File No. 34766
This rule was published in the May 15, 2011, issue (Vol. 2011, No. 10) of the Utah State Bulletin.
Health, Health Care Financing, Coverage and Reimbursement Policy
Rule R414-504
Nursing Facility Payments
Notice of Proposed Rule
(Amendment)
DAR File No.: 34766
Filed: 05/02/2011 05:10:44 PM
RULE ANALYSIS
Purpose of the rule or reason for the change:
The purpose of this change is to update the Quality Improvement Incentive programs for state fiscal year 2012. It also simplifies the rule by removing language that is repeated in both this rule and Attachment 4.19-D of the Utah Medicaid State Plan. The Utah Medicaid State Plan is a federal requirement outlining how the Medicaid program operates in a state.
Summary of the rule or change:
This amendment removes language regarding the calculation of rates for nursing facilities; Quality Improvement Incentive programs for nursing care facilities and intermediate care facilities for the mentally retarded in state fiscal year 2012 and replaces it with references to Attachment 4.19-D of the Utah Medicaid State Plan, which is incorporated by reference in Rule R414-1.
State statutory or constitutional authorization for this rule:
- Section 26-1-5
- Section 26-18-3
- Title 26, Chapter 35a
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:
Implementation of the current incentive program authorized by this rule will have a positive fiscal impact on business.
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:
HealthHealth 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:
06/14/2011
This rule may become effective on:
06/21/2011
Authorized by:
David Patton, Executive Director
RULE TEXT
R414. Health, Health Care Financing, Coverage and Reimbursement Policy.
R414-504. Nursing Facility Payments.
R414-504-3. Principles of Facility Case Mix Rates and Other Payments.
The following principles apply to the payment of freestanding and provider based nursing facilities for services rendered to nursing care level I, II, and III Medicaid patients, as defined in Rule R414-502. This rule does not affect the system for reimbursement for intensive skilled Medicaid patient add-on amounts.
(1) Approximately 59% of total payments in aggregate to nursing facilities for nursing care level I, II and III Medicaid patients are based on a prospective facility case mix rate. In addition, these facilities shall be paid a flat basic operating expense payment equal to approximately 29% of the total payments. The balance of the total payments will be paid in aggregate to facilities as required by Section R414-504-3 based on other authorized factors, including property and behaviorally complex residents, in the proportion that the facility qualifies for the factor.
(2) Each quarter, the Department shall calculate a new case mix index for each nursing facility. The case mix index is based on three months of MDS assessment data. The newly calculated case mix index is applied to a new rate at the beginning of a quarter according to the following schedule:
(a) January, February and March MDS assessments are used for July 1 rates.
(b) April, May and June MDS assessments are used for October 1 rates.
(c) July, August and September MDS assessments are used for January 1 rates.
(d) October, November and December MDS assessments are used for April 1 rates.
(3) MDS data is used in calculating each facility's case mix index. This information is submitted by each facility and, as such, each facility is responsible for the accuracy of its data. The Department may exclude inaccurate or incomplete MDS data from the calculation.
(4) MDS assessments for recipients who are eligible for the "Intensive Skilled" add-on are excluded from the case mix calculation. A facility with less than 20 percent of its total census days as Medicaid days, as reported on its FCP or FRV data report, is excluded from the state case mix average. The state average case mix index is used to set the rate for that facility.
(5) A facility may apply for a special add-on rate for behaviorally complex residents by filing a written request with the Division of Health Care Financing. The Department may approve an add-on rate if an assessment of the acuity and needs of the patient demonstrates that the facility is not adequately reimbursed by the RUGS score for that patient. The rate is added on for the specific resident's payment and is not subsumed as part of the facility case mix rate. Utah's Bureau of Health Facility Licensure, Certification and Resident Assessment will make the determination as to qualification for any additional payment. The Division of Health Care Financing shall determine the amount of any add-on.
(6) Property costs are paid separately from the RUGS rate.
(7)
Reimbursement for nursing home rates is in accordance with
Attachment 4.19-D of the Utah Medicaid State Plan, which is
incorporated by reference in Rule R414-1.[Property costs shall be calculated once per year, each July
1, and reimbursed as a component of the facility rate based on an
FRV System.
