Current through Register Vol. 51, No. 19, September 20, 2024
A.
Recreational Services. The allowable costs of recreational services of a
facility shall be based on an hourly or salary rate, not on a fee-for-service
basis.
B. Over-the-Counter Drugs.
The cost of over-the-counter drugs is not to exceed the average wholesale price
plus 50 percent, or the usual selling price, whichever is lower.
C. Leave of Absence. The Department shall pay
the sum of the rates identified in Regulations .09-.11 of this chapter, less
patient resources for the cost of reserving beds for recipients for therapeutic
home visits or participation in State-approved therapeutic or rehabilitative
programs, subject to the following conditions:
(1) The recipient's plan of care provides for
the absence;
(2) The leave of
absence does not exceed 18 days during any calendar year;
(3) The recipient's attending physician shall
complete the physician's authorization form not more than 30 days before the
recipient's anticipated leave of absence; and
(4) The facility submits the physician's
authorization form to the Department with the facility's invoice, which covers
the month in which the leave of absence occurred.
D. Administrative Days. The Department shall
pay the sum of the rates identified in Regulations .09-.11 of this chapter, and
50 percent of the rate identified in Regulation .12 of this chapter, less
patient resources for administrative days, documented on forms designated by
the Department, which satisfy the following conditions:
(1) The recipient's required level of care
has changed, and the following conditions are met:
(a) The Department or its designee has
determined that the recipient's level of care is provided by an Intermediate
Care Facility for Individuals with Intellectual Disabilities
(ICF/IID);
(b) The provider has
implemented a predischarge planning program and initiated placement activities
for the recipient at the earliest appropriate time;
(c) The provider has actively pursued
placement of the recipient at the required level of care in an appropriate
facility during the entire period of administrative days;
(d) The provider has submitted documentation
to the Department or its designee that it has complied with the requirements of
§D(1)(a)-(c) of this regulation for the entire period of the
administrative stay claimed for reimbursement; and
(e) The recipient is transferred promptly to
the first available appropriate facility licensed and certified for the
required level of care;
(2) When institutional care is no longer
appropriate, and the following conditions are met:
(a) The Department or its designee has
determined that the recipient no longer requires the level of care, which is
provided by a nursing facility or Intermediate Care Facility for Individuals
with Intellectual Disabilities (ICF/IID);
(b) The provider has implemented a
predischarge planning program and initiated placement activities for the
recipient at the earliest appropriate time;
(c) The provider has actively pursued
placement of the recipient at the required level of care at home or in an
appropriate setting during the entire period of administrative days;
(d) The provider has submitted documentation
to the Department or its designee that it has complied with the requirements of
§D(2)(a)-(c) of this regulation for the entire period of the
administrative stay claimed for reimbursement; and
(e) The recipient is transferred promptly
after appropriate placement has been found; and
(3) When the recipient is at an inappropriate
level of care but cannot be moved, and the following conditions are met:
(a) The attending physician has declared
that, because of physical or emotional problems, the recipient is unable to be
moved;
(b) The reason the recipient
cannot be moved is adequately documented by the attending physician in the
recipient's record; and
(c)
Reevaluation by the attending physician of the recipient's inability to be
moved and appropriate documentation of it in the recipient's record have been
made at least every 60 days.
E. Bed Occupancy. The Statewide average
occupancy, defined in Regulation .09B(4) of this chapter, shall be calculated
after the exclusion of all providers which operated under a waiver of the
occupancy standard during any part of the cost report period.
F. A waiver of the occupancy standards
defined in Regulation .09B(4) of this chapter may be made by the Department
under the following conditions:
(1) During a
period not to exceed the first 12 months of operation for a newly constructed
facility or for a newly constructed portion of an existing facility;
(2) During periods throughout which the
occupancy standard could not be attained due to labor strike, fire, flood, or
act of God, when this event is reported to the State licensing authority within
10 days of the event and request for waiver is submitted to the Program within
30 days of the event;
(3) For a
period not to exceed 12 months when a voluntary reduction in licensed nursing
facility bed capacity has been granted by the Department and the provider has
received prior approval from the Program to reduce available beds while
renovations are being completed;
(4) For a period not to exceed 12 months
after a new provider acquires an existing facility which has been operated by
the previous provider below the occupancy standard due to a ban on admissions,
and when prior approval for the waiver has been granted by the
Program;
(5) For a period not to
exceed 12 months after a new provider acquires an existing facility which was
in bankruptcy and operated below the occupancy standard at the time of
purchase; or
(6) For a period not
to exceed 12 months after a new provider has acquired or leased a building that
was not licensed as a nursing facility immediately before the provider's
acquisition or lease.
G. When a waiver is granted under the
provisions of §F(3) of this regulation, the occupancy standards shall be
applied to the reduced licensed capacity.
H. A waiver of the occupancy standards
defined in Regulation .09B(4) of this chapter may not be allowed due to a ban
on admissions or under any circumstances other than those described in §F
of this regulation.
I. Rates that
are determined in accordance with the provisions of §F of this regulation
are effective only for the period during which the waiver of the occupancy
standard is in effect.
