Current through Register Vol. 54, No. 44, November 2, 2024
(a)
Failure by the nursing facility to file a timely MA-11, other than a final
MA-11 and annual MA-11s due along with a final MA-11, may result in termination
of the nursing facility's provider agreement and will result in adjustment of
the nursing facility's per diem rate as provided in this subsection. An MA-11
is considered timely filed if the MA-11 is received within 120 days following
the June 30 or December 31 close of each fiscal year as designated by the
nursing facility, or if an extension has been granted, within the additional
time allowed by the extension. The Department may also seek injunctive relief
to require proper filing, as the Department may deem is in the best interest of
the efficient and economic administration of the MA program.
(1)
Cost report periods prior to
January 1, 2001.
(i) If an MA-11 is
not timely filed, the nursing facility's per diem rate will be adjusted
downward by 5% beginning the first day of the next month and will remain in
effect until the date that an acceptable MA-11 is filed with the
Department.
(ii) If an MA-11 is
timely filed and is unacceptable, the Department will return the MA-11 to the
nursing facility for correction. If an acceptable MA-11 is not filed by the end
of the 30th day from the date of the letter returning the unacceptable MA-11
from the Department, the nursing facility's per diem rate will be adjusted
downward by 5% beginning the first day of the next month and will remain in
effect until the date that an acceptable MA-11 is filed with the
Department.
(2)
Cost report periods beginning January 1, 2001, and thereafter.
(i) If an MA-11 is not timely filed, the net
operating components of the nursing facility's per diem rate will be adjusted
downward by 5% and the movable property component of the nursing facility's
capital per diem rate will be reduced to $0. This per diem rate reduction will
begin the first day of the next month and remain in effect until the date that
an acceptable MA-11 is filed with the Department.
(ii) If an MA-11 is timely filed and is
unacceptable, the Department will return the MA-11 to the nursing facility for
correction. If an acceptable MA-11 is not filed by the end of the 30th day from
the date of the letter returning the unacceptable MA-11 from the Department,
the net operating components of the nursing facility's per diem rate will be
adjusted downward by 5% and the movable property component of the nursing
facility's capital per diem rate will be reduced to $0. This per diem rate
reduction will begin the first day of the next month and remain in effect until
an acceptable MA-11 is filed with the Department.
(b) If a nursing facility fails to file a
timely final MA-11 and outstanding annual MA-11s:
(1) The net operating components of the
nursing facility's per diem rate will be determined on the basis of the nursing
facility's peer group medians, prior to the percent of median adjustment in
accordance with §
1187.96 (relating to price and
rate setting computations), for the last fiscal period for which the nursing
facility has an acceptable MA-11 on file.
(2) The capital component of the nursing
facility's per diem rate will be set at $0.