(a) Under this FRV system, the Department reimburses a
facility based on the estimated value of its capital assets in
lieu of direct reimbursement for depreciation, amortization,
interest, and rent or lease expenses. The FRV system establishes
a nursing facility's bed value based on the age of the
facility and total square footage.
(i) The initial age of each nursing facility used in the
FRV calculation is determined as of September 15, 2004, using
each facility's initial year of construction.
(ii) The age of each facility is adjusted each July 1 to
make the facility one year older.
(iii) The age is reduced for replacements, major
renovations, or additions placed into service since the facility
was built, as reported on the FRV Data Report, provided there is
sufficient documentation to support the historical
changes.
(A) If a facility adds new beds or replaces existing
beds, these beds are averaged into the age of the original beds
to arrive at the facility's age. Bed additions and bed
replacements must be completed within a 24-month period and be
reported on an FRV Data Report for the reporting period used for
the July 1 rate year.
(B) If a facility completed a major renovation, the cost
of the project is represented by an equivalent number of new
beds.
(I) The renovation must have been completed during a
24-month period and reported on an FRV Data Report for the
reporting period used for the July 1 rate year and be related to
the reasonable functioning of the nursing facility. Renovations
unrelated to either the direct or indirect functioning of the
nursing facility shall not be used to adjust the facility's
age.
(II) The equivalent number of new beds is determined by
dividing the cost of the project by the accumulated depreciation
per bed of the facility's existing beds immediately before
the project.
(III) The equivalent number of new beds is then
subtracted from the total actual beds. The result is multiplied
by the difference in the year of the completion of the project
and the age of the facility, which age is based on the initial
construction year or the last reconstruction or renovation
project. The product is then divided by the actual number of beds
to arrive at the number of years to reduce the age of the
facility.
(b) A nursing facility's fair rental value per diem
is calculated as follows:
As used in this subsection (b), "capital index"
is the percent change in the nursing home "Per bed or
person, total cost" row and "3/4" column as found
in the two most recent annual R.S. Means Building Construction
Cost Data as adjusted by the weighted average total city cost
index for Salt Lake City, Utah.
(i) The buildings and fixtures value per licensed bed is
$50,000, which is based upon a standard facility size of at least
450 square feet determined using the R.S. Means Building
Construction Cost Data adjusted by the weighted average total
city cost index for Salt Lake City, Utah. To this $50,000 is
added 10% ($5,000) for land and 10% ($5,000) for movable
equipment. Each nursing facility's total licensed beds are
multiplied by this amount to arrive at the "total bed
value." The total bed value is trended forward by
multiplying it by the capital index and adding it to the total
bed value to arrive at the "newly calculated total bed
value." The newly calculated total bed value is depreciated,
except for the portion related to land, at 1.50 percent per year
according to the weighted age of the facility. The maximum age of
a nursing facility shall be 35 years. There shall be no recapture
of depreciation. The base value per licensed bed is updated
annually using the R.S. Means Building Construction Cost Data as
noted above. Beginning July 1, 2008, the 2007 base value per
licensed bed is used for all facilities, except facilities having
completed a qualifying addition, replacement or major renovation.
These qualifying facilities have that year's base value per
licensed bed used in their FRV calculation until an additional
qualifying addition, replacement or major renovation project is
completed and reported, at which time the base value is updated
again.
(ii) A nursing facility's annual FRV is calculated by
multiplying the facility's newly calculated bed value times a
rental factor. The rental factor is the sum of the 20-year
Treasury Bond Rate as published in the Federal Reserve Bulletin
using the average for the calendar year preceding the rate year
and a risk value of three percent. Regardless of the result
produced in this subsection (ii), the rental factor shall not be
less than nine percent or more than 12 percent.
(iii) The facility's annual FRV is divided by the
greater of:
(A) the facility's annualized actual resident days
during the cost reporting period; and
(B) for rural providers, 65 percent of the annualized
licensed bed capacity of the facility and, for urban providers,
85 percent of the annualized licensed bed capacity of the
facility.
