Current through September 24, 2024
A. The duration
of an intermediate care facility for individuals with intellectual
disabilities' (ICF/IID's) Medicaid provider agreement is for the same period of
time as an ICF/IID's certification or recertification for participation by the
Mississippi State Department of Health (MSDH).
B. The certification or recertification for
an ICF/IID remains in effect until it is determined that the ICF/IID is no
longer in compliance with the Conditions of Participation as determined by MSDH
and/or the Centers for Medicare and Medicaid Services (CMS).
1. ICF/IIDs must be surveyed by MSDH
licensure and certification:
a) No later than
fifteen (15) months after the last day of the previous survey to determine
compliance with the Conditions of Participation, and
b) At a state-wide average interval of twelve
(12) months or less which is computed at the end of each federal fiscal year by
comparing the last day of the most recent survey for each participating ICF/IID
to the last day of each ICF/IID's previous survey.
2. ICF/IIDs in compliance with the Conditions
of Participation with standard level deficiencies, defined as when there is
noncompliance with any single requirement or several requirements within a
particular standard that are not of such character as to substantially limit an
ICF/IID's capacity to furnish adequate care, or which would not jeopardize or
adversely affect the health or safety of beneficiaries if the deficient
practice recurred, may be conditionally certified with the understanding that
certification will continue if either of the following applies:
a) All deficiencies have been satisfactorily
corrected, or
b) The ICF/IID has
made substantial progress in correcting the deficiencies and has a new plan of
correction that is acceptable.
C. The Division of Medicaid may deny payment
for new admissions to an ICF/IID that no longer meets the applicable Conditions
of Participation as determined by MSDH and/or CMS.
1. The Division of Medicaid will:
a) Provide the ICF/IID up to sixty (60) days
to come into compliance with the Conditions of Participation, and
b) Notify the ICF/IID of the intent to deny
payment for new admissions and an opportunity for an informal hearing.
2. The Division of
Medicaid will provide an informal hearing upon written request which includes:
a) The opportunity to present to a Division
of Medicaid official not involved in making the initial determination, evidence
or documentation, in writing or in person, to refute the decision that the
ICF/IID is out of compliance with the Conditions of Participation, and
b) A written decision stating the
facts and legal basis governing the resolution of the dispute.
3. If the decision of the informal
hearing is to deny payment for new admissions the Division of Medicaid will
inform the ICF/IID and the public at least fifteen (15) days before the
effective date of the sanction with a notice that includes the:
a) Effective date of the denial of payments,
and
b) Reasons for the denial of
payments.
D.
The denial of payments for new admissions will continue for eleven (11) months
after the month it was imposed unless, before the end of that period:
1. The ICF/IID has come into compliance or is
making a good faith effort to achieve compliance with the Conditions of
Participation and the deficiencies do not present an immediate jeopardy to
residents' safety and health, or
2. The non-compliance is such that it
presents an immediate jeopardy to residents' safety and health and it is
necessary to terminate the ICF/IID's provider agreement.
E. The Division of Medicaid must terminate an
ICF/IID's provider agreement if an ICF/IID has been unable to achieve
compliance with the Conditions of Participation during the period that payments
for new admissions have been denied with the termination effective the day
following the last day of the denial of payments.
F. The Division of Medicaid may terminate an
ICF/IID's provider agreement when the ICF/IID is not in substantial compliance
with program requirements.
1. The Division of
Medicaid will provide written notification to the ICF/IID and the public.
2. The Division of Medicaid will
notify CMS of the decision to terminate the ICF/IID's provider agreement.
3. The notice of termination will
include an opportunity for the ICF/IID to request a hearing before an
Administrative Law Judge prior to termination.
G. When a provider agreement is terminated,
the Division of Medicaid may continue to make payments for up to thirty (30)
days to provide time for an orderly transfer of residents, whose primary source
of payment is Medicaid, as specified in federal law. The ICF/IID must notify
every resident, whose primary source of payment is Medicaid, and/or guardian or
legal representative in writing within forty-eight (48) hours of receipt by the
ICF/IID of the notice of termination.
H. An ICF/IID may request an evidentiary
hearing in writing within sixty (60) days of the receipt of the notice of a
denial of payments or notice of termination or nonrenewal of its provider
agreement.
1. The evidentiary hearing must be
completed either before the effective date of the adverse action or within one
hundred twenty (120) days after said date, and
2. If the hearing is made available only
after the effective date of the action, the Division of Medicaid will, before
that date, offer the ICF/IID an informal reconsideration that meets the
following requirements:
a) A written notice
to the ICF/IID of the denial, termination or nonrenewal and the findings upon
which it was based,
b) A
reasonable opportunity for the ICF/IID to refute those findings in writing, and
c) A written affirmation or
reversal of the denial, termination, or nonrenewal.
History: Revised eff. 08/01/2017; Revised eff. 12/01/2015.
42 C.F.R. §§
431.108, 431.153-154,
442.15,
442.109-110, 442.117-119; Miss. Code Ann. §
43-13-121.
