Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-401-5

Penalties and Interest

Notice of Proposed Rule

(Amendment)

DAR File No.: 35583
Filed: 12/27/2011 09:13:22 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to implement penalties on nursing facilities that do not pay their Nursing Care Facility Assessment mandated by Utah Code Title 26, Chapter 35a, on a timely basis.

Summary of the rule or change:

This amendment outlines the penalties for delinquent deficiency assessments that include a suspension of all Medicaid payments, a negligence penalty, an intentional disregard penalty, and an intent to evade penalty.

State statutory or constitutional authorization for this rule:

• Section 26-18-3

Anticipated cost or savings to:

the state budget:

The Department anticipates a possible savings to the state budget as a result of this amendment. Nevertheless, there is not enough data to estimate how many nursing facilities will default on their assessment payments or what kinds of penalties they will incur.

local governments:

The Department anticipates a possible loss in revenue to local hospitals that default on their assessment payments. Nevertheless, there is not enough data to estimate how many of these hospitals will default or what kinds of penalties they will incur.

small businesses:

The Department anticipates a possible loss in revenue to nursing facilities that default on their assessment payments. Nevertheless, there is not enough data to estimate how many nursing facilities will default or what kinds of penalties they will incur.

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

The Department anticipates a possible loss in revenue to nursing facilities that default on their assessment payments. Nevertheless, there is not enough data to estimate how many nursing facilities will default or what kinds of penalties they will incur. Medicaid recipients will continue to receive nursing facility services and will not incur out-of-pocket expenses.

Compliance costs for affected persons:

The Department anticipates a possible loss in revenue to a single nursing facility or to a local hospital that defaults on its assessment payment. Nevertheless, there is not enough data to estimate the kinds of penalties that these facilities will incur. A Medicaid recipient will continue to receive nursing facility services and will not incur out-of-pocket expenses.

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

This rule amendment implements the penalties provided for by the Legislature and assures that all facilities are treated fairly and equally in the event that payment of the assessment is not made on a timely basis.

David Patton, PhD, 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
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 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:

02/14/2012

This rule may become effective on:

02/21/2012

Authorized by:

David Patton, Executive Director

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

R414-401. Nursing Care Facility Assessment.

R414-401-5. Penalties and Interest.

(1) 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. The Department shall suspend all Medicaid payments to a nursing facility until the facility pays the assessment due in full or until the facility and the Department reach a negotiated settlement.

(2) The Department shall charge a nursing facility a negligence penalty as prescribed in Subsection 26-35a-105(3)(a) if the facility does not pay in full (or file its report) within 45 days of a notice of deficiency of the assessment.

(3) The Department shall charge a nursing facility an intentional disregard penalty as prescribed in Subsection 26-35-105(3)(b) if the facility does not pay in full (or file its report) within 45 days of a notice of deficiency of the assessment two times within a 12-month period, or if the facility does not pay in full (or file its report) within 60 days of a notice of deficiency of the assessment.

(4) The Department shall charge a nursing facility an intent to evade penalty as prescribed in Subsection 26-35a-105(4) if the facility does not pay in full (or file its report) within 45 days of a notice of deficiency of the assessment three times with a 12-month period, or if the facility does not pay in full (or file its report) within 75 days of a notice of deficiency of the assessment.

 

KEY: Medicaid, nursing facility

Date of Enactment or Last Substantive Amendment: [July 1, 2011]2012

Notice of Continuation: June 25, 2009

Authorizing, and Implemented or Interpreted Law: 26-1-30; 26-35a; 26-18-3