Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-401

Nursing Care Facility Assessment

Notice of Proposed Rule

(Amendment)

DAR File No.: 33594
Filed: 04/29/2010 03:36:12 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The 2010 Utah Legislature increased appropriations for this program through an increase to the assessment on Medicaid beds in nursing facilities. This change implements that assessment increase.

Summary of the rule or change:

In Subsection R414-401-3(2), nonintermediate care facilities for the mentally retarded are assessed at the uniform rate of $12.25 per patient day, which is an increase from the previous $10.20 per patient day assessment. This change becomes effective 07/01/2010. This increase in assessment allows for the appropriated increase in reimbursement rates and for the change in assessment for hospice stays in nursing homes that are paid at the higher, assessment increased, reimbursement rates. In Subsection R414-401-4(7), a provision is added to allow providers to amend previously submitted assessment reports for 90 days following original submission.

State statutory or constitutional authorization for this rule:

• Section 26-18-3

Anticipated cost or savings to:

the state budget:

Budget neutral due to collection of $983,400 total funds from nursing and swing bed facilities and an increase in state-funded reimbursement of $983,400 total funds to nursing home and swing bed facilities.

local governments:

Local hospitals with swing beds will also have no increased revenue. Funding will be applied for swing bed reimbursement rates beginning in calendar year 2011. Inasmuch as swing beds are variable, it is not possible to determine the additional funding that will be made available to these facilities.

small businesses:

Nursing facility providers for small businesses will see a net enhanced revenue of approximately $700,000 as a result of increased federal matching funds. In addition, there is an estimated increase in cost of $21,678 to non-Medicaid certified facilities, based on four facilities and an estimated number of 10,579 patient days.

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

Nursing facility providers will see a net enhanced revenue of approximately $700,000 as a result of increased federal matching funds. In addition, there is an estimated increase in cost of $21,678 to non-Medicaid certified facilities, based on four facilities and an estimated number of 10,579 patient days.

Compliance costs for affected persons:

Compliance costs include an increased collection of $2.05 per non-Medicare patient day from each nursing facility. This increase in the assessment collection will be used to draw down federal matching funds. All Medicaid certified nursing and swing bed facilities will gain from this process. The amount of gain depends on the number of Medicaid patients in the facility. In addition, there is an average cost of $5,420 to four non-Medicaid certified facilities.

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

This assessment supported by the majority of long term care facilities will generate additional revenue for Medicaid certified facilities to support care of Medicaid recipients.

David Patton, Acting Executive Director

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

Health
Health Care Financing, Coverage and Reimbursement Policy
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 cdevashrayee@utah.gov

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:

06/14/2010

This rule may become effective on:

06/21/2010

Authorized by:

David Sundwall, Executive Director

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

R414-401. Nursing Care Facility Assessment.

R414-401-1. Introduction and Authority.

(1) This rule implements the assessment imposed on certain nursing care facilities by Utah Code Title 26, Chapter 35a.

(2) The rule is authorized by Section 26-1-30 and Utah Code Title 26, Chapter 35a.

 

R414-401-2. Definitions.

(1) The definitions in Section 26-35a-103 apply to this rule.

(2) The definitions in R414-1 apply to this rule.

 

R414-401-3. Assessment.

(1) The collection agent for the nursing care facility assessment shall be the Department, which is vested with the administration and enforcement of the assessment.

(2) The uniform rate of assessment for every facility is [$10.20]$12.25 per non-Medicare patient day provided by the facility, except that intermediate care facilities for the mentally retarded shall be assessed at the uniform rate of $6.53 per patient day. Swing bed facilities shall be assessed the uniform rate for nursing facilities effective January 1, 2006. The Utah State Veteran's Home is exempted from this assessment and this rule.

(3) Each nursing care facility must pay its assessment monthly on or before the last day of the next succeeding month.

(4) The Department shall extend the time for paying the assessment to the next month succeeding the federal approval of a Medicaid State Plan Amendment allowing for the assessment, and consequent reimbursement rate adjustments.

 

R414-401-4. Reporting and Auditing Requirements.

(1) Each nursing care facility shall, on or before the end of the succeeding month, file with the Department a report for the month, and shall remit with the report the assessment required to be paid for the month covered by the report.

(2) Each report shall be on the Department-approved form, and shall disclose the total number of patient days in the facility, by designated category, during the period covered by the report.

(3) Each nursing care facility shall supply the data required in the report and certify that the information is accurate to the best of the representative's knowledge.

(4) Each nursing care facility subject to this assessment shall maintain complete and accurate records. The Department may inspect each nursing care facility's records and the records of the facility's owners to verify compliance.

(5) Separate nursing care facilities owned or controlled by a single entity may combine reports and payments of assessments provided that the required data are clearly set forth for each separately reporting nursing care facility.

(6) The Department shall extend the time for making required reports to the next month succeeding the federal approval of a Medicaid State Plan Amendment allowing for the assessment, and consequent reimbursement rate adjustments.

(7) Providers may update previously submitted patient day assessment reports for 90 days following the original submission date.

 

R414-401-5. Penalties and Interest.

The penalties for failure to file a report, to pay the assessment due within the time prescribed, to pay within 30 days of a notice of deficiency of the assessment, for underpayment of the assessment, for intent to evade the assessment are as provided in Utah Code Section 26-35a-105.

 

KEY: Medicaid, nursing facility

Date of Enactment or Last Substantive Amendment: [July 1, 2009]2010

Notice of Continuation: June 25, 2009

Authorizing, and Implemented or Interpreted Law: 26-1-30; 26-35a