Medicaid; directing establishment of certain nursing facility add-on rate under specified conditions; effective date; emergency.

Updated the legislative session designation from the 1st Session of 2025 to the 2nd Session of 2026.

Added a co-sponsor, Senator Pittman, to the bill's authorship list.

Changed the bill title from 'Committee Substitute' to 'Floor Substitute' and added 'Engrossed' to the description.

Adjusted page numbers and formatting headers to reflect the new version of the document.

Updated the document's request number from 12471 to 13235 and changed the bill date from February 10, 2025, to March 6, 2025, reflecting the committee's revision process.

All provisions regarding nursing facility staffing ratios, reimbursement calculations, and audit requirements were deleted.

A new 'Intergenerational Education Revolving Fund' was created within the State Treasury to support the new program.

A new 'Intergenerational Education Program' was established to award grants in the form of rate adjustments to qualifying nursing facilities.

The effective date was updated to July 1, 2025, replacing the original dates from 2000 and 2019.

New provisions authorize the Oklahoma Health Care Authority to promulgate rules and establish eligibility criteria for the grant program.

Removed the creation of the 'Intergenerational Education Revolving Fund' and the associated grant program for intergenerational education.

Added specific minimum direct-care staff-to-resident ratios for different times of day (morning, afternoon, and night) starting in 2000.

Modified staffing ratio requirements to be stricter over time, reducing the number of residents per staff member from 17 in 2000 to 6 in 2019.

Added provisions allowing facilities to use 24-hour-based scheduling with a minimum of 2.9 hours of direct care per resident per day.

Added enforcement mechanisms requiring facilities with staffing deficiencies or fraudulent reporting to maintain stricter ratios for three months before being allowed to use flexible scheduling.

Changed the effective date from July 1, 2025 to various dates starting in 2000, 2001, 2004, and 2019.

Removed language about budgeting and expenditure procedures for a new fund, replacing it with instructions for recalculating reimbursement rates based on historical costs.

Removed all specific staffing ratio requirements (e.g., 1 staff per 8 residents) and reimbursement calculation rules for nursing facilities.

Created a new 'Intergenerational Education Revolving Fund' within the State Treasury to support grant programs.

Established a competitive grant program aimed at expanding intergenerational education between nursing facilities and public school districts.

Changed the effective date of the act from January 1, 2020 (in the original) to July 1, 2025 (in the new version).

Removed all provisions related to the 'Children Services Improvements Act of 2025' and intergenerational education funds.

Added new requirements for nursing facilities to maintain specific minimum direct-care staff-to-resident ratios based on time of day and facility bed size.

Added a mandate for the Oklahoma Health Care Authority to recalculate reimbursement rates for nursing facilities using historical cost data and inflation factors.

Changed the effective dates and implementation schedules from a 2025 date to historical dates (2000-2003) and specific future dates (2019-2020) for staffing ratio enforcement.