DAR File No. 41054

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-504

Nursing Facility Payments

Notice of Proposed Rule

(Amendment)

DAR File No.: 41054
Filed: 12/07/2016 08:35:05 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to remove ambiguity and to clarify requirements for the Quality Improvement (QI) Incentive applications.

Summary of the rule or change:

This amendment includes language that removes ambiguity and clarifies requirements for the QI Incentive applications.

Statutory or constitutional authorization for this rule:

• Title 26, Chapter 35a
• Section 26-1-5

Anticipated cost or savings to:

the state budget:

There is no budget impact because the changes to this rule do not alter the overall amount of state and federal funds that regulated health care facilities may receive.

local governments:

There is no budget impact because the changes to this rule do not alter the overall amount of state and federal funds that local government-operated health care facilities may receive.

small businesses:

The aggregate amount that the Department pays to Medicaid-certified nursing homes does not change. This amendment impacts small and large businesses equally. Nursing homes that take advantage of the incentives will receive more than nursing homes that do not. The total incentive amount available to nursing homes is $5,475,900, which is reserved from the base rate budget for nursing homes. The incentives positively impact the treatment that nursing home residents receive.

persons other than small businesses, businesses, or local governmental entities:

The aggregate amount that the Department pays to Medicaid-certified nursing homes does not change. Nursing homes that take advantage of the incentives will receive more than nursing homes that do not. The total incentive amount available to nursing homes is $5,475,900, which is reserved from the base rate budget for nursing homes. The incentives positively impact the treatment that nursing home residents receive.

Compliance costs for affected persons:

There are no compliance costs because there are only increases in funds for a nursing facility that takes advantage of the quality improvement incentives that are available, and the references to the Utah Medicaid State Plan do not alter the operation of the program.

Comments by the department head on the fiscal impact the rule may have on businesses:

The rule amendment would have a positive fiscal impact for any business who voluntarily submits an application for quality improvement incentives in that it clarifies the application process to qualify for the incentives.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at [email protected]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

01/31/2017

This rule may become effective on:

02/07/2017

Authorized by:

Joseph Miner, Executive Director

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-504. Nursing Facility Payments.

R414-504-4. Quality Improvement Incentive.

(1) Reimbursement for Nursing Home Quality Improvement Incentives is in accordance with Attachment 4.19-D of the Utah Medicaid State Plan, which is incorporated by reference in Rule R414-1.

(2) Division staff are not required to request additional information relating to any application submission.

(3) Providers shall ensure all necessary information is included in the application in order to qualify.

(4) For applications received and reviewed by division staff prior to the annual submision deadline, if the application is incorrect or lacks sufficient supporting documentation, then the application shall be denied. If it is received prior to the annual submission deadline, the provider may submit a subsequent application that includes all needed supporting documentation for consideration.

(5) For applications received prior to the annual submission deadline and reviewed by division staff after the annual submission deadline, then the provider's application may be considered for qualification of a reduced amount, where possible, based on the submitted documentation.

(6) In all cases, no additional applications, documentation or explanation will be accepted if submitted after the annual submission deadline.

 

R414-504-5. Reimbursement for Intermediate Care Facilities for the Mentally Retarded.

The following principles apply to the payment of community-based intermediate care facilities for the mentally retarded (ICF/MRs) that are licensed under [Utah Code]Section 26-21-13.5:

(1) The Department pays approximately 93% of the aggregate payments to ICF/MRs based on a prospective flat rate established in Utah State Plan Attachment 4.19-D. The Department pays the balance as a property cost component calculated by the Fair Rental Value system pursuant to Section R414-504-3.

(2)(a) Reimbursement for the ICF/MR Quality Improvement Incentive is in accordance with Attachment 4.19-D of the Utah Medicaid State Plan, which is incorporated by reference in Rule R414-1.

(b) Division staff are not required to request additional information relating to any application submission.

(c) Providers shall ensure all necessary information is included in the application in order to qualify.

(d) For applications received and reviewed by division staff prior to the annual submission deadline, if the application is incorrect or lacks sufficient supporting documentation, then the application shall be denied. If it is received prior to the annual submission deadline, the provider may submit a subsequent application that includes all needed supporting documentation for consideration.

(e) For applications received prior to the annual submission deadline and reviewed by division staff after the annual submission deadline, then the provider's application may be considered for qualification of a reduced amount, where possible, based on the submitted documentation.

(f) In all cases, no additional applications, documentation or explanation will be accepted if submitted after the annual submission deadline.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [July 1, 2011]2017

Notice of Continuation: November 14, 2012

Authorizing, and Implemented or Interpreted Law: 26-1-5; [26-18-3;]26-35a