(iv) The FRV per diem determined under this fair rental
value system shall be no lower than $8.
(c) A pass-through component of the rate is applied and
is calculated as follows:
(i) The nursing facility's per diem real property tax
and real property insurance cost is determined by dividing the
sum of the facility's allowable real property tax and real
property insurance costs, as reported in the most recent FCP or
FRV Data Report, as applicable, by the facility's actual
total patient days.
(ii) For a newly constructed or newly certified facility
that has not submitted an FCP or FRV Data Report that would be
used in the rate period, the per diem real property tax and real
property insurance is the state average daily real property tax
and real property insurance cost of all facilities.
(8) Newly constructed or newly certified facilities'
case mix component of the rate shall be paid using the average
case mix index. This average case mix index remains in place
until sufficient MDS data exist for the facility to calculate the
case mix as described in R414-504-3(2). At the following
quarter's rate setting, the Department shall issue a new case
mix adjusted rate. The property payment to the facility is
controlled by R414-504-3(7).
(9) An existing facility acquired by a new owner will
continue at the same case mix index and property cost payment
established for the facility under the previous ownership for the
remainder of the quarter.
(a) The subsequent quarter's case mix index is
established using the prior ownership facility MDS data until
sufficient MDS data exist for the facility to calculate the case
mix as described in R414-504-3(2).
(b) The property component is calculated for the facility
at the beginning of the next state fiscal year, as noted in
R414-504-3(7).]
[(10)](8) A sole community provider that is financially distressed
may apply for a payment adjustment above the case mix index
established rate. The maximum increase will be 7.5% above the
average of the most recent Medicaid daily rate for all Medicaid
residents in all freestanding nursing facilities in the state. The
maximum duration of this adjustment is for no more than a total of
12 months per facility in any five-year period.
(a) The application shall propose what the adjustment should be and include a financial review prepared by the facility documenting:
(i) the facility's income and expenses for the past 12 months; and
(ii) specific steps taken by the facility to reduce costs and increase occupancy.
(b) Financial support from the local municipality and county governing bodies for the continued operation of the facility in the community is a necessary prerequisite to an acceptable application. The Department, the facility and the local governing bodies may negotiate the amount of the financial commitment from the governing bodies, but in no case may the local commitment be less than 50% of the state share required to fund the proposed adjustment. Any continuation of the adjustment beyond 6 months requires a local commitment of 100% of the state share for the rate increase above the base rate. The applicant shall submit letters of commitment from the applicable municipality or county, or both, committing to make an intergovernmental transfer for the amount of the local commitment.
(i) If the governmental agency receives donations in order to provide the financial contribution, it must document that the donations are "bona fide" as set forth in 42 CFR 433.54.
(c) The Department may conduct its own independent financial review of the facility prior to making a decision whether to approve a different payment rate.
(d) If the Department determines that the facility is in imminent peril of closing, it may make an interim rate adjustment for up to 90 days.
(e) The Department's determination shall be based on maintaining access to services and maintaining economy and efficiency in the Medicaid program.
(f) If the facility desires an adjustment for more than 90 days, it must demonstrate that:
(i) the facility has taken all reasonable steps to reduce costs, increase revenue and increase occupancy;
(ii) despite those reasonable steps the facility is currently losing money and forecast to continue losing money; and
(iii) the amount of the approved adjustment will allow the facility to meet expenses and continue to support the needs of the community it serves, without unduly enriching any party.
(g) If the Department approves an interim or other adjustment, it shall notify the facility when the adjustment is scheduled to take effect and how much contribution is required from the local governing bodies. Payment of the adjustment is contingent on the facility obtaining a fully executed binding agreement with local governing bodies to pay the contribution to the Department.
(h) The Department may withhold or deny payment of the interim or other adjustment if the facility fails to obtain the required agreement prior to the scheduled effective date of the adjustment.
[(11)](9) A provider may challenge the rate set pursuant to this
rule using the appeal in
Rule R410-14. This applies to which rate methodology is used
as well as to the specifics of implementation of the methodology. A
provider must exhaust administrative remedies before challenging
rates in any other forum.
