No. 31360 (Amendment): R414-27. Medicare Nursing Home Certification

DAR File No.: 31360
Filed: 05/01/2008, 03:49
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to implement Medicaid certification requirements for nursing facilities in accordance with H.B. 366 (2008). H.B. 366 will not allow, in most cases, any increase in bed capacity for nursing facilities certified by Medicaid. (DAR NOTE: H.B. 366 (2008) is found at Chapter 347, Laws of Utah 2008, and was effective 03/18/2008.)

Summary of the rule or change:

This change specifies Medicaid certification requirements for nursing care facilities. Facilities will not be allowed to increase bed capacity in most cases.

State statutory or constitutional authorization for this rule:

Sections 26-18-3 and 26-18-503

Anticipated cost or savings to:

the state budget:

There may be a savings to the state budget because of this rule change. Facilities will not be allowed to expand in most cases which may mitigate upward pressure on nursing home reimbursement resulting from excess bed capacity. The exact amount cannot be quantified.

local governments:

Local governments that operate nursing care facilities will not be allowed to expand. This could have a negative impact on revenue. The number of their occupied beds may increase as overall bed capacity in the system is stabilized. If so, the fiscal impact of the rule would be positive as their fixed costs are spread over more residents. The exact amount cannot be quantified.

small businesses and persons other than businesses:

Nursing care facilities will not be allowed to expand. This could have a negative impact on revenue. The number of their occupied beds may increase as overall bed capacity in the system is stabilized. If so, the fiscal impact of the rule would be positive as their fixed costs are spread over more residents. The exact amount cannot be quantified.

Compliance costs for affected persons:

There are no compliance costs mandated by this rule or reporting requirements.

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

Pressure to increase reimbursement to Medicaid certified nursing facilities may be mitigated by this rule. The fiscal impact on business may be positive as their fixed costs are spread over more residents. David N. Sundwall, MD, 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 [e-mail]

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:

06/16/2008

This rule may become effective on:

06/23/2008

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

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

R414-27. [Medicare Nursing Home Certification]Medicaid Certification of Nursing Care Facilities.

[R414-27-1. Medicare Nursing Home Certification.

All skilled nursing homes must be certified for Medicare participation as a condition of Medicaid certification. The effects of this rule will be to enable more third-party collections (Medicare) and reduce Medicaid nursing home payments.]

R414-27-1. Introduction and Authority.

(1) This rule governs the certification of nursing care facilities to receive Medicaid payments for services to Medicaid eligible individuals.

(2) This rule implements Title 26, Chapter 18, Part 5.

(3) Section 26-18-3 authorizes this rule.

 

R414-27-2. Medicaid Certification Requirements.

(1) The director of the Division of Health Care Financing (DHCF) within the Department of Health may authorize Medicaid certification for a nursing care facility that:

(a) is in compliance with 42 CFR Part 483 or has a plan of correction approved by the Department to remedy areas of noncompliance;

(b) is in compliance with the Health Care Facility Licensing and Inspection Act, Title 26, Chapter 21, and the rules applicable to nursing homes made pursuant to that act or has a plan of correction approved by the Department to remedy areas of noncompliance;

(c) has not increased its certified bed capacity by more than 30 percent annually after March 31, 2004, except as authorized in Subsection 26-18-503(5);

(d) since March 18, 2008, has not increased its licensed bed capacity except in conjunction with an increase in certified bed capacity as authorized in Subsection 26-18-503(5) or for which the DHCF Director has approved the increase in the nursing care facility program's certified bed capacity expansion before October 15, 2007; and

(e) since March 18, 2008, has not increased its certified bed capacity except as authorized in Subsection 26-18-503(5).

(2) A nursing care facility is not eligible for Medicaid certification if it expands bed capacity without prior approval from the DHCF Director as authorized in this section.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [1987]2008

Notice of Continuation: January 17, 2008

Authorizing, Implemented or Interpreted Law: 26-1-5; 26-18-3; 26-18-503