Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 323 - Sanctions › Section VII-32307 - Withholding of Vendor Payments

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Withholding of Vendor Payments. DHH may withhold vendor payments in whole or in
				  part in the following situations, which are not all inclusive.
1. Delinquent Staffing Report. When the
				  ICF/MR provider fails to timely submit a required, completed staffing report.
				  After DHH notifies the provider of the delinquent report, vendor payment may be
				  withheld until the completed report is received.
2. Unapproved Staffing Shortage. When a
				  staffing report indicates an unapproved staffing shortage, vendor payment may
				  be withheld until staffing is brought into compliance.
3. Incorrect/Inappropriate Charges. When DHH
				  determines that the ICF/MR provider has incorrectly or inappropriately charged
				  clients, families, or responsible parties, or there has been misapplication of
				  client funds, vendor payment may be withheld until the provider does the
				  following:
a. makes restitution;
				  and
b. submits documentation of
				  such restitution to BHSF's Institutional Reimbursement Section.
4. Delinquent Cost Report. When an
				  ICF/MR provider fails to submit a cost report within 90 days from the fiscal
				  year end closing date, a penalty of 5 percent of the total monthly payment for
				  the first month and a progressive penalty of 5 percent of the total monthly
				  payment for each succeeding month may be levied and withheld from the vendor's
				  payment for each month that the cost report is due, not extended, and not
				  received. The penalty is nonrefundable.
NOTE: DHH's Institutional Reimbursement Section may grant a
					 30-day extension of the 90-day time limit, when requested by the ICF/MR
					 provider, if just cause has been established. Extensions beyond 30 days may be
					 approved for situations beyond the ICF/MR provider's control.
5. Cost Reports Errors. Cost reports errors
				  greater than 10 percent in the aggregate for the ICF/MR provider for the cost
				  report year may result in a maximum penalty of 10 percent of the current per
				  diem rate for each month the cost report errors are not correct. The penalty is
				  nonrefundable.
6. Corrective Action
				  for Audit Findings. Vendor payments may be withheld when an ICF/MR facility
				  fails to submit corrective action in response to financial and compliance audit
				  findings within 15 days after receiving the notification letter until such time
				  compliance is achieved.
7. Failure
				  to Respond or Adequately Respond to Requests for Financial/Statistical
				  Information. When an ICF/MR facility fails to respond or adequately respond to
				  requests from DHH for financial and statistical information within 15 days
				  after receiving the notification letter, vendor payments may be withheld until
				  such time the requested information is received.
8. Insufficient Medical Recertification. When
				  an ICF/MR provider fails to secure recertification of a client's need for care
				  and services, the vendor's payment for that individual may be withheld or
				  recouped until compliance is achieved.
9. Inadequate Review/Revision of Plan of Care
				  (IHP). When an ICF/MR provider repeatedly fails to ensure that an adequate plan
				  of care for a client is reviewed and revised at least at required intervals,
				  the vendor's payment may be withheld or recouped until compliance is
				  achieved.
10. Failure to Submit
				  Response to Survey Reports. When an ICF/MR provider fails to submit an
				  acceptable response within 30 days after receiving a survey report from DHH,
				  HCFA, OIG and the legislative auditor, vendor payments may be withheld until an
				  adequate response is received, unless the appropriate agency extends the time
				  limit.
11. Corrective Action on
				  Complaints. When an ICF/MR fails to submit an adequate corrective action plan
				  in response to a complaint within seven days after receiving the complaint
				  report, vendor payments may be withheld until an adequate corrective action
				  plan is received, unless the time limit is extended by the DHH.
12. Delinquent Utilization Data Requests.
				  Facilities will be required to timely submit utilization data requested by the
				  DHH. Providers will be given written notice when such utilization data has not
				  been received by the due date. Such notice will advise the provider of the date
				  the utilization data must be received by to avoid withholding of vendor
				  payments. The due date will never be less than 10 days from the date the notice
				  is mailed to the provider. If the utilization data is not received by the due
				  date provided in the notice, the medical vendor's payment will be withheld
				  until the utilization data is received.
13. Termination or Withdrawal from the
				  Medicaid Program. When a provider is terminated or withdraws from the Medicaid
				  Program, vendor payment will be withheld until all programmatic and financial
				  issues are resolved.