All Roll Calls
Yes: 425 • No: 64
OklahomaHB 2749Oklahoma 2026 Regular SessionHouseWALLET
Medicaid; directing establishment of certain nursing facility add-on rate under specified conditions; effective date; emergency.
Sponsored By: Trey Caldwell (Republican)
Signed by Governor
Senate Committee
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Bill Overview
Analyzed Economic Effects
7 provisions identified: 5 benefits, 0 costs, 2 mixed.
Add-on pay and tax waiver for nursing homes
If federal approval and funds are available, the state pays a Medicaid add‑on to homes that run multigenerational activities. When Medicaid rates reach $94.11 (plus later increases) and fund 4.1 direct‑care hours per bed per day, the Authority may ask CMS to waive the uniform health‑care‑related tax rule. If CMS approves a waiver, the Authority sets up a program for all nursing homes.
Medicaid pay tied to staffing costs
The state recalculates and pays nursing homes and ICF/IIDs using audited 1998–1999 costs adjusted to mid‑2000–2001. The updated rate starts September 1, 2000, and Quality of Care Fund payments start October 1, 2000. A new method splits each facility’s pay into a direct‑care part (RNs, LPNs, CMAs, CNAs) and other costs. The direct‑care base equals the lesser of each facility’s allowable costs or a cap set at or above the 90th percentile. Beginning October 1, 2019, when money is appropriated, the statewide average rate uses audited 2018 costs (inflated). If a facility’s rate rises, half raises its base and half follows the 70/30 split; later increases follow the 70/30 method and cannot exceed the federal upper payment limit. The state seeks CMS approval to use a Medicare‑equivalent method for that limit and must not adjust these rates less favorably than most other providers. A state advisory committee designs this facility‑specific method and delivers it to the Authority (initial plan due January 15, 2005; final by July 1, 2005) for new funds.
One statewide tool to assess care needs
All state‑regulated long‑term care providers use one assessment tool to decide client service needs. The Health Care Authority develops it with the State Department of Health.
Stronger staffing and reporting in nursing homes
Facilities with 17 or more beds must meet minimum direct‑care ratios: days 1:6, evenings 1:8, nights 1:15 (effective October 1, 2019). Starting January 1, 2020, a home may use 24‑hour scheduling if it keeps at least 2.9 hours of direct care per resident per day, never goes below 1 staff per 15 residents, and always has two awake staff. Shift start times may move by up to one hour. Homes must post daily the names and titles of on‑duty direct‑care staff, including the supervising nurse. Homes with 17+ beds must file monthly staffing reports; the public can request them. The Authority may fine homes that fail to file after written notice; at least a one‑day penalty applies. Simple math errors are not fined. Penalty money goes to the Nursing Facility Quality of Care Fund. The Health Department monitors 24‑hour schedulers and can require shift‑based ratios for at least three months; repeat findings within two years trigger longer corrective steps. Homes can appeal staffing penalties and use informal dispute resolution. The Health Commissioner will set staffing rules for small ICF/IID homes that serve 6 or fewer and 16 or fewer clients.
More personal needs money for nursing home residents
Starting October 1, 2019, nursing home and ICF/IID residents on Medicaid get $75 per month for personal needs, up from $50. The law funds this by cutting the Medicaid base rate by $0.82 per day; any extra cost comes from the Nursing Facility Quality of Care Fund.
Alzheimer's training for nursing home staff
Starting January 1, 2020, nursing homes must give and pay for at least four hours of Alzheimer’s or dementia training each year for clinical employees.
When these nursing home changes start
The law declares an emergency, so it takes effect when it is passed and approved. One section takes effect on July 1, 2026.
Sponsors & Cosponsors
Sponsor
Trey Caldwell
Republican • House
Cosponsors
Chuck Hall
Republican • Senate
Pittman
Affiliation unavailable
Roll Call Votes
House vote • 5/6/2026
FOURTH READING
Yes: 74 • No: 13
Senate vote • 5/4/2026
THIRD READING
Yes: 34 • No: 10
Senate vote • 4/23/2025
emergency
Yes: 0 • No: 0
Senate vote • 4/23/2025
Committee vote: Appropriations
Yes: 25 • No: 0
Senate vote • 4/7/2025
Committee vote: Health & Human Services
Yes: 10 • No: 2
Senate vote • 4/7/2025
emergency
Yes: 0 • No: 2
House vote • 3/25/2025
EMERGENCY
Yes: 68 • No: 14
House vote • 3/25/2025
THIRD READING
Yes: 82 • No: 9
House vote • 3/25/2025
EMERGENCY
Yes: 68 • No: 14
House vote • 3/5/2025
DO PASS
Yes: 32 • No: 0
House vote • 3/5/2025
DO PASS
Yes: 32 • No: 0
Actions Timeline
Approved by Governor 05/11/2026
5/12/2026HouseSent to Governor
5/6/2026HouseEnrolled measure signed, returned to House
5/6/2026SenateEnrolled, signed, to Senate
5/6/2026HouseReferred for enrollment
5/6/2026HouseFourth Reading, Measure and Emergency Passed: Ayes: 74 Nays: 13
5/6/2026HouseSA's read, adopted
5/6/2026HouseSA's received
5/5/2026HouseEngrossed to House
5/5/2026SenateReferred for engrossment
5/4/2026SenateEmergency passed: Ayes: 42 Nays: 2
5/4/2026SenateMeasure passed: Ayes: 34 Nays: 10
5/4/2026SenateTitle restored
5/4/2026SenateGeneral Order, Amended by Floor Substitute
5/4/2026SenatePlaced on General Order
4/28/2025SenateReported Do Pass Appropriations committee; CR filed
4/23/2025SenateReferred to Appropriations
4/7/2025SenateTitle stricken
4/7/2025SenateReported Do Pass as amended Health and Human Services committee; CR filed
4/7/2025SenateSecond Reading referred to Health and Human Services Committee then to Appropriations Committee
4/1/2025SenateCoauthored by Representative Pittman
3/26/2025SenateFirst Reading
3/26/2025SenateEngrossed, signed, to Senate
3/26/2025HouseReferred for engrossment
3/25/2025HouseThird Reading, Measure and Emergency passed: Ayes: 82 Nays: 9; Ayes: 68 Nays: 14
3/25/2025House
Bill Text
Enrolled (final version)
5/6/2026
Amended And Engrossed
5/5/2026
Floor (Senate)
4/24/2025
Senate Committee Report 2
4/23/2025
Senate Committee Report 1
4/7/2025
Engrossed
3/26/2025
Floor (House)
3/10/2025
House Committee Report
3/10/2025
House Committee Substitute
3/10/2025
Introduced
1/16/2025
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