[(12)](10) In developing payment rates, the Department may adjust
urban and non-urban rates to reflect differences in urban and
non-urban labor costs. The urban labor costs reimbursement cannot
exceed 106% of the non-urban labor costs. Labor costs are as
reported on the most recent FCP but do not include FCP-reported
management, consulting, director, and home office fees.
[(13)](11) The Department reimburses swing beds, transitional care
unit beds, and small health care facility beds that are used as
nursing facility beds, using the prior calendar year state-wide
average of the daily nursing facility rate.
[(14)](12) Withholding of Title XIX payments
(a) The Department may withhold Title XIX payments from providers if:
(i) there is a shortage in a resident trust account managed by the facility;
(ii) the facility fails to submit a complete and accurate FCP as required by Utah State Plan Attachment 4.19-D, Section 332;
(iii) the facility fails to submit timely, accurate Minimum Data Set (MDS) data;
(iv) the facility owes money to the Division of Health Care Financing because of an overpayment, nursing care facility assessment, civil money penalty, or other offset; or
(v) the facility fails to respond within ten business days to requests for information relating to desk review or audit findings relating to the facility's submitted FCP or FRV Data Report.
(b) For ongoing operations, the Department will provide notice before withholding payments. The Department and provider may negotiate a repayment schedule acceptable to the Department for monies owed to the Department listed in subsection (a)(iv). The repayment schedule may not exceed 180 days.
(c) When the Department rescinds withholding of payments to a facility, it will resume payments according to the regular claims payment cycle.
R414-504-4. Quality Improvement Incentive.
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.
[
(1) The incentive period is from July 1, 2010 through May
31, 2011.
(2) In order for a facility to qualify for any Quality
Improvement Incentive or initiative in subsections (3) or
(4):
(a) The application form and all supporting documentation
for that Incentive or Initiative must be faxed in or mailed with
a postmark during the incentive period. Failure to include all
required supporting documentation precludes a facility from
qualification.
(b) Facilities choosing to mail in applications and
supporting documentation are responsible to ensure that documents
are mailed to the correct address, as follows:
Via United States Postal Service
Utah Department of Health
DHCF, BCRP
Attn: Reimbursement Unit
P.O. Box 143102
Salt Lake City, UT 84114-3102
Via United Parcel Service or Federal Express
Utah Department of Health
DHCF, BCRP
Attn: Reimbursement Unit
288 North 1460 West
Salt Lake City, UT 84116-3231
(c) The facility must clearly mark and organize all
supporting documentation to facilitate review by Department
staff.
(3)(a) Upon federal approval of the Nursing Care
Facilities State Plan Amendment for the quality program outlined
in this subsection (3), funds in the amount of $1,000,000 shall
be set aside from the base rate budget annually to reimburse
current Medicaid certified non-ICF/MR facilities that
have:
(i) a meaningful quality improvement plan which includes
the involvement of residents and family;
(ii) a demonstrated process of assessing and measuring
that plan;
(iii) customer satisfaction surveys conducted by an
independent third-party in each quarter of the incentive period,
along with an action plan addressing survey items rated below
average for the year;
(iv) a plan for culture change along with an example of
how the facility has implemented culture change;
(v) an employee satisfaction program;
(vi) no violations that are at an "immediate
jeopardy" level, as determined by the Department, at the
most recent re-certification survey and during the incentive
period;
(vii) a facility that receives a substandard quality of
care level F, H, I, J, K, or L during the incentive period is
eligible for only 50% of the possible reimbursement. A facility
receiving substandard quality of care level F, H, I, J, K, or L
in more than one survey during the incentive period is ineligible
for reimbursement under this incentive.
(b) The Department shall distribute incentive payments to
qualifying, current Medicaid certified facilities based on the
proportionate share of the total Medicaid patient days in
qualifying facilities.
(c) If a facility seeks administrative review of the
determination of a survey violation, the incentive payment will
be withheld pending the final administrative adjudication. If
violations are found not to have occurred, the incentive payment
will be paid to the facility. If the survey findings are upheld,
the remaining incentive payments will be distributed to all
qualifying facilities.
