Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 10 - Nursing Home Program › Section 13 CSR 70-10.120 - Reimbursement for Nurse Assistant Training

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment updates the maximum allowable
				  reimbursement for nurse assistant training to one thousand five hundred dollars
				  ($1,500) per person and updates other outdated terms and
				  references.
EMERGENCY STATEMENT: The Department of Social
				  Services (DSS), MO HealthNet Division (MHD), by rule and regulation, must
				  define the reasonable costs, manner, extent, quantity, quality, charges, and
				  fees of medical assistance provided to MO HealthNet participants. The General
				  Assembly included additional funds to nursing facilities' and HIV nursing
				  facilities' reimbursements for nurse assistant training (NAT) in SFY 2024. MHD
				  is carrying out the General Assembly's intent by providing for an increase in
				  the maximum allowable reimbursement to nursing facilities and HIV nursing
				  facilities for NAT to one thousand five hundred dollars ($1,500) per person.
				  The increase is necessary to ensure that payments for NAT for nursing
				  facilities and HIV nursing facilities are in line with the funds appropriated
				  for that purpose. There are a total of four hundred eighty-four (484) nursing
				  facilities and HIV nursing facilities currently enrolled in MO HealthNet that
				  will receive an increase to its NAT reimbursement in SFY 2024. This emergency
				  amendment will ensure payment for nursing facility and HIV nursing facility
				  services to approximately twenty-two thousand (22,000) MO HealthNet
				  participants in accordance with the appropriation authority. For the SFY 2024
				  payment to be made, MHD was required to submit a Medicaid State Plan Amendment
				  (SPA) to the Centers for Medicare and Medicaid Services (CMS). CMS approved the
				  SPA on December 18, 2023. This emergency amendment is necessary to protect the
				  public health and welfare of MO HealthNet participants in nursing facilities
				  and HIV nursing facilities. This emergency amendment is necessary to protect a
				  government interest to reimburse nursing facilities and HIV nursing facilities
				  as required by the General Assembly, and to provide MO HealthNet participants
				  with quality nursing facility services. As a result, MHD finds an immediate
				  danger to public health, safety, and/or welfare and a compelling governmental
				  interest, which requires emergency action. MHD has a compelling government
				  interest in providing continued cash flow for nursing facility and HIV nursing
				  facility services. The scope of this emergency amendment is limited to the
				  circumstances creating the emergency and complies with the protections extended
				  by the Missouri and United States Constitutions. MHD believes this emergency
				  amendment is fair to all interested persons and parties under the
				  circumstances. A proposed amendment covering this same material will be
				  published in the Missouri Register. This emergency amendment was filed February
				  26, 2024, effective March 11, 2024, and expires September 6,
				  2024.
(1) Definitions.
(A) "Nurse assistant training agency" is an
				agency which is approved by the Department of Health and Senior Services under
				19 CSR
				30-84.010(7).
(B) "Basic course" is the seventy-five (75)
				hours of classroom training, the one hundred (100) hours of on-the-job
				supervised training, and the final examination of the approved nurse assistant
				training course.
(C) "Challenge the
				final examination" means taking the final examination of the basic course
				without taking the entire basic course.
(D) "Cost report" is the Financial and
				Statistical Report for Nursing Facilities, required attachments, and all
				worksheets supplied by the division for this purpose per
				13 CSR
				70-10.015, effective January 1, 1995, through June 30,
				2022, and 13 CSR 70-10.020, effective
				beginning July 1, 2022. The cost report details the cost of rendering both
				covered and noncovered services for the fiscal reporting period in accordance
				with the procedures prescribed by the division, and on forms provided by and/or
				approved by the division.
(E)
				"Department of Health and Senior Services" is the department responsible for
				the survey, certification, and licensure as prescribed in Chapter 198,
				RSMo.
(F) "Desk audit" is the MO
				HealthNet Division or its authorized agent's audit of a provider's cost report
				without a field audit.
(G)
				"Division," unless otherwise specified, refers to the Department of Social
				Services, MO HealthNet Division that is charged with administration of MO
				HealthNet (Medicaid) Program.
(H)
				"Facility fiscal year" is a facility's twelve- (12-) month fiscal reporting
				period.
(I) "Field audit" is an
				on-site audit of the nursing facility's records performed by the department or
				its authorized agent.
(J) "Nursing
				facility (NF)" is, effective October 1, 1990, skilled nursing facilities,
				skilled nursing facilities/intermediate care facilities and intermediate care
				facilities as defined in Chapter 198, RSMo participating in the Medicaid
				Program will all be subject to the minimum federal requirements found in
				section 1919 of the Social Security Act.
(K) "Occupancy rate" is a facility's total
				actual patient days divided by the total bed days for the same period as
				determined from the desk audited and/or field audited cost report.
(L) "Patient day" is the period of service
				rendered to a patient between the census-taking hour on two (2) consecutive
				days. Census shall be taken in all facilities at midnight each day and a census
				log maintained in each facility for documentation purposes. Patient day
				includes the allowable temporary leave-of-absence days per
				13 CSR
				70-10.015(5)(D), effective January 1,
				1995, through June 30, 2022, and
				13 CSR
				70-10.020 (5)(C), effective beginning
				July 1, 2022, and hospital leave days per
				13 CSR
				70-10.070. The day of discharge is not a patient day
				for reimbursement purposes unless it is also the day of admission.
(M) "Provider or facility" is a nursing
				facility with a valid Medicaid participation agreement with the Department of
				Social Services for the purpose of providing nursing facility services to Title
				XIX-eligible participants.