Senate Health & Welfare reviews H.13 amendment changing ‘determine’ to ‘calculate’ in payment-rate law

Jen McCarthy, legislative counsel in the Office of Legislative Council, told the Senate Health & Welfare Committee on April 23 that an amendment to H.13 replaces the word “determine” with “calculate” throughout the statutory language governing payment rates for providers.

The change, McCarthy said, is largely terminological but carries drafting implications: the amendment also clarifies reporting language, retains a provision for rate studies “at least once every five years,” and adds language about recalculation and annual reporting of rates for informational purposes rather than as a binding appropriation decision by the Agency of Human Services (AHS).

Nut graf: The amendment seeks to align statutory wording with the agency’s role in producing payment-rate calculations while preserving the General Assembly’s control of appropriations. Committee members debated wording that affects how often AHS must review and report rates and whether an “extraordinary financial relief” process should apply beyond nursing homes and private nonmedical institutions.

McCarthy walked the committee through the draft amendment, saying it strikes and replaces section 2 and substitutes “calculate” for “determine” across multiple subsections. She said the amendment keeps language about “a predictable timeline for redetermination of face rates” and that the secretary would “for informational purposes” ensure calculations take certain factors into account. Members pressed staff about the placement of the phrase “for informational purposes” and whether it could be misconstrued as creating an obligation to appropriate funds.

Committee staff noted that AHS will calculate what would be appropriate rates but does not control the amount ultimately appropriated by the General Assembly or the governor’s recommended budget. The draft retains a provision that rate studies occur “at least once every five years,” a change from agency-proposed language allowing review at “reasonable intervals in accordance with agency capacity.” The amendment also contemplates an annual recalculation and reporting of rates for informational purposes, rather than imposing a mandatory appropriations action.

The draft adds, in subsection C, a process for providers whose financial condition places them at imminent risk of closure to seek extraordinary financial relief; McCarthy said that parallel language currently applies to nursing homes and private nonmedical institutions and could be extended to other provider types as a policy decision rather than a drafting error.

After discussing the changes — terminology, study cadence, and the stabilization process — committee members indicated they would keep the amendment as presented. There was no formal recorded vote on the amendment; staff reported, and members agreed, to leave the draft in place and to revisit some timing language and market-related questions at a later meeting.

Ending: The committee paused further action on H.13 and proceeded to consider H.266 on prescription drug pricing and reporting. The committee also signaled it may revisit the timing provisions in H.13 and discuss market impacts in a future session.