(4) Upon federal approval of the Nursing Care Facilities
State Plan Amendment for the quality program outlined in this
subsection (4) and in addition to the above incentive, funds in
the amount of $4,275,900 shall be set aside from the base rate
budget in state fiscal year 2011 for use in state fiscal year
2011.
(a) Qualifying, current Medicaid certified providers may
receive up to $590.43 total, across all initiatives in Subsection
R414-504-4(4), for each Medicaid certified bed. The Medicaid
certified bed count used for each facility for this incentive and
for each initiative in this incentive is the count in the
facility as at the beginning of the incentive period.
(b) A facility may not receive more for any initiative
than its documented costs for that initiative.
(c) In order to qualify for any of the quality
improvement initiatives in Subsection R414-504-4(4)(d):
(i) Each item purchased under initiatives (i) through
(iii) of Subsection R414-504-4(4)(d) must be purchased by the end
of the incentive period, and installed during the incentive
period. Each item purchased under initiatives (iv) to (ix) of
Subsection R414-504-4(d) must be purchased by the end of the
incentive period, and installed between July 1, 2009, and May 31,
2011.
(ii) A facility, with its application, must submit a
detailed description of the functionality of each item purchased,
attesting to its meeting all of the criteria for that
initiative.
(iii) A facility, with its application, must submit
detailed documentation supporting all purchase, installation and
training costs for the initiative. This documentation must
include invoices and proof of purchase (i.e. copies of cancelled
checks, credit card slips, etc.).
(iv) A facility must clearly mark and organize all
supporting documentation to facilitate review by Department
staff.
(d) Each Medicaid provider may apply for the following
quality improvement initiatives:
(i) Incentive for facilities to purchase or enhance nurse
call systems. Qualifying Medicaid providers may receive up to
$391 for each Medicaid certified bed. Qualifying criteria include
the following:
(A) The nurse call system is compliant with approved
"Guidelines for Design and Construction of Health Care
Facilities."
(B) The nurse call system does not primarily use overhead
paging; rather a different type of paging system is used. The
paging system could include pagers, cell phones, Personal Digital
Assistant devices, hand-held radio, etc. If radio frequency
systems are used, consideration should be given to
electromagnetic compatibility between internal and external
sources.
(C) The nurse call system shall be designed so that a
call activated by a resident will initiate a signal distinct from
the regular staff call system and that can be turned off only at
the resident's location.
(D) The signal shall activate an annunciator panel or
screen at the staff work area or other appropriate location, and
either a visual signal in the corridor at the resident's door
or other appropriate location, or staff pager indicating the
calling resident's name and/or room location, and at other
areas as defined by the functional program.
(E) The nurse call system must be capable of tracking and
reporting response times, such as the length of time from the
initiation of the call to the time a nurse enters the room and
answers the call.
(ii) Incentive for facilities to purchase new patient
lift systems capable of lifting patients weighing up to 400
pounds each. Qualifying Medicaid providers may receive up to $45
for each Medicaid certified bed per patient lift, with a maximum
of $90 for each Medicaid certified bed.
(iii) Incentive for facilities to purchase new patient
bathing systems. Qualifying Medicaid providers may receive up to
$110 for each Medicaid certified bed.
(A) To quality, a facility must, at a minimum, purchase
one new side-entry bathing system that allows the resident to
enter the bathing system without having to step over or be lifted
into the bathing area.
(iv) Incentive for facilities to purchase or enhance
patient life enhancing devices. Qualifying Medicaid providers may
receive up to $495 for each Medicaid certified bed. Patient life
enhancing devices must be one or more of the following:
(A) Telecommunication enhancements primarily for patient
use. This may include land lines, wireless telephones, voice mail
and push to talk devices. Overhead paging, if any, must be
reduced.
(B) Wander management systems and patient security
enhancement devices.
(C) Computers and game consoles for patient use.
(D) Garden enhancements.
(E) Furniture enhancements for patients.
(v) Incentive for facilities to educate staff on quality.
Qualifying Medicaid providers may receive up to $110 for each
Medicaid certified bed. The education or training must:
(A) Be provided by an industry recognized organization,
and
(B) Have a patient centered perspective focused on
improving quality of life or care for patients.
