Current through Register Vol. 18, September 20, 2024
(1) Nursing facility service providers, as a
condition of participation in the Montana Medicaid program must meet the
following requirements:
(a) comply with and
agree to be bound by all laws, rules, regulations and policies generally
applicable to Medicaid providers, including but not limited to the provisions
of ARM 37.85.401,
37.85.402,
37.85.406,
37.85.407,
37.85.410,
37.85.414, and
37.85.415;
(b) maintain a current license issued by the
department of public health and human services under Montana law for the
category and level of care being provided, or, if the facility is located
outside the state of Montana, maintain a current license under the laws of the
state in which the facility is located for the category and level of nursing
facility care being provided;
(c)
maintain a current certification for Montana Medicaid issued by the Department
of Public Health and Human Services under applicable state and federal laws,
rules, regulations and policies for the category and level of care being
provided, or, if the facility is located outside the state of Montana, maintain
current Medicaid certification in the state in which the facility is located
for the category and level of nursing facility care being provided;
(d) maintain a current agreement with the
department to provide the level of care for which payment is being made, or, if
the facility is located outside the state of Montana, comply with the
provisions of ARM
37.40.337;
(e) operate under the direction of a licensed
nursing home administrator, or other qualified supervisor for the facility, as
applicable laws, regulations, rules, or policies may require;
(f) for providers maintaining resident trust
accounts, insure that any funds maintained in such accounts are used only for
those purposes for which the resident, legal guardian, or personal
representative of the resident has given written authorization. The provider
must maintain personal funds in excess of $50 in an interest bearing account
and must credit all interest earned to the resident's account. Resident's
personal funds in amounts up to $50 must be maintained in such a manner that
the resident has convenient access to such funds within a reasonable time upon
request. A provider may not borrow funds from such accounts or commingle
resident and facility funds for any purpose;
(g) A provider holding personal funds of a
deceased nursing facility resident who received Medicaid benefits at any time
shall, within 30 days following the resident's death, pay those funds as
provided by law and regulation.
(h)
maintain admission policies which do not discriminate on the basis of diagnosis
or handicap, and which meet the requirements of all federal and state laws
prohibiting discrimination against the handicapped, including persons infected
with acquired immunity deficiency syndrome/human immunodeficiency virus
(AIDS/HIV);
(i) comply with ARM
37.40.101,
37.40.105,
37.40.106,
37.40.110,
37.40.120, and
37.40.201 through
37.40.207, regarding screening for
nursing facility services;
(j)
comply with all applicable federal and state laws, rules, regulations, and
policies regarding nursing facilities at the times and in the manner required
therein, including but not limited to
42 USC
1396 r(b) (5) and 1396r(c) (1994 supp.) and
implementing regulations, which contain federal requirements relating to
nursing home reform. The department hereby adopts and incorporates herein by
reference
42 USC
1396 r(b) (5) and 1396r(c). A copy of these
statutes may be obtained from the Department of Public Health and Human
Services, Senior and Long Term Care Division, 111 N. Sanders, P.O. Box 4210,
Helena, MT 59604-4210.
(2) A provider which fails to meet any of the
requirements of this rule may be denied Medicaid payments, refused further
participation in the Medicaid program or otherwise sanctioned or made subject
to appropriate department action, according to applicable laws, rules,
regulations, or policies.
(a) Subject to
applicable federal law and regulations, the department may impose a sanction or
take other action against a provider that is not in compliance with federal
Medicaid participation requirements. Department sanctions or actions may
include imposition of any remedy or combination of remedies provided by state
or federal law and regulations, including but not limited to federal
regulations at 42 CFR 488, subpart F.
(3) A provider must provide the department
with 30 days advance written notice of termination of participation in the
Medicaid program. Notice will not be effective prior to 30 calendar days
following actual receipt of the notice by the department. Notice must be mailed
or delivered to the Department of Public Health and Human Services, Senior and
Long Term Care Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.
(a) For purposes of (3), termination includes
a cessation of provision of services to Medicaid residents, termination of the
provider's business, a change in the entity administering or managing the
facility or a change in provider as defined in ARM
37.40.325.
(b) In the event that discharge or transfer
planning is necessary, the provider remains responsible to provide for such
planning in an orderly fashion and to care for its residents until appropriate
transfers or discharges are effected, even though transfer or discharge may not
have been completed prior to the facility's planned date of termination from
the Medicaid program.
(c) Providers
terminating participation in the Medicaid program must prepare and file, in
accordance with applicable cost reporting rules, a close out cost report
covering the period from the end of the provider's previous fiscal year through
the date of termination from the program. New providers assuming operation of a
facility from a terminating provider must enroll in the Medicaid program in
accordance with applicable rules.
(4) A provider must notify a resident or the
resident's representative of a transfer or discharge as required by
42 CFR
483.12 (a) (4), (5), and (6). The notice must
be provided using the form prescribed by the department. In addition to the
notice contents required by
42 CFR
483.12, the notice must inform the recipient
of the recipient's right to a hearing, the method by which the recipient may
obtain a hearing and that the recipient may represent herself or himself or may
be represented by legal counsel, a relative, a friend, or other spokesperson.
Notice forms are available upon request from the department. Requests for
notice forms may be made to the Department of Public Health and Human Services,
Senior and Long Term Care Division, 111 N. Sanders, P.O. Box 4210, Helena, MT
59604-4210.
53-6-108,
53-6-111,
53-6-113,
53-6-189,
MCA; IMP,
53-2-201,
53-6-101,
53-6-106,
53-6-107,
53-6-111,
53-6-113,
53-6-168,
MCA;
