DAR File No. 43687

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-401

Nursing Care Facility Assessment

Notice of Proposed Rule

(Amendment)

DAR File No.: 43687
Filed: 05/01/2019 03:38:52 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to update the annual assessment amounts for nursing care facilities and intermediate care facilities for individuals with intellectual disabilities (ICFs/IID) for state fiscal year (SFY) 2020. The other purpose is to update reporting requirements, payment procedures, and penalties for failure to pay in full.

Summary of the rule or change:

In Subsection R414-401-3(2), every nursing facility is assessed at the uniform rate of $24.61 per patient day, which is an increase from the previous $23.04 per patient day assessment, based upon projected days. In Subsection R414-401-3(2), ICFs/IID are assessed at the uniform rate of $8.28 per patient day, which is a decrease from the previous $9.71 per patient day assessment, based upon projected days. These updates are based on estimates of patient days for SFY 2020 and the appropriation amounts. This amendment also updates facility reporting requirements, specifies remittance deadlines and procedures, and clarifies penalties for failure to pay within specified time periods.

Statutory or constitutional authorization for this rule:

• Section 26-18-3
• Title 26, Chapter 35a

Anticipated cost or savings to:

the state budget:

The update to the assessment rates is anticipated to be state budget neutral as it does not impact general funds. Additionally, there are no costs or savings associated with reporting requirements, as nursing care facilities and ICFs/IID already track census data for billing and reimbursement purposes.

local governments:

Local governments that own nursing care facilities or have swing bed facilities would see an increase in the assessment cost, but would also realize increased revenues as a result of the higher rates that will be paid. Therefore, it is estimated that local government will realize an additional $984,510 in costs; however, would realize approximately $2,943,135 in additional revenues. Additionally, there are no costs or savings associated with reporting requirements, as nursing care facilities and ICFs/IID already track census data for billing and reimbursement purposes.

small businesses:

Small businesses that own nursing care facilities would see an increase in the assessment cost, but would also realize increased revenues as a result of the higher rates that will be paid. Therefore, it is estimated that small businesses will realize an additional $218,780 in costs; however, would realize approximately $654,030 in additional revenues. ICFs/IID will realize a decreased cost based upon the decrease in the assessment rate. Inasmuch as patient days are variable, it is not possible to determine the decreased cost that will be realized by these facilities. Additionally, there are no costs or savings associated with reporting requirements, as nursing care facilities and ICFs/IID already track census data for billing and reimbursement purposes.

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

Businesses that own nursing care facilities or have swing bed facilities would see an increase in the assessment cost, but would also realize increased revenues as a result of the higher rates that will be paid. Therefore, it is estimated that businesses will realize an additional $984,510 in costs; however, would realize approximately $2,943,135 in additional revenues. ICFs/IID will realize a decreased cost based upon the decrease in the assessment rate. Inasmuch as patient days are variable, it is not possible to determine the decreased cost that will be realized by these facilities. Additionally, there are no costs or savings associated with reporting requirements, as nursing care facilities and ICFs/IID already track census data for billing and reimbursement purposes.

Compliance costs for affected persons:

Compliance costs include an increased collection of $1.57 per non-Medicare patient day from each nursing facility, and a decrease of $1.43 per qualifying patient day for an ICF/IID. The overall gain for nursing each Medicaid-certified nursing facility depends on the size of the facility and the patient days provided. At a high level, an average facility could realize an increase in revenues of approximately $50,610 per year. In addition, there would be an increase in costs to non-Medicaid-certified facilities as those facilities would be assessed the higher amount, and would not realize any payments from Medicaid. The average non-Medicaid-certified nursing facility would pay an additional $909 per year in assessment. Moreover, a nursing care facility or ICF/IID will not see costs associated with reporting requirements, as these facilities already track census data for billing and reimbursement purposes.

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

Businesses may see both an increase and decrease in costs due to the assessment rates, but it is not possible to provide an estimate due to the variability of patient days.

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 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:

06/14/2019

This rule may become effective on:

07/01/2019

Authorized by:

Joseph Miner, Executive Director

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs	FY 2020	FY 2021	FY 2022
State Government	$0	$0	$0
Local Government	$984,510	$0	$0
Small Businesses	$218,780	$0	$0
Non-Small Businesses	$984,510	$0	$0
Other Persons	$0	$0	$0
Total Fiscal Costs:	$2,187,800	$0	$0
Fiscal Benefits
State Government	$0	$0	$0
Local Government	$2,943,135	$0	$0
Small Businesses	$654,030	$0	$0
Non-Small Businesses	$2,943,135	$0	$0
Other Persons	$0	$0	$0
Total Fiscal Benefits:	$6,540,300	$0	$0
Net Fiscal Benefits:	$4,352,500	$0	$0

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described in the narrative. Inestimable impacts for Non - Small Businesses are described in Appendix 2.

 

Appendix 2: Regulatory Impact to Non - Small Businesses

205 non-small business providers of nursing facility care and intermediate care for individuals with intellectual disabilities, will see both an increase and decrease in costs due to assessment rates. Overall,the assessment will increase revenue by about $1,958,625.

 

 

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) This rule implements reporting requirements, which allow the Department to have the required occupancy information needed to evaluate requests under Title 26, Chapter 18, Part 5.

([2]3) The rule is authorized by Section 26-1-30 , [and Utah Code ]Title 26, Chapter 35a , and Title 26, Chapter 18, Part 5.

 

R414-401-2. Definitions.

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

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

(3) The definitions in Section 26-18-501 apply to the reporting and auditing requirements found in Section R414-401-4.

 

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 $[23.04]24.61 per non-Medicare patient day provided by the facility, except that intermediate care facilities for people with intellectual disabilities shall be assessed at the uniform rate of $[9.71]8.28 per patient day. Swing bed facilities shall be assessed the uniform rate for nursing facilities.[ 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, and shall not combine payments of assessments with other nursing care facilities owned or controlled by a single entity.

[(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.

Facilities subject to the assessment in Title 26, Chapter 35a, shall submit one report for each facility. The reporting and auditing requirements are as follows:

(1) Each nursing care facility, shall[,] file with the Department a report for the month 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]the 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]shall not 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]6) Providers may update previously submitted patient day assessment reports for 90 days following the original submission date.

(7) Penalties for failure to submit the report are described in Section R432-150-8.

 

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 are provided in 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, 2018]2019

Notice of Continuation: November 15, 2018

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