Current through Register Vol. 50, No. 9, September 20, 2024
A. Intermediate
care facilities for individuals with intellectual disabilities (ICFs/IID) are
required to file annual cost reports to the bureau in accordance with the
following instructions.
1. Each ICF/IID is
required to report all reasonable and allowable costs on a regular facility
cost report, including any supplemental schedules designated by the
bureau.
2. Separate cost reports
must be submitted by central/home offices and habilitation programs when costs
of those entities are reported on the facility cost report.
B. Cost reports must be prepared
in accordance with cost reporting instructions adopted by the bureau using
definitions of allowable and nonallowable cost contained in the Medicare
provider reimbursement manual unless other definitions of allowable and
nonallowable cost are adopted by the bureau.
1. Each provider shall submit an annual cost
report for fiscal year ending June 30. The cost reports shall be filed within
90 days after the state's fiscal year ends.
2. Exceptions . Limited exceptions for
extensions to the cost report filing requirements will be considered on an
individual facility basis upon written request by the provider to the Medicaid
director or designee. Providers must attach a statement describing fully the
nature of the exception request. The extension must be requested by the normal
due date of the cost report.
C. Direct Care Floor
1. ...
2. For providers receiving pervasive plus
supplements in accordance with
§32903.H or other
client specific adjustments to the rate in accordance with
§32903 I, the facility wide direct care
floor is established at 94 percent of the per diem direct care payment and at
100 percent of any rate supplements or add-on payments received by the
provider, including the pervasive plus supplement, the complex care add-on
payment and other client specific adjustments to the rate. The direct care
floor will be applied to the cost reporting year in which the facility receives
a pervasive plus supplement and/or a client specific rate adjustment. In no
case, however, shall a facility receiving a pervasive plus supplement and/or
client specific rate adjustment have total facility payments reduced to less
than a safe harbor percentage of 104 percent of the total facility cost as a
result of imposition of the direct care floor, except as noted in
§32901.C.4 a
3. For providers receiving complex care
add-on payment in accordance with §32915, but not receiving pervasive plus
supplements in accordance with
§32903.H or other
client specific adjustments to the rate in accordance with
§32903 I, the facility wide direct care
floor is established at 85 percent of the per diem direct care payment and at
100 percent of the complex care add-on payment. The direct care floor will be
applied to the cost reporting year in which the facility receives a complex
care add-on payment.
In no case shall a facility receiving a complex care
add-on payment have total facility payments reduced to less than a safe harbor
percentage of 104 percent of the total facility cost as a result of imposition
of the direct care floor, except as noted in
§32901.C.4 a
4. For facilities for which the
direct care floor applies, if the direct care cost the facility incurred on a
per diem basis is less than the appropriate facility direct care floor, the
facility shall remit to the bureau the difference between these two amounts
times the number of facility Medicaid days paid during the cost reporting
period. This remittance shall be payable to the bureau upon submission of the
cost report.
a. For dates of service on or
after July 1, 2022, if a provider receiving complex care or pervasive plus
add-on payments in accordance with
§32915 or
§32903 H, respectively, has facility
payments reduced as a result of imposition of the direct care floor, the
department may, at its discretion, levy a non-refundable administrative penalty
separate from any other reduction in facility payments. The administrative
penalty is not subject to any facility specific safe harbor percentage
specified in
§32901 C, and is calculated solely on
the final reduced payment amount for the cost report period in question. Under
LAC 50.I.4147 of the Surveillance and Utilization Review Subsystem (SURS) Rule,
the department may impose sanctions for noncompliance with Medicaid laws,
regulations, rules, and policies. Facilities who have payments reduced as a
result of imposition of the direct care floor that have consecutive subsequent
years of reduced payments shall have the following safe harbor and
administrative penalty impacts:
|
Consecutive Cost Report
Period with Reduced Payments
|
Administrative Penalty
Levied on Reduced Payments
|
Safe Harbor
Percentages
|
|
1st Year
|
0 percent
|
104 percent
|
|
2nd Year
|
0 percent
|
102 percent
|
|
3rd Year
|
5 percent
|
100 percent
|
|
4th Year and Onwards
|
10 percent
|
100 percent
|
b. At its discretion, LDH may terminate
provider participation in the complex care or pervasive plus add-on payment
programs as a result of imposition of the direct care floor.
5. Upon completion of desk reviews
or audits, facilities will be notified by the bureau of any changes in amounts
due based on audit or desk review adjustments.
a. Direct care floor recoupment and/or
administrative penalty assessed as a result of a facility not meeting the
required direct care per diem floor is considered effective 30 days from the
issuance of the original notice of determination. Should an informal
reconsideration be requested, the recoupment and/or penalty will be considered
effective 30 days from the issuance of the results of an informal hearing. The
filing of a timely and adequate notice of an administrative appeal does not
suspend or delay the imposition of a recoupment(s) and/or penalty.
AUTHORITY
NOTE: Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
