Section 405 IAC 1-14.7-7 - Additional reimbursementAuthority: IC 12-15-1-10; IC 12-15-21-3
Affected: IC 4-21.5-3; IC 12-13-7-3; IC 12-15
Sec. 7.
(a) For purposes of this section, "Schedule Z" refers to the special facility qualification report, which shall be completed by a provider requesting reimbursement for an SCU or a ventilator program, or both, as follows: (1) Nursing facilities previously qualified as an SCU or a ventilator facility, or both, shall annually recertify that the facility is still in compliance with the requirements to continue to receive reimbursement. For annual recertifications, Schedule Z shall be completed based on a calendar year reporting period, January 1 through December 31, and submitted to the office not later than March 31 after the end of each calendar year.(2) Nursing facilities that have developed an SCU or a ventilator program, or both, between October 1 and March 31 shall submit Schedule Z not later than March 31 to determine qualification and eligibility for reimbursement at the following July 1 rate effective date.(3) Nursing facilities that have developed an SCU or a ventilator program, or both, between April 1 and September 30 shall submit Schedule Z not later than September 30 to determine qualification and eligibility for reimbursement at the following January 1 rate effective date.(4) Nursing facilities that have discontinued an SCU or a ventilator program, or both, shall notify the office and indicate the date in which the program was discontinued.(5) Nursing facilities that have developed an SCU or a ventilator program, or both, before December 31, 2023, may submit Schedule Z to determine qualification and eligibility for reimbursement beginning on the effective date of the submission, if the applicable criteria were met.(b) The office shall increase Medicaid reimbursement to nursing facilities with a qualifying ventilator program. Additional Medicaid reimbursement shall be made to those facilities at a rate of eighty dollars ($80) an eligible Medicaid resident day. The additional reimbursement shall:(1) begin with the later of the effective date of the program, or the first day for residents considered ventilator- dependent under the Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual (RAI Manual) or its successor published by CMS; and(2) remain in effect until the earlier of the first day the resident is no longer considered ventilator-dependent under the RAI Manual, or the program terminates.(c) The office shall increase Medicaid reimbursement to nursing facilities with a qualifying SCU program. The additional Medicaid reimbursement shall be made to the facilities at a rate of twelve dollars ($12) an eligible Medicaid Alzheimer's and dementia resident day in their SCU. The additional reimbursement shall: (1) begin with the later of the effective date of the program, or the first day for residents diagnosed with Alzheimer's or dementia; and(2) remain in effect until the earlier of the first day the resident no longer has a diagnosis of Alzheimer's or dementia, or the program terminates.(d) The office shall increase Medicaid reimbursement to all nursing facilities for NEMT through an add-on in the amount of one dollar and twenty-one cents ($1.21) a Medicaid resident day.Office of the Secretary of Family and Social Services; 405 IAC 1-14.7-7; filed 8/20/2024, 9:11 a.m.: 20240918-IR-405240088FRA