Current through Register Vol. 50, No. 9, September 20, 2024
A. Intermediate care facilities for persons
with intellectual disabilities required to participate in an evacuation, as
directed by the appropriate parish or state official, or which act as a host
shelter site may be entitled to reimbursement of its documented and allowable
evacuation and temporary sheltering costs.
1.
The expense incurred must be in excess of any existing or anticipated
reimbursement from any other sources, including the Federal Emergency
Management Agency (FEMA) or its successor.
2. ICFs/ID must first apply for evacuation or
sheltering reimbursement from all other sources and request that the department
apply for FEMA assistance on their behalf.
3. ICFs/ID must submit expense and
reimbursement documentation directly related to the evacuation or temporary
sheltering of Medicaid residents to the department.
B. Eligible Expenses. Expenses eligible for
reimbursement must occur as a result of an evacuation and be reasonable,
necessary, and proper. Eligible expenses are subject to audit at the
departments discretion and may include the following.
1. Evacuation Expenses. Evacuation expenses
include expenses from the date of evacuation to the date of arrival at a
temporary shelter or another ICF/ID. Evacuation expenses include:
a. resident transportation and lodging
expenses during travel;
b. nursing
staff expenses when accompanying residents, including:
i. transportation;
ii. lodging; and
iii. additional direct care expenses, when a
direct care expense increase of 10 percent or more is documented:
(a). the direct care expense increase must be
based on a comparison to the average of the previous two pay periods or other
period comparisons determined acceptable by the department;
c. any additional
allowable costs that are directly related to the evacuation and that would
normally be allowed under the ICF/ID rate methodology.
2. Non-ICF/ID Facility Temporary Sheltering
Expenses. Non-ICF/ID facility temporary sheltering expenses include expenses
from the date the Medicaid residents arrive at a non-ICF/ID facility temporary
shelter to the date all Medicaid residents leave the shelter. A non-ICF/ID
facility temporary shelter includes shelters that are not part of a licensed
ICF/ID and are not billing for the residents under the ICF/ID reimbursement
methodology or any other Medicaid reimbursement system. Non-ICF/ID facility
temporary sheltering expenses may include:
a.
additional nursing staff expenses including:
i. lodging; and
ii. additional direct care expenses, when a
direct care expense increase of 10 percent or more is documented:
(a). the direct care expense increase must be
based on a comparison to the average of the previous two pay periods or other
period comparisons determined acceptable by the department;
b. care-related
expenses incurred in excess of care-related expenses prior to the
evacuation;
c. additional medically
necessary equipment such as beds and portable ventilators that are not
available from the evacuating nursing facility and are rented or purchased
specifically for the temporary sheltered residents; and
i. these expenses will be capped at a daily
rental fee not to exceed the total purchase price of the item;
ii. the allowable daily rental fee will be
determined by the department;
d. any additional allowable costs as
determined by the department and that are directly related to the temporary
sheltering and that would normally be allowed under the ICF/ID reimbursement
methodology.
3. Host
ICF/ID Temporary Sheltering Expenses. Host ICF/ID temporary sheltering expenses
include expenses from the date the Medicaid residents are admitted to a
licensed ICF/ID to the date all temporary sheltered Medicaid residents are
discharged from the ICF/ID, not to exceed a six-month period.
a. The host ICF/ID shall bill for the
residents under Medicaids ICF/ID reimbursement methodology.
b. Additional direct care expenses may be
submitted when a direct care expense increase of 10 percent or more is
documented.
i. The direct care expense
increase must be based on a comparison to the average of the previous two pay
periods or other period comparisons determined acceptable by the
department.
C. Payment of Eligible Expenses
1. For payment purposes, total eligible
Medicaid expenses will be the sum of nonresident-specific eligible expenses
multiplied by the facilitys Medicaid occupancy percentage plus Medicaid
resident-specific expenses.
a. If Medicaid
occupancy is not easily verified using the evacuation resident listing, the
Medicaid occupancy from the most recently filed cost report will be
used.
2. Payments shall
be made as quarterly lump-sum payments until all eligible expenses have been
submitted and paid. Eligible expense documentation must be submitted to the
department by the end of each calendar quarter.
3. All eligible expenses documented and
allowed under
§33105 will be removed from allowable
expenses when the ICF/IDs Medicaid cost report is filed. These expenses will
not be included in the allowable cost used to set ICF/ID reimbursement rates in
future years.
a. Equipment purchases that are
reimbursed on a rental rate under
§33105. B.2.c may have
their remaining basis included as allowable cost on future costs reports
provided that the equipment is in the ICF/ID and being used. If the remaining
basis requires capitalization then depreciation will be recognized.
4. Payments shall remain under the
upper payment limit cap for ICFs/ID.
D. When an ICF/ID resident is evacuated to a
temporary sheltering site (an unlicensed sheltering site or a licensed ICF/ID)
for less than 24 hours, the Medicaid vendor payment to the evacuating facility
will not be interrupted.
E. When an
ICF/ID resident is evacuated to a temporary sheltering site (an unlicensed
sheltering site or a licensed NF) for greater than 24 hours, the evacuating
ICF/ID may submit the claim for Medicaid vendor payment for a maximum of five
days, provided that the evacuating ICF/ID provides sufficient staff and
resources to ensure the delivery of essential care and services to the resident
at the temporary shelter site.
F.
When an ICF/ID resident is evacuated to a temporary shelter site, which is an
unlicensed sheltering site, for greater than five days, the evacuating ICF/ID
may submit the claim for Medicaid vendor payment for up to an additional 15
days, provided that the evacuating ICF/ID:
1.
has received an extension to stay at the unlicensed shelter site; and
2. provides sufficient staff and resources to
ensure the delivery of essential care and services to the resident, and to
ensure the needs of the resident are met.
G. When an ICF/ID resident is evacuated to a
temporary shelter site, which is a licensed ICF/ID, for greater than 5 days,
the evacuating ICF/ID may submit the claim for Medicaid vendor payment for an
additional period, not to exceed 55 days, provided that:
1. the host/receiving ICF/ID has sufficient
licensed and certified bed capacity for the resident, or the host/receiving
ICF/ID has received departmental and/or CMS approval to exceed the licensed and
certified bed capacity for a specified period; and
2. the evacuating ICF/ID provides sufficient
staff and resources to ensure the delivery of essential care and services to
the resident, and to ensure the needs of the resident are met.
H. If an ICF/ID resident is
evacuated to a temporary shelter site which is a licensed ICF/ID, the
receiving/host ICF/ID may submit claims for Medicaid vendor payment under the
following conditions:
1. beginning day two
and continuing during the "sheltering period" and any extension period, if the
evacuating nursing home does not provide sufficient staff and resources to
ensure the delivery of essential care and services to the resident and to
ensure the needs of the residents are met;
2. upon admission of the evacuated residents
to the host/receiving ICF/ID; or
3.
upon obtaining approval of a temporary hardship exception from the department,
if the evacuating ICF/ID is not submitting claims for Medicaid vendor
payment.
I. Only one
ICF/ID may submit the claims and be reimbursed by the Medicaid Program for each
Medicaid resident for the same date of service.
J. An ICF/ID may not submit claims for
Medicaid vendor payment for non-admitted residents beyond the expiration of its
extension to exceed licensed (and/or certified) bed capacity or expiration of
its temporary hardship exception.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
