Current through September 24, 2024
A. Nurse Aide
Training and Testing Reimbursement
1. The
Division of Medicaid uses the direct reimbursement method for nurse aide
training and testing expenses incurred by nursing facilities.
2. Reasonable cost of training and competency
testing of nurse aides in order to meet the requirements necessary for the
nurse aide to be certified are to be billed directly to Medicaid
B. In-House Training Programs
1. The nursing facility will be directly
reimbursed by Medicaid for covered services, equipment, and supplies. In order
to receive Medicaid reimbursement, the training program must have approval from
the Mississippi State Department of Health (MSDH), Division of Health
Facilities Licensure and Certification.
2. Services and supplies approved for payment
will be subject to application of the nursing facility's percentage of Medicaid
utilization. The Medicaid utilization percentages of every facility are
redetermined annually and are applicable for one (1) state fiscal year. The
percentages are taken from the most recent cost report at the time of
redetermination. Nursing facilities and training centers are notified in
writing of their Medicaid utilization percent. In cases where no cost report
data is available, eighty (80) percent will be applied to approved billings
until such time that the correct Medicaid utilization percent can be
determined. Nurse aide training centers' Medicaid utilization percentage will
be redetermined annually and will be calculated based on the weighted average
of Medicaid utilization percentages of associated facilities weighted by bed
size.
3. Only costs actually
incurred by the facility will be considered for reimbursement. No
reimbursements will be made for estimated cost.
4. In-house training programs refer to the
training area set up within a nursing facility or training center. In-house
training programs include training areas set up by a nursing facility in a
remote location due to space restrictions. A training center is an area set up
for nurse aide training which serves more than one (1) facility and is located
in an area remote from any of the associated facilities.
C. Testing Fees are allowable for direct
reimbursement for nurse aides who have been through an approved certification
training program. Medicaid will reimburse for written or oral and clinical
testing fees based on the fee schedule from the current testing services
contracted by MSDH. Testing reimbursement will be subject to a nursing
facility's Medicaid utilization percent just like training reimbursement.
Testing must be billed by the employing facility of the nurse aide who was
tested. This applies even to nurse aides trained in a training center. Training
centers do not bill the nurse aide testing fees. Medicaid will reimburse the
cost for a nurse aide to be tested up to three (3) times. If after three (3)
attempts, a nurse aide fails to pass the tests, Medicaid requires the aide to
complete another training program before any additional tests will be
reimbursed. Testing fees must be billed with thirty (30) days of the test date.
Pass/fail results must be included with the billing. Pass/fail results can
include either the results received from the current testing service or the
actual results given to the aides at the time of the tests.
D. Out of Facility Training
1. Facilities which do not have an approved
nurse aide training and testing program and are not associated with an approved
training center may acquire training for their employed aides at any approved
non-facility-based Nurse Aide Training and Competency Evaluation Program
(NATCEP). Medicaid has set a limit on reimbursable cost on training and
evaluating a nurse aide outside the facility.
2. The current limit is set at five hundred
dollars ($500.00) for each nurse aide's training session and testing. Medicaid
will apply the Medicaid utilization percent of the employing facility to the
lesser of the cost incurred or the limit to determine the amount reimbursable.
Under no circumstances will Medicaid reimburse a facility for off-site training
and testing costs when it is determined that the off-site training and testing
site is receiving reimbursement from Medicaid for the same training or testing
session. Out of facility training should be billed using the billing form for
nurse assistant training expenses. Pass/fail results should be submitted with
the billing form if the aide was tested.
3. Facilities that do not have an approved
nurse aide training program, which receive training for their employed nurse
aides at an approved site that is a related party, are subject to reimbursement
limits at cost. The training program must submit to Medicaid a record of the
actual allowable costs incurred to run the training program for a month. Costs
are determined allowable following the guidelines stated for approved training
centers. Documentation must be submitted with the record of costs in accordance
with other paragraphs of this section. The allowable reimbursement for each
nurse aide trained for the related party nursing facility will be limited to
cost and will be subject to the application of the Medicaid utilization
percent.
4. The Medicaid
utilization percent is determined by the total allowable monthly costs that
will be divided by two (2) to recognize the time for two (2) training sessions
of two (2) weeks each in each month. The monthly costs will be further divided
by the maximum number of aides allowed in each training session. This
calculation will result in the determination of the allowable tuition rate for
a nurse aide employed by a related party nursing facility. The related party
nursing facility will bill Medicaid the predetermined allowable tuition rate.
Medicaid will then apply the facility's Medicaid utilization percent when
approving the billing. The training program will be allowed to submit actual
monthly costs as often as once per month. Submission of costs for subsequent
months are only required when there is a permanent change. Facilities will have
an option exercisable at the beginning of each state fiscal year and at the
inception of the training program to report actual numbers of aides trained in
total and for the related party nursing facility in each training session in
order to prorate the monthly costs.
E. Reimbursement to an Individual Not Yet
Employed at the Time of Training - Medicaid will reimburse the cost of an
approved nurse aide training and competency evaluation program to an individual
who is not employed, or who does not have an offer of employment, as a nurse
aide on a pro rata basis under the following conditions:
1. The individual is employed or receives an
offer of employment from a nursing facility not later than twelve (12) months
after completing an approved program.
2. The individual incurred costs for the
training and testing and can provide documentary evidence of them. Medicaid
will not reimburse costs to an individual who received training through a
grant.
3. Medicaid will not approve
costs in excess of the training and testing limits set for out-of-facility
training. The Medicaid utilization percent(s) of the facility(s) which employs
the nurse aide will be applied to the approved cost to determine the
reimbursement amount.
4. Medicaid
will reimburse one-half (1/2) of the settlement after six (6) months of full
time employment by one (1) or more Mississippi nursing facilities. The
remaining one-half (1/2) of the settlement will be reimbursed after the nurse
aide has been employed full time for twelve (12) months by Mississippi nursing
facilities.
5. The facility which
employs the nurse aide must submit the bill for reimbursement to Medicaid on
the billing form for Nurse Assistant Training Expenses.
F. Prohibition of Charges - No nurse aide who
is employed by, or who has an offer of employment from, a facility on the date
on which the aide begins training and testing program may be charged for any
portion of the program.
G.
Withdrawal of Program Approval - MSDH will notify Medicaid in writing when
program approval is withdrawn. As a result, reimbursement from Medicaid will be
stopped as of the date of withdrawal of program approval. As an exception,
Medicaid will reimburse the allowable costs incurred to complete a training
session which is in progress on the date of withdrawal of program approval. If
it is determined by the MSDH that the equipment and supplies purchased for the
nurse aide training program were never used for nurse aide training, Medicaid
will require reimbursement from the facility for all costs incurred by
Medicaid. Where possible used training equipment should be transferred to
another approved training site. Any funds received from the sale of nurse aide
training equipment, which was paid for by Medicaid must be refunded at the
Medicaid utilization percent in effect at the time of original
reimbursement.
Miss. Code Ann. §
43-13-121;
42 CFR § 483; OBRA 1987
