(a) In accordance with title Title 42 of the Code of Federal Regulations, Part 438, the department shall use revenues from the nursing facility sustainability fee and federal matching funds to enhance the capitated rates paid to medicaid managed care health plans consistent with the following objectives:

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Terms Used In Hawaii Revised Statutes 346F-10

  • Department: means the department of human services. See Hawaii Revised Statutes 346F-3
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • month: means a calendar month; and the word "year" a calendar year. See Hawaii Revised Statutes 1-20
  • Nursing facility: means any facility licensed pursuant to chapter 11-94. See Hawaii Revised Statutes 346F-3
(1) The department shall use moneys from the nursing facility sustainability program solely to fulfill the requirements of section 346F-4(c);
(2) The rate enhancement shall be paid by the department to medicaid managed care health plans, which shall provide documentation to the department and the nursing facility trade association located in the State certifying that the revenues received under paragraph (3) are used in accordance with this section;
(3) The rate enhancement shall be used exclusively to increase reimbursements to private nursing facilities to support the availability of services and ensure access to care for medicaid managed care health plan enrollees;
(4) The rate enhancement shall be actuarially sound and approved by the federal government for federal fund participation;
(5) The department shall modify the fee-for-service reimbursement rates of the nursing facilities to recognize the medicaid portion of the nursing facility sustainability fee as an additional cost of serving medicaid patients, and to provide a uniform percentage increase in preexisting facility-specific rates;
(6) Payments made by the medicaid managed care health plans shall be made within thirty calendar days upon receipt of payment from the department; and
(7) Each medicaid managed care health plan shall expend one hundred per cent of any increased payments it receives under this section to carry out the goals of the nursing facility sustainability program.
(b) If federal approval pursuant to section 346F-7 is not received until after the end of any month for which the nursing facility sustainability fee is applicable, the department shall make the initial monthly payments within five days after receipt of the nursing facility sustainability fee for the respective month.
(c) To the extent the nursing facility sustainability program is not effective for the entire year, the nursing facility sustainability fee, the state medicaid expenses and administrative fee, and the corresponding payments to fulfill the requirements of section 346F-4(c) shall be based on the proportion of the fiscal year the program is in effect.

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