§346F-5  Nursing facility sustainability fee.  (a)  Effective July 1, 2012, the department shall charge and collect a provider fee on health care items or services provided by nursing facilities.

     (b)  The nursing facility sustainability fee shall be based on the total resident days of all nursing facilities that are subject to the sustainability fee, as determined by the department.

     (c)  The nursing facility sustainability fee shall not exceed six per cent of overall net patient service revenue and shall be calculated and paid on a per resident day basis, unless the facility qualifies for an exemption identified in subsection (d)(1).  The facilities described in subsection (d)(2) shall pay a reduced daily fee compared to other facilities participating in the program.

     (d)  In accordance with the redistribution method set forth in title 42 Code of Federal Regulations section 433.68(e)(1) and (2), the department shall seek a waiver of the broad-based and uniformity provider fee requirements under federal law from which to exclude certain nursing facilities and to permit certain high volume medicaid nursing facilities or facilities with a high number of total annual patient days to pay the sustainability fee at a lesser amount per resident day, as follows:

     (1)  The department shall exempt the following nursing facility providers from the nursing facility sustainability fee subject to federal approval under title 42 Code of Federal Regulations section 433.68(e)(2):

          (A)  Nursing facilities with twenty-eight or fewer licensed beds;

          (B)  Nursing facilities owned, operated by, or affiliated with the Hawaii health systems corporation; and

          (C)  Continuing care retirement communities;

     (2)  The department shall reduce the fee for facilities with high medicaid resident days in order to meet the redistributive tests of title 42 Code of Federal Regulations section 433.68(e)(2); and

     (3)  The department, upon good faith consultation and negotiation with the nursing facility trade association located in the State, may modify, add to, or exclude facilities from the assessment if necessary to obtain and maintain approval of the waiver by the Centers for Medicare and Medicaid Services, if the modification, addition, or exclusion is consistent with the purposes of this chapter. [L 2012, c 156, pt of §2, §5; am L 2013, c 142, §3; am L 2014, c 124, §2; am L 2015, c 69, §§1(2), 2; am L 2016, c 59, §2; am L 2017, c 60, §5; am L 2019, c 163, §§3, 6; am L 2021, c 24, §§3, 7; am L 2023, c 109, §§7, 13]