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26B-3-311
0
Nursing Care Facility Program Amendments
2026 GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Bridger Bolinder
Senate Sponsor: Evan J. Vickers
LONG TITLE
General Description:
This bill amends requirements related to nursing care facility program Medicaid
certification.
Highlighted Provisions:
This bill:
amends a permitted extension of the time period for certifying a nursing care facility
program that was previously Medicaid certified under certain circumstances;
provides that a previously-approved two-year extension may be extended to four years
under certain circumstances; and
makes technical and conforming changes.
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
26B-3-311
, as last amended by Laws of Utah 2024, Chapter 312
Be it enacted by the Legislature of the state of Utah:
Section 1. Section
26B-3-311
is amended to read:
26B-3-311
. Authorization to renew, transfer, or increase Medicaid certified
programs -- Reimbursement methodology.
(1)
(a)
The division may renew Medicaid certification of a certified program if the
program, without lapse in service to Medicaid recipients, has its nursing care facility
program certified by the division at the same physical facility as long as the licensed
and certified bed capacity at the facility has not been expanded, unless the director
has approved additional beds in accordance with Subsection
(5)
.
(b)
The division may renew Medicaid certification of a nursing care facility program
that is not currently certified if:
(i)
since the day on which the program last operated with Medicaid certification:
(A)
the physical facility where the program operated has functioned solely and
continuously as a nursing care facility; and
(B)
the owner of the program has not, under this section or Section
26B-3-313
,
transferred to another nursing care facility program the license for any of the
Medicaid beds in the program; and
(ii)
except as provided in Subsection
26B-3-310(4)
, the number of beds granted
renewed Medicaid certification does not exceed the number of beds certified at the
time the program last operated with Medicaid certification, excluding a period of
time where the program operated with temporary certification under Subsection
26B-3-312(3)
.
(2)
(a)
The division may issue a Medicaid certification for a new nursing care facility
program if a current owner of the Medicaid certified program transfers its ownership
of the Medicaid certification to the new nursing care facility program and the new
nursing care facility program meets all of the following conditions:
(i)
the new nursing care facility program operates at the same physical facility as the
previous Medicaid certified program;
(ii)
the new nursing care facility program gives a written assurance to the director in
accordance with Subsection
(4)
;
(iii)
the new nursing care facility program receives the Medicaid certification within
one year of the date the previously certified program ceased to provide medical
assistance to a Medicaid recipient; and
(iv)
the licensed and certified bed capacity at the facility has not been expanded,
unless the director has approved additional beds in accordance with Subsection
(5)
.
(b)
A nursing care facility program that receives Medicaid certification under the
provisions of Subsection
(2)(a)
does not assume the Medicaid liabilities of the
previous nursing care facility program if the new nursing care facility program:
(i)
is not owned in whole or in part by the previous nursing care facility program; or
(ii)
is not a successor in interest of the previous nursing care facility program.
(3)
(a)
The division may issue a Medicaid certification to a nursing care facility program
that was previously a certified program but now resides in a new or renovated
physical facility if the nursing care facility program meets all of the following:
(a)
(i)
the nursing care facility program met all applicable requirements for Medicaid
certification at the time of closure;
(b)
(ii)
the new or renovated physical facility is in the same county or within a
five-mile radius of the original physical facility;
(c)
(iii)
the time between which the certified program ceased to operate in the
original facility and will begin to operate in the new physical facility is not more
than three years, unless:
(i)
(A)
an emergency is declared by the president of the United States or the
governor, affecting the building or renovation of the physical facility;
(ii)
(B)
the director approves an exception to the three-year requirement for any
nursing care facility program within the three-year requirement;
(iii)
(C)
the provider submits documentation supporting a request for an
extension to the director that demonstrates a need for an extension; and
(iv)
(D)
the exception does not extend for more than
two
four
years beyond the
three-year requirement;
(d)
(iv)
if Subsection
(3)(c)
(3)(a)(iii)
applies, the certified program notifies the
department within 90 days after ceasing operations in its original facility, of its
intent to retain its Medicaid certification;
(e)
(v)
the provider gives written assurance to the director in accordance with
Subsection
(4)
that no third party has a legitimate claim to operate a certified
program at the previous physical facility; and
(f)
(vi)
the bed capacity in the physical facility has not been expanded unless the
director has approved additional beds in accordance with Subsection
(5)
.
(b)
If the director approved an exception described in Subsection
(3)(a)(iii)
for two years
beyond the three-year requirement before May 6, 2026, the director may extend the
exception to four years beyond the three-year requirement, including after the
original exception has expired, if the nursing care facility program for which the
original exception was approved requests the extension within four years beyond the
three-year requirement.
(4)
(a)
The entity requesting Medicaid certification under Subsections
(2)
and
(3)
shall
give written assurances satisfactory to the director or the director's designee that:
(i)
no third party has a legitimate claim to operate the certified program;
(ii)
the requesting entity agrees to defend and indemnify the department against any
claims by a third party who may assert a right to operate the certified program; and
(iii)
if a third party is found, by final agency action of the department after exhaustion
of all administrative and judicial appeal rights, to be entitled to operate a certified
program at the physical facility the certified program shall voluntarily comply
with Subsection
(4)(b)
.
(b)
If a finding is made under the provisions of Subsection
(4)(a)(iii)
:
(i)
the certified program shall immediately surrender its Medicaid certification and
comply with division rules regarding billing for Medicaid and the provision of
services to Medicaid patients; and
(ii)
the department shall transfer the surrendered Medicaid certification to the third
party who prevailed under Subsection
(4)(a)(iii)
.
