2014 Tennessee Code
Title 68 - Health, Safety and Environmental Protection
Health
Chapter 11 - Health Facilities and Resources
Part 2 - Regulation of Health and Related Facilities
§ First - of 2 versions of this section

68-11-216. Annual license fees -- Liens -- Revocation of licenses -- Penalties -- Annual nursing home assessment fee. [Effective until July 1, 2015. See the version effective on July 1, 2015.]

(a) (1) The board is authorized to promulgate, in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, such rules and regulations as are necessary to set fees for licensure, renewal of licensure, late renewal fees and such other fees as are necessary to comply with the intent of subsection (b), for the entities and facilities listed in § 68-11-202(a)(1).

(2) The entities and facilities referenced in subdivision (a)(1), except those operated by the United States government or the state of Tennessee, shall make application for licensure and renewal under this part and shall pay the fees applicable to them to the department for regulatory purposes.

(3) The licensure and annual renewal fees for the following types of home care organizations shall not exceed twenty-five percent (25%) of the total licensure and annual renewal fees set by the board for all other home care organizations:

(A) Home care organizations that also pay a fee to be licensed by the department of mental health and substance abuse services;

(B) Home care organizations owned and operated by therapists who pay a fee to be licensed under title 63, chapter 13 or chapter 17; or

(C) Home care organizations that are owned and controlled by another home care organization that pays an annual license or renewal fee.

(4) Excluded from payment of the fees as an ambulatory surgical treatment center and an outpatient diagnostic center are hospital based ambulatory surgical treatment centers and outpatient diagnostic centers that are included in the licensing and renewal fee of the hospital in which they are located.

(5) Prior to the promulgation of a rule increasing fees for licensed health care facilities, the department of health shall present to the board a detailed report justifying the proposed fee amount. The report shall include at least the following elements:

(A) The fees currently charged, the proposed new fees, and the percentage increase expected from the proposed fees;

(B) The total number of full-time equivalent positions funded, and how those positions are funded, if not entirely from fee revenue;

(C) Justification for any increase in fees, including an itemization of actual or expected increases in costs to the board, and inspection or licensure activities on which any proposed increases in funding will be spent; and

(D) A specific breakdown that differentiates the costs incurred for licensure activities under state law from any other activity required by a contractual or legal requirement with the federal government.

(6) Not later than sixty (60) calendar days prior to the presentation of the report and the information outlined in subdivision (a)(5) to the board, the report and the information outlined in subdivision (a)(5) shall be provided to the board and any provider association representing such a facility affected by a proposed change in licensure fees. The report and information shall be provided in both paper and electronic format, and shall be made available to any affected licensed facility upon request.

(7) Any increase or decrease in fees proposed or approved by the board must increase or decrease the fees for all licensed facilities by a similar percentage amount, which shall not vary more than five percent (5%) between facility types.

(b) (1) The fees established by the board shall be submitted with the appropriate applications. All fees so collected shall be deposited by the department with the state treasurer to the credit of the general fund, and shall be expended by the department and included in the appropriation made for the board in the general appropriations act.

(2) It is the intent of the general assembly that the board establish and collect fees in an amount sufficient to pay the costs of operating the board, including, but not limited to, licensure and inspection costs. On or before December 31 of each year, the commissioner shall certify and report to the government operations committee of each house of the general assembly, if the board did not, during the fiscal year, collect fees in an amount sufficient to pay the costs of operating the board. If the board fails to collect sufficient fees to pay the costs of operating the board for a period of two (2) consecutive fiscal years, the board shall be reviewed by the joint evaluation committees and shall be subject to a revised termination date of June 30 of the fiscal year immediately following the second consecutive fiscal year during which the board operated at a deficit.

(c) (1) It is declared to be the legislative intent that every person is exercising a taxable privilege who engages in the business of providing nursing home care. The assessment fee imposed by this subsection (c) shall be in addition to all other privilege taxes.

(2) Effective for one (1) year beginning July 1, 2013, in addition to the fees set forth in subsection (a), each nursing home shall pay a nursing home annual assessment fee as set forth in this subsection (c). Such assessment fee shall be paid in equal monthly installments of one-twelfth (1/12) of the annual amount established by this subsection (c). The installments are due on the fifteenth day of each following month beginning August 15, 2013, for the July 2013 installment and ending with a final payment on July 15, 2014.