(vi) Incentive for facilities to purchase or make
improvements to vans and van equipment for patient use.
Qualifying Medicaid providers may receive up to $320 for each
Medicaid certified bed.
(vii) Incentive for facilities to:
(A) Purchase or lease new or enhance existing clinical
information systems software, which incorporates advanced
technology into improved patient care including better
integration, capture of more information at the point of care,
more automated reminders etc. Qualifying Medicaid providers may
receive up to $109 for each Medicaid certified bed. The following
clinical tracking minimum requirements must all be included in
the software:
(I) Care plans;
(II) Current conditions;
(III) Medical orders;
(IV) Activities of daily living;
(V) Medication administration records;
(VI) Timing of medications;
(VII) Medical notes; and
(VIII) Point of care data tracking.
(B) Purchase or lease new or enhance existing clinical
information systems hardware. Qualifying Medicaid providers may
receive up to $90 for each Medicaid certified bed. The hardware
must facilitate the tracking of patient care and integrate the
collection of data into clinical information systems software
that meets all the tracking criteria in Subsection
R414-504-4(4)(d)(vii)(A).
(viii) Incentive for facilities to purchase a new or
enhance its existing heating, ventilating, and air conditioning
system (HVAC). Qualifying Medicaid providers may receive up to
$162 for each Medicaid certified bed.
(ix) Incentive for facilities to use innovative means to
improve the residents' dining experience. These changes may
include meal ordering, dining times or hours, atmosphere, more
food choices etc. Qualifying Medicaid providers may receive up to
$111 for each Medicaid certified bed.
(A) A facility, with its application, must submit a
detailed description of the changes along with supporting
documentation and proof of costs incurred.
(B) Costs under this initiative are limited to
incremental costs resulting from the dining program
changes.
]
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 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 R414-504-3.
(2)
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.[The incentive period is from July 1, 2010, through May 31,
2011.
(3)(a) The Department shall set aside $200,000 annually
from the base rate budget for incentives to current Medicaid
certified facilities. In order for a facility to qualify for an
incentive:
(i) The application form and all supporting documentation
for this incentive must be faxed in or mailed with a postmark
during the incentive period. Failure to include all required
supporting documentation precludes a facility from
qualification.
(ii) Facilities choosing to mail in applications and
supporting documentation are in addition responsible to ensure
that documents are mailed to the correct address, as
follows:
Via United States Postal Service
Utah Department of Health
DHCF, BCRP
Attn: Reimbursement Unit
P.O. Box 143102
Salt Lake City, UT 84114-3102
Via United Parcel Service or Federal Express
Utah Department of Health
DHCF, BCRP
Attn: Reimbursement Unit
288 North 1460 West
Salt Lake City, UT 84116-3231
(iii) The facility must clearly mark and organize all
supporting documentation to facilitate review by Department
staff.
(b) In order to qualify for an incentive, a facility must
have:
(i) a meaningful quality improvement plan which includes
the involvement of residents and family;
(ii) a demonstrated means to measure that plan;
(iii) customer satisfaction surveys conducted by an
independent third-party in each quarter of the incentive
period;
(iv) an employee satisfaction program; and
(v) no violations, as determined by the Department, that
are at an "immediate jeopardy" level at the most recent
re-certification survey and during the incentive period.
(vi) A facility receiving a "condition of
participation" during the incentive period is eligible for
only 50% of the possible reimbursement.
(c) The Department shall distribute incentive payments to
qualifying facilities based on the proportionate share of the
total Medicaid patient days in qualifying facilities.
(d) If a facility seeks administrative review of a survey
violation, the incentive payment will be withheld pending the final
administrative determination. If violations are found not to have
occurred at a severity level of "immediate jeopardy" or
higher, the incentive payment will be paid to the facility. If the
survey findings are upheld, the Department shall distribute the
remaining incentive payments to all qualifying
facilities.]
KEY: Medicaid
Date of Enactment or Last Substantive Amendment: [July 1, 2010]2011
Notice of Continuation: December 12, 2007
Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3; 26-35a
Additional Information
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For questions regarding the content or application of this rule, please contact 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.