(5)
(a)
The director may approve additional nursing care facility programs for Medicaid
certification, or additional beds for Medicaid certification within an existing nursing
care facility program, if a nursing care facility or other interested party requests
Medicaid certification for a nursing care facility program or additional beds within an
existing nursing care facility program, and the nursing care facility program or other
interested party complies with this section.
(b)
Except as provided under Subsection
(5)(e)
, a nursing care facility or other interested
party requesting Medicaid certification for a nursing care facility program or
additional beds within an existing nursing care facility program under Subsection
(5)(a)
shall submit to the director:
(i)
proof of the following as reasonable evidence that bed capacity provided by
Medicaid certified programs within the county or group of counties impacted by
the requested additional Medicaid certification is insufficient:
(A)
nursing care facility occupancy levels for all existing and proposed facilities
will be at least 90% for the next three years;
(B)
current nursing care facility occupancy is 90% or more; or
(C)
there is no other nursing care facility within a 35-mile radius of the nursing
care facility requesting the additional certification; and
(ii)
an independent analysis demonstrating that at projected occupancy rates the
nursing care facility's after-tax net income is sufficient for the facility to be
financially viable.
(c)
Any request for additional beds as part of a renovation project are limited to the
maximum number of beds allowed in Subsection
(7)
.
(d)
The director shall determine whether to issue additional Medicaid certification by
considering:
(i)
whether bed capacity provided by certified programs within the county or group of
counties impacted by the requested additional Medicaid certification is
insufficient, based on the information submitted to the director under Subsection
(5)(b)
;
(ii)
whether the county or group of counties impacted by the requested additional
Medicaid certification is underserved by specialized or unique services that would
be provided by the nursing care facility;
(iii)
whether any Medicaid certified beds are subject to a claim by a previous certified
program that may reopen under the provisions of Subsections
(2)
and
(3)
;
(iv)
how additional bed capacity should be added to the long-term care delivery
system to best meet the needs of Medicaid recipients;
(v)
(A)
whether the existing certified programs within the county or group of
counties have provided services of sufficient quality to merit at least a two-star
rating in the Medicare Five-Star Quality Rating System over the previous
three-year period; and
(B)
information obtained under Subsection
(9)
; and
(vi)
subject to Subsection
(5)(e)
, for a state-owned veterans nursing care facility,
whether the facility has previously been approved for a Medicaid certified bed
increase under this Subsection
(5)
.
(e)
For a state-owned veterans nursing care facility that has not previously been
approved for a Medicaid certified bed increase under this Subsection
(5)
:
(i)
the facility is exempt from the requirements under Subsection
(5)(b)
; and
(ii)
the director may approve, for that facility location only, up to five total Medicaid
certified beds.
(6)
The department shall adopt administrative rules in accordance with Title 63G, Chapter 3,
Utah Administrative Rulemaking Act, to adjust the Medicaid nursing care facility
property reimbursement methodology to:
(a)
only pay that portion of the property component of rates, representing actual bed
usage by Medicaid clients as a percentage of the greater of:
(i)
actual occupancy; or
(ii)
(A)
for a nursing care facility other than a facility described in Subsection
(6)(a)(ii)(B)
, 85% of total bed capacity; or
(B)
for a rural nursing care facility, 65% of total bed capacity; and
(b)
not allow for increases in reimbursement for property values without major
renovation or replacement projects as defined by the department by rule.
(7)
(a)
Except as provided in Subsection
26B-3-310(3)
, if a nursing care facility does not
seek Medicaid certification for a bed under Subsections
(1)
through
(6)
, the
department shall, notwithstanding Subsections
26B-3-312(3)(a)
and
(b)
, grant
Medicaid certification for additional beds in an existing Medicaid certified nursing
care facility that has 90 or fewer licensed beds, including Medicaid certified beds, in
the facility if:
(i)
the nursing care facility program was previously a certified program for all beds
but now resides in a new facility or in a facility that underwent major renovations
involving major structural changes, with 50% or greater facility square footage
design changes, requiring review and approval by the department;
(ii)
the nursing care facility meets the quality of care regulations issued by CMS; and
(iii)
the total number of additional beds in the facility granted Medicaid certification
under this section does not exceed 10% of the number of licensed beds in the
facility.
(b)
The department may not revoke the Medicaid certification of a bed under this
Subsection
(7)
as long as the provisions of Subsection
(7)(a)(ii)
are met.
(8)
(a)
If a nursing care facility or other interested party indicates in its request for
additional Medicaid certification under Subsection
(5)(a)
that the facility will offer
specialized or unique services, but the facility does not offer those services after
receiving additional Medicaid certification, the director shall revoke the additional
Medicaid certification.
(b)
The nursing care facility program shall obtain Medicaid certification for any
additional Medicaid beds approved under Subsection
(5)
or
(7)
within three years of
the date of the director's approval, or the approval is void.
(9)
(a)
If the director makes an initial determination that quality standards under
Subsection
(5)(d)(v)
have not been met in a rural county or group of rural counties
over the previous three-year period, the director shall, before approving certification
of additional Medicaid beds in the rural county or group of counties:
(i)
notify the certified program that has not met the quality standards in Subsection
(5)(d)(v)
that the director intends to certify additional Medicaid beds under the
provisions of Subsection
(5)(d)(v)
; and
(ii)
consider additional information submitted to the director by the certified program
in a rural county that has not met the quality standards under Subsection
(5)(d)(v)
.
(b)
The notice under Subsection
(9)(a)
does not give the certified program that has not
met the quality standards under Subsection
(5)(d)(v)
, the right to legally challenge or
appeal the director's decision to certify additional Medicaid beds under Subsection
(5)(d)(v)
.
Section 2.
Effective Date.
This bill takes effect on
May 6, 2026
.
3-2-26 9:12 AM