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HCR 15

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2025 Regular Session Introduced by Brandon Steele

The bill aims to stabilize SNF funding by folding UPL payments into daily Medicaid rates and ensuring a minimum fee through MCOs.

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Bill Summary · HCR 15

HCR 15 — Summary (Idaho)

A concurrent resolution directing the Idaho Department of Health and Welfare and the Division of Medicaid to convene stakeholders and develop revisions to the state’s Skilled Nursing Facility (SNF) Medicaid reimbursement methodology.

Main purpose

To develop a CMS‑compliant, more stable and operationally efficient Medicaid reimbursement model for skilled nursing facilities by integrating Upper Payment Limit (UPL) funds into daily Medicaid rates, establishing minimum fee payments through Medicaid Managed Care Organizations (MCOs), and changing assessment collection timing.

Key provisions

  • Directs the Idaho Department of Health and Welfare to convene a stakeholder council (broad stakeholder base) to coordinate and develop revisions and improvements to the SNF reimbursement methodology.
  • Requires the council to consider placing current UPL payments into the daily Medicaid rate paid to SNFs (i.e., converting supplemental UPL payments into base per‑diem Medicaid rates).
  • Directs that Medicaid MCOs be required to pay those UPL‑derived amounts to facilities as part of a minimum fee schedule administered by the plans.
  • Changes the nursing facility fee assessment (Chapter 15, Title 56, Idaho Code) collection frequency from annual to quarterly.
  • Directs the Division of Medicaid to pursue all necessary approvals from the Centers for Medicare & Medicaid Services (CMS), including preparing state plan amendments, directed payment preprints, and any other federal submissions; to update quality metrics used in the methodology; and to modify MCO contracts as needed to operationalize the changes.
  • Requires the council or a representative stakeholder organization to report findings, recommendations, and proposed legislation to the Idaho Legislature by January 31, 2026.
  • Notes a CMS requirement that Idaho change its SNF reimbursement system by July 1, 2026.

Who is affected

  • Skilled Nursing Facilities (SNFs) — payment timing, per‑diem rates, and revenue predictability could change.
  • Medicaid Managed Care Organizations (MCOs) — may need to adopt a minimum fee schedule and adjust contracts.
  • Idaho Department of Health and Welfare / Division of Medicaid — responsible for convening the council, preparing federal submissions, negotiating with CMS, and updating quality measures and contracts.
  • Entities subject to the nursing facility assessment — assessment timing and cash‑flow considerations change from annual to quarterly.
  • Medicaid beneficiaries relying on long‑term care services could experience indirect effects if changes affect facility viability or access.

Timeline and procedural notes

  • CMS has required Idaho to change its SNF reimbursement system by July 1, 2026.
  • The council (or a stakeholder organization) must report to the Second Regular Session of the Sixty‑eighth Idaho Legislature by January 31, 2026.
  • Fiscal note attached states the resolution imposes no new appropriation or direct fiscal impact; agencies are to use existing resources.
  • As a concurrent resolution, HCR 15 expresses legislative direction and expectation and instructs executive‑branch action but does not itself appropriate funds.

Potential impacts (practical)

  • Intended to create a more predictable, stable revenue stream for SNFs by folding supplemental UPL payments into daily rates.
  • May require administrative resources at Medicaid and among MCOs to renegotiate contracts, submit federal approvals, and implement quarterly assessment collections.
  • Could improve financial sustainability and access to long‑term care if approved by CMS and implemented as planned.

Compiled from official sources — confirm details with the bill’s official record.

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