Current through September 24, 2024
A. Participating Mississippi facilities must
prepare and submit a Medicaid cost report for reimbursement of long term care
facilities.
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 determined from cost report
data.
2. Standard rates are
determined annually with an effective date of January first (1st).
3. In no case may the reimbursement rate for
services provided exceed an individual facility's customary charges to the
general public for such services in the aggregate, except for those public
facilities rendering such services free of charge or at a nominal
charge.
4. Prospective rates may be
adjusted by the Division of Medicaid pursuant to changes in federal and/or
state laws or regulations when authorized by the state legislature.
5. Prospective rates may be adjusted by the
Division of Medicaid based on revisions to allowable costs or to correct errors
when authorized by the state legislature.
a
These revisions may result from amended cost reports, field visit reviews, 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. This is
applicable to claims for dates of service since July 1, 1993.
C. The Division of
Medicaid conducts periodic field level cost report financial reviews of
selected long term care facilities, including nursing facilities, intermediate
care facilities for the mentally retarded, and psychiatric residential
treatment 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 reviewed cost reports based on the
results of the reviews.
D.
Notwithstanding any other provision of this article, it shall be the duty of
each nursing facility, intermediate care facility for the mentally retarded,
psychiatric residential treatment facility, and nursing facility for the
severely disabled that is participating in the Medicaid program to 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 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 facility.
b All non-governmental facilities must file
cost reports based on the accrual method of accounting.
c Governmental facilities have the option to
use the cash basis of accounting for reporting.
2. Documentation of financial and statistical
data should be maintained in a consistent manner from one period to another and
must be current, accurate and in sufficient detail to support costs contained
in the cost report.
3. Providers
must make available to the Division of Medicaid all documentation that
substantiates the information included in the facility cost report for the
purpose of determining compliance.
a These
records must be made available as requested by the Division of
Medicaid.
b All documentation which
substantiates the information included in the cost report, including any
documentation relating to home office and/or management company costs must be
made available to Division of Medicaid reviewers as requested by the
Division.
E.
Services and charges include the following:
1.
The facility may charge any amount greater than or equal to the Medicaid rate
for nonMedicaid residents for the provision of services under the State
Medicaid Plan.
2. While the
facility may set their basic per diem charge for non-Medicaid residents at any
level, the services covered by that charge must be identical to the services
provided to Medicaid residents and covered by the Medicaid per diem
rate.
3. Any items and services
available in the facility that are not covered under Title XVIII or the
facility's basic per diem rate or charge must be available and priced
identically for all residents in the facility.
F. Medicaid allows payment for the date of
admission to the PRTF. Medicaid does not cover the date of discharge from the
facility. A Medicaid-eligible beneficiary cannot be charged for the date of
discharge. If a beneficiary is discharged on the date of admission, the day is
covered as the date of admission.
G. Private room coverage by Medicaid is as
follows:
1. The overall average cost per day
determined from the cost report includes the cost of private rooms.
2. The average cost per day is used to
compute PRTF reimbursement rates. Therefore, the cost of a private room is
included in the reimbursement rate and no extra charge can be made to the
beneficiary, his/her family or the Medicaid program.
3. Medicaid reimbursement is considered as
payment in full for the beneficiary.
H. The following rules apply to hospital
leave:
1. A fifteen (15) day length of stay is
allowed in a non-psychiatric unit of a hospital. The facility must reserve the
hospitalized resident's bed in anticipation of his/her return. The bed cannot
be filled with another resident during the covered period of hospital
leave.
2. A resident must be
discharged from the facility if he/she remains in the hospital for over fifteen
(15) days. A leave of absence for hospitalization is broken if the resident
returns to the facility for twenty-four (24) hours.
3. Facilities cannot refuse to readmit a
resident from hospital leave when the resident has not been hospitalized for
more than fifteen (15) days and still requires PRTF services.
I. If a resident elopes from the
facility and remains absent for twenty-four (24) hours or longer, he/she must
be discharged from the facility. If further treatment at the same facility is
desired after the end of the twenty-four (24) hours, the child/adolescent must
go through a readmission process.
J. The following rules apply to therapeutic
leave:
1. An absence from the facility for
eight (8) hours or more within one calendar day constitutes a leave
day.
2. Medicaid coverage of
therapeutic leave days per fiscal year, July 1 - June 30, is eighteen (18) days
for a PRTF.
3. Each therapeutic
leave day taken each month must be reported on the billing mechanism.
4. The attending physician must approve all
therapeutic leave days. Documentation must include goals to be achieved during
the leave, the duration of leave, who participated in the leave, and the
outcome of the leave.
K.
Payment during therapeutic leave from the facility is as follows:
1. A temporary absence of a resident from a
PRTF does not interrupt the monthly payments to the facility under the
provisions as outlined in Part 207, Chapter 4 Rule 4.6 J.
2. Each facility is required to maintain
leave records and indicate periods of therapeutic leave days.
3. Before a resident departs on therapeutic
leave, the facility must provide each resident and family member or legal
representative written information explaining leave policies. The information
must define the period of time the resident is permitted to return and resume
residence in the facility.
4. A
refund of payment will be demanded for all leave days taken in excess of the
allowable or authorized number of days.
L. The PRTF must provide non-emergency
transportation.
1. Effective February 1, 2019,
the PRTF cannot use the Non-Emergency Transportation (NET) Broker to arrange
transportation for residents. PRTFs may use NET providers that also provide NET
services for the NET Broker if:
a The facility
arranges the transportation, and
b
Pays the NET provider directly.
2. Prior to February 1, 2019, the PRTF must:
a Arrange and pay for non-emergency
transportation and place the cost on the cost report, or
b Utilize the NET Broker to arrange
non-emergency transportation for residents.
Miss. Code
Ann. §§
43-13-117,
43-13-121, 42 CFR § 447
Subparts B & C, Miss. Code Ann. §
43-13-117, 42 CFR §
447.15.
