(a) Each nursing home shall pay the nursing home assessment in quarterly installments to the account in accordance with this part. In the event of a change of ownership or management of a nursing facility, the successor entity shall be liable for all unpaid nursing home assessment fees, penalties, and interest, and full payment of those fees, penalties, and interest shall be a precondition to the successor entity obtaining a TennCare identification number.
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Terms Used In Tennessee Code 71-5-1003

  • Account: means the nursing home assessment trust fund created under this part. See Tennessee Code 71-5-1001
  • Bureau: means the bureau of TennCare. See Tennessee Code 71-5-1001
  • Continuing care retirement community: means an entity or organization that offers on a single campus setting a continuum of services and facilities for each resident including single and congregate dwellings, assisted living units, and nursing facility services, pursuant to a contract between a resident and a provider by which the resident pays a fee for the right to occupy a space in a designated facility and to receive continuing care for life. See Tennessee Code 71-5-1001
  • 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.
  • Fund: as used in this part shall mean the nursing home assessment trust fund created under this part. See Tennessee Code 71-5-1001
  • Month: means a calendar month. See Tennessee Code 1-3-105
  • Net patient service revenue: means gross inpatient revenues from services provided to nursing home patients less reductions from gross inpatient revenue resulting from an inability to collect payment of charges. See Tennessee Code 71-5-1001
  • Nursing facility: means any entity defined as a nursing home under §. See Tennessee Code 71-5-1001
  • State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
  • Year: means a calendar year, unless otherwise expressed. See Tennessee Code 1-3-105
(b) The aggregated amount of assessments for all nursing facilities during a fiscal year shall not be less than the amount necessary to fund this part or exceed the maximum amount that may be assessed pursuant to the indirect guarantee threshold as established pursuant to 42 C.F.R. § 433.68(f)(3)(i). The bureau shall determine the assessment rate prospectively for the applicable fiscal year on a per-resident-day basis, exclusive of medicare resident days. The per-resident day assessment rate shall be established pursuant to subsection (c). The bureau shall promulgate rules for facility reporting of non-medicare resident days and for payment of the assessment.
(c) The total aggregated amount of assessments for all nursing facilities from July 1, 2023, through June 30, 2024, is equal to six percent (6%) of the net patient service revenue. The total aggregated amount of assessment for all nursing facilities, and the annual assessment determined for each nursing facility, must be established on July 1 of each year. Except as provided in subdivision (c)(8), the bureau may allow for one (1) mid-year adjustment to be established prior to January 1. Once established, neither amount must vary during the fiscal year. Each nursing facility has an annual assessment amount that is determined as follows:

(1) A licensed nursing home that is licensed on July 1, 2023, for fifty (50) beds or fewer shall pay an assessment rate equal to two and three-quarters percent (2.75%) of net patient service revenue, divided by all non-medicare days. The facility shall pay the per diem rate for each of its non-medicare days;
(2) A licensed nursing home that on July 1, 2023, either operates as part of a continuing care retirement community or is certified only to provide medicare skilled nursing facility services, shall pay an assessment rate equal to two and three-quarters percent (2.75%) of net patient service revenue, divided by all non-medicare days. The facility shall pay the per diem rate for each of its non-medicare days;
(3) A licensed nursing home that is licensed on July 1, 2023, and provided thirty-five thousand (35,000) or greater medicaid patient days for the twelve (12) months ending December 31 of the prior year shall pay an assessment rate equal to two and three-quarters percent (2.75%) of net patient service revenue divided by all non-medicare patient days. The facility shall pay the per diem rate for each of its non-medicare days;
(4) A new nursing home facility that is initially licensed and commences operations on or after July 1, 2023, shall pay in FY 2023-2024 a prorated assessment equal to two thousand two hundred twenty-five dollars ($2,225) per licensed bed per year, prorated to accrue from the date the nursing facility became licensed. The change in ownership of an existing licensed facility does not meet the requirements of this subdivision (c)(4);
(5) A licensed nursing home not meeting the criteria of subdivisions (c)(1)-(4) shall pay an equal per facility annual assessment amount at such amount as is necessary to ensure that the total aggregated amount of assessment for all nursing facilities from July 1, 2023, through June 30, 2024, equals six percent (6%) of the net patient service revenue, when such total aggregated assessment amount is established on July 1 of each year;
(6) Any excess collections of per facility annual assessments above the targeted six percent (6%) of the net patient service revenue must be retained in the nursing home assessment trust fund account created under this part. If actual collections of per facility annual assessments do not equal the targeted six percent (6%) of the net patient service revenue, then any shortfall may be made up from funds in the nursing home assessment trust fund account created under this part, or from other appropriations to the TennCare program;
(7) A facility that ceases to be licensed by the health facilities commission is not required to pay assessment fees accruing after the date of its licensure termination; and
(8) The bureau may modify the amount of the annual assessment for each nursing facility established by this subsection (c) if such modification is necessary to comply with 42 C.F.R. § 433.68.
(d) Each nursing home shall pay its nursing home annual assessment fee as set forth in subsection (c) in equal quarterly installments, with the first quarterly installment due on the fifteenth day of the first month of the first quarter of the state fiscal year after the bureau of TennCare has satisfied the requirements of subsection (f) [deleted]. Subsequent installments shall be due on the fifteenth day of the first month of the three (3) successive calendar quarters following the calendar quarter in which the first installment is due.
(e) Nursing homes shall not create a separate line-item charge on the bill reflecting the assessment.
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