No. 27143 (New Rule): R414-401. Nursing Care Facility Assessment

DAR File No.: 27143
Filed: 05/07/2004, 02:13
Received by: NL

 

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rulemaking is necessary in order for all nursing facilities to be assessed a uniform amount for each non-Medicare patient day. The Division of Health Care Financing serves as the collecting agent for the assessment, which will be deposited in a restricted account from which the state legislature may appropriate funds to the Division to be used only to increase reimbursement rates to nursing care facilities. These reimbursement rates are used to provide services pursuant to the state Medicaid program and are used for administrative expenses applicable to the assessment and collection of funds. Administrative expenses are not to exceed 3% of the collected amount.

 

Summary of the rule or change:

This is a new rule that implements a uniform amount to be assessed for each non-Medicare patient day in a nursing facility.

 

State statutory or constitutional authorization for this rule:

Sections 26-18-3 and 26-1-5

 

Anticipated cost or savings to:

the state budget:

Budget neutral due to collection of $10,100,000 from nursing facilities and a draw down of federal matching funds in the amount of approximately $26,000,000.

 

local governments:

There is no budget impact to local governments because local governments do not fund nursing care facilities.

 

other persons:

There is an enhanced revenue of approximately $26,000,000 for nursing facility providers as a result of federal matching funds.

 

Compliance costs for affected persons:

Compliance costs include a collection of $6.18 per non-Medicare patient day from each nursing facility or a total of $10,100,000. This collection will be used as state funds to draw down about $26,000,000 in federal funds. 99% of all facilities will gain from this process. The amount of gain depends on the number of Medicaid patients in the facility.

 

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

The 2004 Legislature passed S.B. 128 at the request of nursing facilities to fund a significant rate increase for these facilities. This rule implements the assessment which will have positive fiscal impact on this industry. Scott D. Williams, MD (DAR NOTE: S.B. 128 is found at UT L 2004 Ch 284, and will be effective 07/01/2004.)

 

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:

Ross Martin at the above address, by phone at 801-538-6592, 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:

07/01/2004

 

This rule may become effective on:

07/02/2004

 

Authorized by:

Scott D. Williams, Executive Director

 

 

RULE TEXT

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 $6.18 per non-Medicare patient day provided by the facility. 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.

 

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

2004

26-1-30

26-35a