requirements in order to determine the facility's compliance with subsections (b) and (c) of this Section.  Such reported information includes, but is not limited to: staffing ratios; peak in-house resident count; staff hours worked by shift; total patient days; available bed days; Medicare bed days; Medicaid bed days; and total gross receipts.
• (10) Audits may be performed to determine compliance pursuant to subsections (b), (c) and (d) of this Section.  Announced/unannounced on-site audits of reported information may also be performed.
• (11) Direct-care-staff-to-resident information and on-site audit findings pursuant to subsection (c), will be reported to the Oklahoma State Department of Health for their review in order to determine "willful" non-compliance and assess penalties accordingly pursuant to Title 63 Section 1-1912 through Section 1-1917 of the Oklahoma Statutes.  The Oklahoma State Department of Health informs the Oklahoma Health Care Authority of all final penalties as required in order to deduct from the Medicaid facility's payment.  Imposed penalties are not considered for Oklahoma Health Care Authority Cost Reporting purposes.
• (12) If a Medicaid provider is found non-compliant pursuant to subsection (d) based upon a desk audit and/or an on-site audit, for each hour paid to specified staff that does not meet the regulatory minimum wage of $6.65, the facility must reimburse the employee(s) retroactively to meet the regulatory wage for hours worked.  Additionally, an administrative penalty of $25.00 is imposed for each non-compliant staff hour worked.  For Medicaid facilities, a deduction is made to their payment.  Imposed penalties for non-compliance with minimum wage requirements are not considered for Oklahoma Health Care Authority Cost Reporting purposes.
• (13) Under OAC 317:2-1-2, Long Term Care facility providers may appeal the administrative penalty described in (b)(5)(B) and (e)(8) and (e)(12) of this section.
• (14) Facilities that have been authorized by the Oklahoma State Department of Health (OSDH) to implement flexible staff scheduling must comply with OAC 310:675-1 et seq.  The authorized facility is required to complete the flexible staff scheduling section of Part A of the Quality of Care Report.  The Owner, authorized Corporate Officer or Administrator of the facility must complete the flexible staff scheduling signature block, acknowledging their OSDH authorization for Flexible Staff Scheduling.