Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0470 - Nursing Assistant Training and Competency Evaluation Programs Request for Reimbursement

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Omnibus Budget Reconciliation Act (OBRA) of 1987 and 1990 requires that any
			 nursing assistant employed in a nursing facility completes a competency
			 evaluation program. Medicaid reimburses a Medicaid certified nursing facility
			 for the Medicaid share of the allowable cost directly related to meeting the
			 nursing assistant training and competency evaluation requirement.
(2) A facility must notify, in writing, the
			 nursing assistants upon hire that the nursing assistant may receive
			 reimbursement up to 12 months after completing a Nursing Assistant Training and
			 Competency Evaluation Program (NATCEP) training program. Failure to notify or
			 failure to reimburse an eligible nursing assistant, shall result in an
			 assessment for imposition of sanctions.
(3) The nursing facility must reimburse newly
			 employed Certified Nursing Assistants who have personally paid for NATCEP
			 costs. The facility is not required to reimburse the nursing assistant in cases
			 where the expenses were paid by an employer or education training program or
			 reimbursed by a previous employer.
(4) REQUEST FOR REIMBURSEMENT. Medicaid
			 certified nursing facilities must file a NATCEP request for reimbursement with
			 the Department that meets the following standards:
(a) As of January 1, 2013, all requests for
			 reimbursement must be submitted electronically. A facility must submit a
			 request for reimbursement within 12 months after completing a NATCEP training
			 program or reimbursing a nursing assistant as described in section (3) of this
			 rule. The request for reimbursement must identify all costs incurred and
			 related revenues (not including NATCEP payments from the Department) received
			 during the reporting period.
(b) A
			 request for reimbursement must:
(A) Be
			 submitted electronically on a system provided by the Department.
(B) Include actual costs incurred and paid by
			 the facility. The Department may not reimburse a facility prospectively.
(C) Include all revenue (not
			 including NATCEP payments from the Department) received by the facility for
			 conducting the approved nursing assistant training. All revenue must be used to
			 offset the costs incurred and paid in the reporting period.
(D) The facility must maintain and have
			 available for review the appropriate documentation, as described in section (8)
			 of this rule, to support each specific area identified for payment by the
			 Department. Failure to provide required documentation, when requested, shall
			 result in an overpayment to the facility. The facility must repay any
			 overpayment to the Department within 60 days of receipt of notification.
(E) Include all appropriate NATCEP
			 costs and revenues only. NATCEP costs, including costs disallowed, must not be
			 reimbursed as part of the facility's bundled rate. However, NATCEP costs,
			 revenues, and reimbursement must be included on the facility's annual Nursing
			 Facility Financial Statement (NFFS).
(F) Include only true and accurate
			 information. If a facility knowingly, or with reason to know, files a request
			 for reimbursement containing false information, such action must constitute
			 cause for termination of the facility's provider agreement with the Department.
			 Providers filing false requests for reimbursements may be referred for
			 prosecution under applicable statutes.