Current through September 24, 2024
A. Participating Mississippi nursing
facilities must prepare and submit a Medicaid cost report for reimbursement.
1. All cost reports are due by the end of the
fifth (5th) calendar month following the reporting period.
2. Failure to file a cost report by the due
date or the extended due date will result in a penalty of fifty dollars
($50.00) per day and may result in the termination of the provider
agreement.
B. The
Division of Medicaid uses a prospective method of reimbursement.
1. The rates are calculated from cost reports
and resident case-mix assessment data.
2. Standard rates are calculated annually
with an effective date of January first (1st).
3. Rates are adjusted quarterly based on
changes in the case-mix of the facility.
4. In no case may the reimbursement rate for
services exceed an individual nursing facility's customary charges to the
general public for such services in the aggregate, except for those public
nursing facilities rendering such services free of charge or at a nominal
charge.
5. Prospective rates may be
adjusted by the Division of Medicaid pursuant to changes in federal and/or
state laws or regulations.
6.
Prospective rates may be adjusted by the Division of Medicaid based on
revisions to allowable costs or case-mix scores or to correct errors.
a These revisions may result from amended
cost reports, field visit reviews, audits or other corrections.
b Facilities are notified in writing of
amounts due to or from the Division of Medicaid as a result of these
adjustments.
c There is no time
limit for requesting settlement of these amounts.
C. The Division of Medicaid
conducts periodic cost report financial reviews of selected nursing facilities
to verify the accuracy and reasonableness of the financial and statistical
information contained in the Medicaid cost reports. Adjustments will be made as
necessary to the cost reports based on the results of the reviews.
D. Each nursing facility that is
participating in the Medicaid program must keep and maintain books, documents
and other records as prescribed by the Division of Medicaid in substantiation
of its cost reports for a period of three (3) years after the date of
submission to the Division of Medicaid of an original cost report, or three (3)
years after the date of submission to the Division of Medicaid of an amended
cost report.
1. Providers who are required to
pay assessments must keep and preserve books and records as necessary to
determine the amount of the assessments for which it is liable for no less than
five (5) years.
2. Providers must
maintain adequate documentation, including, but not limited to, financial
records and statistical data, for proper determination of costs payable under
the Medicaid program.
a The cost report must
be based on the documentation maintained by the nursing facility.
b All non-governmental nursing facilities
must file cost reports based on the accrual method of accounting.
c Governmental nursing facilities have the
option to use the cash basis of accounting for reporting.
3. Documentation of financial and statistical
data must be maintained in a manner consistent from one (1) period to another
and must be current, accurate and in sufficient detail to support costs
contained in the cost report.
4.
Providers must make available to the Division of Medicaid all documentation
that substantiates the information included in the nursing facility cost report
for the purpose of determining compliance with Medicaid rules.
a These records must be made available as
requested by the Division of Medicaid.
b All documentation which substantiates the
information included in the nursing facility cost report, including any
documentation relating to home office and/or management company costs must be
made available to the Division of Medicaid reviewers as requested by the
Division of Medicaid.
E. The Division of Medicaid reimburses for
the day of admission to a nursing facility.
1. The day of discharge is not reimbursed by
the Division of Medicaid unless it is the same day as the date of
admission.
2. Nursing facilities
cannot bill the resident or responsible party for the day of
discharge.
F. The
Division of Medicaid reimburses for home/therapeutic and inpatient hospital
temporary leave.
1. Home/therapeutic
temporary leave is limited to forty-two (42) days per year in addition to
holidays listed in Miss. Admin. Code Part 207, Rule
2.8. Reimbursement is limited to
fifteen (15) consecutive days per leave period.
2. Inpatient hospital temporary leave days
are not limited except for reimbursement of a maximum of fifteen (15)
consecutive days per leave period.
3. If the resident has utilized the fifteen
(15) consecutive day maximum, the resident must return to the facility for
twenty-four (24) consecutive hours before the nursing facility can be
reimbursed for a new temporary leave period.
G. The Division of Medicaid does not
reimburse for the following instances:
1.
Nursing facilities which bill the Division of Medicaid for fifteen (15)
consecutive days of home/therapeutic or inpatient hospital temporary leave,
discharge the resident from the nursing facility, and subsequently refuse to
readmit the resident under the nursing facility's resident return policy when a
bed is available.
2. Inpatient
hospital temporary leave for days when a resident is transferred to a Medicare
skilled nursing facility (SNF) or a swing bed after an acute care
hospitalization.
3. Medicaid
billing of home/therapeutic or inpatient hospital temporary leave for more than
fifteen (15) consecutive days.
H. Nursing facilities must bill the
appropriate day code as follows:
1. For a
resident who has a home/therapeutic temporary leave bill a home/therapeutic
leave day code beginning the calendar day the resident:
a Leaves the facility for eight (8)
consecutive hours or more during the day excluding:
1 Dialysis,
2 Chemotherapy,
3 Physical therapy,
4 Speech therapy,
5 Occupational therapy, or
6 Medical treatments that occur two (2) or
more days per week,
b Is
out of the facility at twelve midnight (12 a.m.),
c Is out of the facility for a hospital
observation stay of eight (8) or more consecutive hours, or
d Returns from a therapeutic leave if the
resident was out of the facility for eight (8) or more consecutive hours on the
return day except for the day of return after a hospital observation stay of
eight (8) or more consecutive hours.
2. For a resident who has an inpatient
hospital temporary leave, bill an inpatient hospital leave day code beginning
the calendar day the resident is admitted to an inpatient hospital for
continuous acute care.
3. Bill a
room and board day code:
a If the resident
does not meet the criteria for either a home/therapeutic or inpatient hospital
temporary leave,
b If the resident
receives:
1 Dialysis,
2 Chemotherapy,
3 Physical therapy,
4 Speech therapy,
5 Occupational therapy, or
6 Medical treatments that occur two (2) or
more days per week.
c
The day the resident returns to the nursing facility from an inpatient hospital
acute care stay or a hospital observation stay of eight (8) or more consecutive
hours, or
d The day the resident
returns to the nursing facility from a home/therapeutic leave if the resident
was out of the facility for less than eight (8) consecutive hours. [Refer to
Miss. Admin. Code Part 207, Rule 2.5.H.3.c)]
I. Nursing facilities are required to
maintain complete and accurate room and board and temporary leave records in
order to accurately bill the fiscal intermediary.
J. Nursing facilities must enter the correct
temporary leave, regardless of the resident's payment source, in the case-mix
web portal to match the billing records as specified in Miss. Admin. Code Part
207, Rule 2.5.H.1. or 2.
1. The deadline for
entering temporary leave information for the quarter is the fifth (5th) day of
the second (2nd) month following the end of the quarter the leave
occurred.
2. The case-mix review
process includes a review and reconciliation of the facility's official
home/therapeutic and inpatient hospital temporary leave records.
42 C.F.R. Part
447, Subparts B and C; Miss. Code Ann. §§
43-13-117,
43-13-121,
4313-145.
