Section 405 IAC 1-14.7-11 - Quality assessment feeAuthority: IC 12-15-1-10; IC 12-15-21-3
Affected: IC 4-21.5-3; IC 12-13-7-3; IC 12-15-21-3; IC 16-21; IC 16-28-15-7; IC 16-28-15-12; IC 23-2-4
Sec. 11.
(a) Under IC 16-28-15, the office shall collect a quality assessment from each nursing facility licensed under IC 16-28 as a comprehensive care facility. The census days used in the calculation shall be based on the most recently completed desk reviewed or field audited cost report or the nursing facility census data collection form, and the organization type shall be determined based on the organization's type at the rate effective date being established. Unless otherwise specified, the rate used is calculated as follows: (1) For privately owned or operated nursing facilities with total annual nursing facility census days fewer than sixty-two thousand (62,000), sixteen dollars and thirty-seven cents ($16.37) a non-Medicare day.(2) For privately owned or operated and nonstate government owned or operated nursing facilities with total annual nursing facility census days equal to or greater than sixty-two thousand (62,000), four dollars and nine cents ($4.09) a non-Medicare day.(3) For nonstate government owned or operated nursing facilities that became nonstate government owned or operated before July 1, 2003, four dollars and nine cents ($4.09) a non-Medicare day.(4) For nonstate government owned or operated nursing facilities that became nonstate government owned or operated on or after July 1, 2003, with total annual nursing facility census days fewer than sixty-two thousand (62,000), sixteen dollars and thirty-seven cents ($16.37) a non-Medicare day.(b) Under IC 16-28-15-7(2), the following nursing facilities shall be exempt from the quality assessment described in subsection (a):(1) A continuing care retirement community meeting one (1) of the following: (A) A continuing care retirement community registered with the securities commissioner as a continuing care retirement community on or before January 1, 2007, and has continuously maintained at least one (1) continuing care agreement since on or before January 1, 2007, with an individual residing in the continuing care retirement community.(B) A continuing care retirement community that for the entire period from January 1, 2007, through June 30, 2009, operated independent living units, not less than twenty-five percent (25%) of which are provided under contracts requiring the payment of a minimum entrance fee of not less than twenty-five thousand dollars ($25,000).(C) An organization registered under IC 23-2-4 before July 1, 2009, providing housing in an independent living unit for a religious order.(D) A continuing care retirement community as defined in IC 16-28-15-2.(2) A hospital based nursing facility licensed under IC 16-21.(3) The Indiana Veterans' Home.(c) For nursing facilities certified for participation in Medicaid under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.), the quality assessment shall be an allowable cost for cost reporting and auditing purposes. The quality assessment shall be included in Medicaid reimbursement as an add-on to the Medicaid rate. The add-on is determined by dividing the product of the assessment rate times total non-Medicare patient days by total patient days, from the most recently completed desk reviewed cost report.(d) For nursing facilities not certified for participation in Medicaid under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.), the facility shall remit the quality assessment to the state of Indiana within ten (10) days after the due date. If a nursing facility fails to pay the quality assessment under this subsection within ten (10) days after the date the payment is due, the nursing facility shall pay interest on the quality assessment at the same rate as determined under IC 12-15-21-3 (6)(A).(e) The office shall notify each nursing facility of the amount of the facility's assessment after the amount has been computed. If the facility disagrees with the computation of the assessment, the facility shall request an administrative reconsideration by the office. The reconsideration request shall be as follows: (2) Contains the following: (A) Specific issues to be reconsidered.(B) The rationale for the facility's position.(3) Signed by the authorized representative of the facility and shall be received by the office not later than fifteen (15) days after the notice of the assessment is mailed. On receipt of the request for reconsideration, the office shall evaluate the data. After review, the office may amend the assessment or affirm the original decision. The office shall thereafter notify the facility of its final decision in writing, within forty-five (45) days of the office's receipt of the request for reconsideration. If a timely response is not made by the office to the facility's reconsideration request, the request shall be considered denied and the provider may initiate an appeal under IC 4-21.5-3.
(f) An assessment shall be calculated on an annual basis, with equal monthly amounts due on or before the tenth day of each calendar month.(g) A facility may file a request to pay the quality assessment on an installment plan. The request shall be as follows: (1) In writing setting forth the facility's rationale for the request.(2) Submitted to the office. An installment plan established under this section shall not exceed a period of six (6) months from the date of execution of the agreement. This agreement shall set forth the amount of the assessment that shall be paid in installments, and include provisions for the collection of interest. This interest shall not exceed the percentage set forth in IC 12-15-21-3 (6)(A).
(h) A facility that fails to pay the quality assessment due under this section within ten (10) days after the date the payment is due shall pay interest on the quality assessment at the same rate as determined under IC 12-15-21-3(6)(A).(i) The office shall offset the collection of the assessment fee for a facility as follows: (1) Against a Medicaid payment to the facility.(2) Against a Medicaid payment to another health facility related to the facility through common ownership or control.(3) In another manner determined by the office.(j) If a facility fails to: (1) submit patient day information requested by the office to calculate the quality assessment fee; or(2) pay the quality assessment fee; not later than one hundred twenty (120) days after the patient day information is requested or payment of the quality assessment is due, the office shall report each facility to IDOH to initiate license revocation proceedings under IC 16-28-15-12.Office of the Secretary of Family and Social Services; 405 IAC 1-14.7-11; filed 8/20/2024, 9:11 a.m.: 20240918-IR-405240088FRA