Committee reviews Senate amendments to Medicaid payment rates for community-based providers

A legislative committee reviewed Senate amendments to a bill addressing Medicaid payment rates for community-based service providers and took a nonbinding straw poll in favor of reporting the amendment, the committee chair said.

The amendments, summarized by Jen Kirby, Legislative Counsel in the Office of Legislative Counsel, change the bill’s terminology from “home and community based services” to “community based services,” direct the secretary to “calculate” payment rates for informational purposes, preserve a requirement that the methodology provide a predictable timeline for redetermination of base rates, and create a mechanism for a provider at imminent risk of closure to request “provider stabilization.”

The changes matter because they affect how Medicaid rates are described and calculated for providers that serve people in home settings and other community locations. Committee members said the language clarifies the scope of covered settings and preserves a process for rate redetermination and emergency stabilization that could affect providers facing financial distress.

Kirby, describing the Senate amendments, said the change in terminology was intended to avoid an overly broad statutory label while keeping the content of the bill intact. She said the bill “still includes home health and hospice services” and that the Senate’s amendment replaces the phrase “home and community based services” with “community based services.” Kirby also said the agency proposed replacing the word “determine” with “assess,” and that the committee instead agreed to use “calculate,” a word she called clearer because it signals that the provision is for figuring rates rather than imposing them. Kirby quoted the chosen verb: “calculate.”

Committee members pressed on a separate drafting choice intended to exclude certain settings from the bill’s scope. The agency proposed excluding “clinical residential settings or private nonmedical residential settings.” The committee chair said she was concerned the phrase “clinical residential setting” might be read to include certain enhanced residential care programs, noting, “I’m more concerned that they could interpret that as, like ERC, enhanced residential care has a clinical component.” The transcript shows the chair and other members discussed that concern and confirmed the bill’s language includes an explicit list to limit unintended coverage.

On provider financial distress, Kirby said the agency had objected to the phrase “extraordinary financial relief” because of its specificity for nursing homes; the committee accepted language allowing a provider that faces imminent risk of closure to request “provider stabilization” instead. The chair reminded members that a prior budget adjustment (which had not passed) would have set aside up to $10,000,000 in one-time funds to provide financial relief to non-nursing-home community providers. The chair said the intent of the provision is to create a clearer process so providers know the state might offer stabilization assistance.

Kirby said the amendments preserve the committee’s earlier intent about an ongoing redetermination of base rates; she noted that the committee had insisted on retaining a predictable schedule for rate redetermination rather than the agency’s preferred, vaguer phrasing. The transcript records the chair saying the committee left the redetermination language in place to ensure an ongoing review (the discussion referenced keeping a guarantee such as review at least once every five years).

Committee members confirmed the amendment does not appropriate new funds in itself. Kirby said the amendment’s language is largely for informational and methodological purposes and does not change funding authority. The committee held a straw poll on the Senate Health and Welfare amendment; the chair called for members to raise their hands and announced the tally recorded in the room as “8–0–3.” The chair and counsel described the poll as a procedural step to allow the item to be reported to the floor later in the week.

The committee chair said the group plans to report the amendment so it will appear on the calendar the following week. The transcript shows the committee then moved on to scheduling and other agenda items.

The discussion included repeated clarifications about scope and drafting (terminology, what settings the statute covers, the purpose of the calculations, and a provider stabilization pathway) but did not include a final, binding legislative vote during the recorded session; the recorded tally was a nonbinding straw poll to report the amendment.

Members and counsel asked staff to watch procedural steps and fiscal notes as the amendment proceeds through the calendar.