(3) The nursing home annual assessment fee shall be based on the number of nursing home beds licensed by this state on July 1, 2013, for the fiscal year following such date, excluding beds in nursing homes specifically certified as intermediate care beds for the mentally retarded. The assessment fee shall be uniformly applied to all licensed beds at the rate of two thousand two hundred twenty-five dollars ($2,225) per licensed bed per year. Licensed facilities that are owned or operated by an agency of this state are not excluded from paying the assessment fee. There shall be no exclusions, deductions or adjustments applied to the assessment fee of any licensed facility different from any other such facility. Beds licensed after July 1, 2013, shall pay a prorated amount of the annual assessment fee for the fiscal year following such date; provided, that no such assessment fee shall be due to the extent that the beds licensed after July 1, 2013, were the result of the transfer of such beds from one (1) licensed facility to another licensed facility, where the transferor facility had already paid the full amount of the assessment fee on such beds, or where the transferor facility agrees to continue to pay the monthly installments due with respect to such beds.

(4) The commissioner shall adopt rules and regulations governing the collection of such assessment fees. Notwithstanding any other law, the commissioner is authorized to promulgate such rules as emergency rules pursuant to the Uniform Administrative Procedures Act.

(5) Any challenge to the assessment fee imposed by this subsection (c) shall be brought pursuant to title 67, chapter 1, part 9 and § 9-8-307(a)(1)(O).

(6) (A) All revenue collected pursuant to this subsection (c) shall be deposited in the general fund.

(B) All nursing home annual assessment fee payments made by nursing homes under this section and received by this state; all investment earnings credited to the nursing home annual assessment fee payments; any interest and penalties paid under this section by any nursing home; and all funds generated by federal matching payments made relative to the nursing home annual assessment fee shall be available to and used by the bureau of TennCare for the sole purpose of providing payment to nursing homes.

(C) No part of the nursing home annual assessment fee payments made by nursing homes under this section and received by this state; the investment earnings credited to the nursing home annual assessment fee payments; the interest and penalties paid under this section by any nursing home; or the funds generated by federal matching payments made relative to the nursing home annual assessment fee shall be used for any purpose other than providing payment to nursing homes.

(7) (A) If any part of any assessment fee imposed under this subsection (c) is not paid on or before the due date, a penalty of five percent (5%) of the amount due shall at once accrue and be added to such assessment fee. Thereafter, on the first day of each month during which any part of any assessment fee or any prior accrued penalty remains unpaid, an additional penalty of five percent (5%) of the then unpaid balance shall accrue and be added to such assessment fee or prior accrued penalty. In addition, assessment fees under this subsection (c) not paid on the due date shall bear interest at the maximum lawful rate from the due date to the date paid. Payment shall be deemed to have been made upon date of deposit in the United States mail. The commissioner may for good cause approve an alternative payment plan, as long as full payment of the assessment fee plus penalty and interest is made.

(B) If a nursing home is more than ninety (90) days delinquent in paying an installment of its annual nursing home assessment fee, the commissioner shall initiate proceedings before the board in accordance with the Uniform Administrative Procedures Act, so that the board may suspend admissions to the facility or otherwise direct the facility to pay the assessment fee and any accrued penalties and interest in full within a prescribed period of time. If the facility does not pay the assessment fee and any accrued penalties and interest in full within the prescribed period of time as directed by the board, the board shall suspend admissions to the facility. Any suspension of admissions imposed according to this section shall immediately be lifted following the full payment of the assessment fee and any accrued penalties and interest by the facility. If full payment of the assessment fee and any accrued penalties and interest is not paid within sixty (60) days from the first day of the suspension of admissions, the commissioner shall be authorized to initiate proceedings before the board in accordance with the Uniform Administrative Procedures Act so that the board may consider the revocation of the facility's license.

(C) (i) In cases where a licensed nursing home is delinquent on assessment fees beginning July 1, 2009, and ending June 30, 2012, and is currently participating in a payment plan, the commissioner shall be authorized to reduce the amount of penalties and interest due for that time period to twenty-five percent (25%) of the total assessment fee outstanding balance as of June 30, 2012. For purposes of this subdivision (c)(7)(C), the total assessment fee outstanding balance is calculated as the total assessment fees owed not including any penalties and interest, less any payments made by the facility, beginning July 1, 2009, and ending June 30, 2012.

(ii) This subdivision (c)(7)(C) shall terminate on July 1, 2015, unless reenacted or extended by the general assembly prior to such date.

(8) The assessment fee imposed by this subsection (c) may not be billed by the nursing home as a separately stated charge, but this shall not prevent the nursing home from adjusting its rates to defray the cost associated with the assessment fee.

(9) The fiscal review committee shall review and have oversight of the implementation of this subsection (c).

(10) Enactment of this subsection (c) and any amendments to this subsection (c) shall not operate to excuse the monthly installment payment of the nursing home assessment fee due on July 15, 2013.

(11) Any assessment fee obligation imposed by this subsection (c) shall be suspended to the extent that, and for the period that receipt of the assessment fee by the state results in, a corresponding reduction in federal financial participation under Title XIX of the federal Social Security Act, compiled in 42 U.S.C. § 1396 et seq.

(12) The nursing home annual assessment fee established by this subsection (c) shall terminate on June 30, 2014.