Current through September 24, 2024
A. The Division of
Medicaid will use one (1) or more of the following remedies when deemed
appropriate by the Centers for Medicare and Medicaid Services (CMS) or the
Division of Medicaid based on results of surveys conducted by the Mississippi
State Department of Health, Bureau of Health Facilities Licensure and
Certification (MSDH HFLC):
1. Temporary
Management,
2. Denial of payment
for new admissions,
3. Civil money
penalties,
4. Transfer of
residents,
5. Closure of the
facility and transfer of residents, and/or
6. State monitoring.
B. Remedies will be applied in accordance
with federal and state requirements.
C. The Division of Medicaid and/or CMS may
terminate any Medicaid participating nursing facility's (NF's) provider
agreement if an NF nursing facility:
1. Is
not in substantial compliance with the requirements of participation,
regardless of whether or not immediate jeopardy is present,
2. Fails to submit an acceptable plan of
correction within the timeframe specified by CMS and/or the Division of
Medicaid, or
3. Fails to relinquish
control to the temporary manager, if that remedy is imposed by CMS and/or the
Division of Medicaid.
D.
Notice of Termination: Before terminating a provider agreement, CMS and/or the
Division of Medicaid will provide written notification to the NF and public
notification via local and/or general newspaper publication as follows:
1. At least two (2) calendar days before the
effective date of the termination for an NF with immediate jeopardy
deficiencies, and
2. At least
fifteen (15) calendar days before the effective date of termination for an NF
with non-immediate jeopardy deficiencies that constitute
noncompliance.
E.
Reimbursement: When a provider agreement is terminated, federal regulations
provide that payments may continue for no more than thirty (30) days from the
date the provider agreement is terminated if it is determined that:
1. Reasonable efforts are being made to
transfer the residents to another NF, community care, or other alternate care,
and
2. Additional time is needed to
facilitate an orderly transfer of the residents.
F. Discharge and Relocation of Residents
1. When CMS or the Division of Medicaid
terminates a nursing facility's (NF) provider agreement, the Division of
Medicaid will arrange for the safe and orderly transfer of all Medicare and
Medicaid residents to another NF. The NF must send written notification to each
Medicaid resident, legal representative and/or responsible party, and attending
physician, advising of the impending closure.
2. The resident or the resident's legal
representative and/or responsible party must be given an opportunity to
designate a preference for a specific NF or other alternative arrangements. A
resident's rights/freedom of choice in selecting an NF or alternative to NF
placement must be respected. An NF chosen for the relocation of a Medicaid
beneficiary must be:
a) Title XIX certified
and in good standing under its provider agreement, and
b) Able to meet the needs of the resident.
G. Resident
Trust Fund Accounts maintained by the closing facility must be properly
inventoried and receipts obtained for audit purposes by the Division of
Medicaid. All documentation required to perform an audit of the residents'
trust fund account must be maintained and available for review. This includes,
but is not limited to, residents' trial balances, residents' transactions
histories, bank statements, vouchers, and receipts of purchases. In addition,
the NF must maintain a current surety bond to cover the total amount of funds
in the trust fund account.
H.
Reinstatement After Termination
1. When a
provider agreement has been terminated by the Office of Inspector General
(OIG), CMS and/or the Division of Medicaid under
42 C.F.R. §
489.53, a new agreement with that provider
will not be accepted unless it is found that:
a) The reason for termination of the previous
agreement has been removed and there is reasonable assurance that it will not
recur, and
b) The provider has
fulfilled, or has made satisfactory arrangements to fulfill, all of the
statutory and regulatory responsibilities of its previous agreement.
2. To be considered for
re-instatement the Division of Medicaid must receive:
a) A notification of re-instatement from the
appropriate entity,
b) An
application for re-instatement to participate in the Medicaid program, and
c) The Division of Medicaid has
the sole discretion to determine the final retroeligibility effective
date.
42 C.F.R. Part 488,
Subpart F;
42 C.F.R. §§
483.10;
483.75;
489.53;
489.55;
Miss. Admin. Code Title 15, Part 16, Subpart 1, Chapter 45; Miss. Code Ann.
§§
43-13-117, 43-13-121.
