016.06.09 Ark. Code R. 014
DEFINITIONS
"Intermediate care facility for individuals with developmental disabilities" has the same meaning as "intermediate care facility for the mentally retarded" or "ICF/MR" under federal law;
"Intermediate care facility for individuals with developmental disabilities" does not include:
PROVIDER REVENUES
Aggregate gross receipts used for the purpose of calculating the multiplier will be projected for each annual period. Gross receipts will be projected for each Facility by multiplying projected patient days by their projected per diem rate. Gross receipts by Facility will be added together to derive aggregate gross receipts.
MIDNIGHT CENSUS DATA
All Facilities shall report their patient days on a monthly basis on a form prescribed by the Division of Medical Services for the specific purpose of reporting patient days.
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FEE ASSESSMENT, BILLING, COLLECTION
Each Facility shall file a report with the Department of Human Services by the 10th of each month for the preceding month, listing the patient days per midnight census as required by regulations promulgated by the Division of Medical Services.
Accounts Receivable will calculate the Provider Fee by multiplying patient days as reported by the Facilities for the previous month by the multiplier for that date of service. Billing will be sent no later than the 15th of each month. A copy of the Patient Census Report and statement will be forwarded to Division of Medical Services.
The fee shall then be due and payable for the previous month by the 30th of the month.
From July 31, 2009, to June 30, 2010, the multiplier shall be set at $15.15 per patient day. The multiplier will be recalculated each July 1st in accordance with Act 433 of 2009.
Failure of any Facility to file required reports and/or pay fees on a timely basis may result in the withholding of Medicaid reimbursement, license non-renewal, letters of caution, sanctions and/or fines. The fine shall be at least one thousand dollars ($1,000) but no more than one thousand five hundred dollars ($1,500). The fine and if applicable, the outstanding balance of the provider fee, shall accrue interest at the maximum rate permitted by law from the date the fine and, if applicable, the provider fee, is due until payment of the outstanding balance of the fine and if applicable, the provider fee. Accounts Receivable will initiate the collection process on the 1st of the month following the due date for payments not postmarked by close of business on 30th of the month. Outstanding accounts report will be forwarded to Division of Medical Services for determination of further action.
CHANGE OF OWNERSHIP OR MANAGEMENT
The liability for any amount owed the Division in connection with the Provider Fee is joint and several as between or among the original obligor and any successor licensees.
ADMINISTRATION OF FEES
Fees assessed and collected will be deposited in a designated account within the Arkansas Medicaid Program Trust Fund as established under Arkansas Code Annotated § 19-5-985.
SANCTIONS
Sanctions will be assessed by the Division on all Facilities that fail to comply with the provisions of Act 433 of 2009, "An Act To Establish A Provider Fee For Intermediate Care Facilities For Individuals With Developmental Disabilities" (the "Act"), as implemented by these regulations. Any fee or fine imposed under these regulations, as authorized by the Act, shall accrue interest at the maximum rate permitted by law from the date the fee and/or fine is imposed until the Facility pays the fee and/or fine.
For the purposes of this section, "postmarked" shall mean dated for delivery to the Division and submitted to the appropriate carrier by whatever means
designated by the Division including electronic or other means. The procedures for suspension and reinstatement of a license set forth in this section shall only apply to violations of these regulations.
Should a Facility fail to submit Midnight Census data to the Division within the time specified in the Act, the following sanctions shall be imposed:
a. First finding of non-compliance: | $1,000 |
b. Second finding of non-compliance: | $1,250 |
c. Third finding of non-compliance: | $1,500 |
Should a Facility fail to pay any Provider Fee to the Division, the following sanctions shall be imposed upon that facility.
dependent upon the number of times the Facility has been found to be in non-compliance with the obligation to remit imposed fees to the Division within the twelve (12) months immediately preceding the date of noncompliance:
a. First finding of non-compliance: | $1,000 |
b. Second finding of non-compliance: | $1,250 |
c. Third finding of non-compliance: | $1,500 |
Should a license for a Facility be suspended under the terms of these regulations, except for those suspensions provided for in Part E of this section, the license will be reinstated upon full payment of all fines, fees, interest or other charges imposed by the Division, along with a showing, to the Division's satisfaction, that measures are in place to ensure future compliance with the Act.
Any Facility that is in non-compliance on six (6) or more occasion in any twelve (12) month period with any obligation imposed by the Act, as implemented in these regulations, shall be deemed to be a chronic violator of the Act and a threat to the safety of Arkansans in an "Intermediate Care Facility For Individuals With Developmental Disabilities." Any Facility found to a chronic violator of the Act shall have its license suspended by the Office of Long Term Care and such license will be reinstated only after the Facility complies with the Act's requirements, including payment of all applicable fees, fines, interest or other sanction and adopts measures that, to the satisfaction of the Division, will ensure future compliance with the Act. After the adoption of these measures and satisfaction of all sanctions, the license for the Facility. Any subsequent violation of the Act by a Facility within twelve (12) months after its license is reinstated pursuant to the procedures set forth in this part of this section, will result in a suspension of the Facility license by the Office of Long Term Care for a period of not less that ninety (90) days and no more than one hundred eighty (180) days, such duration to be
determined by the Director, and such license shall be reinstated only for good cause shown.
Any period of suspension of a Facility license to operate under this section shall extend from the end of any appeal made by that facility that is resolved in favor of the Division.
The Division may withhold from a licensee's vendor payment any amount owed the Medicaid program as a result of an imposed fine for noncompliance as detailed in sections A, B, C, above, or any provider fee not paid by the due date. For purposes of this paragraph, a fine is considered imposed once the Division notifies the licensee of the fine and the licensee has an opportunity to appeal the fine.
In any action taken under this section by the Division to enforce the payment of the provider fee established under Ark. Code Ann. § 20-48-901 -904, or to compel the payment of such fees, it shall be a complete defense for a Facility that:
The Division may re-file any action that is subject to the defense provided in this section at such time as the action is no longer barred.
APPEAL PROCEDURES
Appeal procedures for a Facility are outlined in Section 1-10 of the Department of Human Services Medical Assistance Program Manual of Cost Reimbursement Rules For Long Term Care Facilities. Providers can obtain a copy of these procedures by contacting the Provider Reimbursement Unit at (501) 682-8366.
REFERENCES
Act 433 of the Regular Session of the 87th General Assembly. Effective July 31, 2009
Department of Human Services Medical Assistance Program Manual of Cost Reimbursement Rules For Long Term Care Facilities.
Arkansas Administrative Procedure Act, Arkansas Code Annotated § 25-15-201, et seq.
Title XIX of the Social Security Act, 42 U.S.C § 1396 et seq.
016.06.09 Ark. Code R. 014