reglab/statecodes huggingface dataset:
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 4 - Operating Cost Component › Section 12VAC30-90-40 - Operating cost

Current through Register Vol. 40, No. 24, July 15, 2024
Effective July 1, 2001, operating cost shall be the
						  total allowable inpatient cost less plant cost or capital, as appropriate, and
						  NATCEPs costs. See Subpart VII (12VAC30-90-170 et
						  seq.) of this part for rate determination procedures for NATCEPs costs.
						  Operating cost shall be made up of direct patient care operating cost and
						  indirect patient care operating cost. Direct patient care operating cost is
						  defined in
						  12VAC30-90-271. Indirect patient
						  care operating cost includes all operating costs not defined as direct patient
						  care operating costs or NATCEPs costs or the actual charges by the Central
						  Criminal Records Exchange for criminal records checks for nursing facility
						  employees (see
						  12VAC30-90-272 ). For purposes of
						  calculating the reimbursement rate, the direct patient care operating cost per
						  day shall be the Medicaid portion of the direct patient care operating cost
						  divided by the nursing facility's number of Medicaid patient days in the cost
						  reporting period. The indirect patient care operating cost per day shall be the
						  Medicaid portion of the indirect patient care operating cost divided by the
						  greater of the actual number of Medicaid patient days in the cost reporting
						  period, or the required occupancy percentage of the potential patient days for
						  all licensed beds throughout the cost reporting period times the Medicaid
						  utilization percentage. The required occupancy percentage for dates of service
						  on or before June 30, 2013, shall be 90%, and for dates of service on or after
						  July 1, 2013, shall be 88%. For facilities that also provide specialized care
						  services, see subdivision 9 of
						  12VAC30-90-264 for special
						  procedures for computing the number of patient days required to meet the
						  occupancy percentage requirement.
Statutory Authority: § 32.1-325 of the Code of
							 Virginia; 42 USC § 1396 et seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 4 - Operating Cost Component › Section 12VAC30-90-42 to 12VAC30-90-43

Current through Register Vol. 40, No. 24, July 15, 2024
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 4 - Operating Cost Component › Section 12VAC30-90-45 - Supplemental payments for state-owned nursing facilities

Current through Register Vol. 40, No. 24, July 15, 2024
A. Effective July 1, 2018, DMAS shall make
						supplemental payments to state-owned nursing facilities owned by a Type One
						hospital. Quarterly supplemental payments for each facility shall be calculated
						in the manner described in this section.
B. Reimbursement methodology. The
						supplemental payment shall equal inpatient nursing facility claim payments
						times the upper payment limit (UPL) gap percentage.
1. The annual UPL gap percentage is the
						percentage calculated where the numerator is the difference for each nursing
						facility between a reasonable estimate of the amount that would be paid under
						Medicare payment principles for nursing facility services provided to Medicaid
						patients calculated in accordance with
						42 CFR
						447.272 and what Medicaid paid for such
						services, and the denominator is Medicaid payments to each nursing facility for
						nursing facility services provided to Medicaid patients in the same year used
						in the numerator.
2. The UPL gap
						percentage will be calculated annually for each nursing facility using data for
						the most recent year for which comprehensive annual data are available and
						inflated to the state fiscal year for which payments are to be made.
3. Maximum aggregate payments to all
						qualifying nursing facilities shall not exceed the available UPL. If nursing
						facility payments for state nursing facilities would exceed the UPL, the
						numerator in the calculation of the UPL gap percentage shall be reduced
						proportionately.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 4 - Operating Cost Component › Section 12VAC30-90-46 to 12VAC30-90-49 - Reserved

Current through Register Vol. 40, No. 24, July 15, 2024
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 5 - Allowable Cost Identification › Section 12VAC30-90-50 - Allowable costs

Current through Register Vol. 40, No. 24, July 15, 2024
A. Costs which
						are included in rate determination procedures and final settlement shall be
						only those allowable, reasonable costs which are acceptable under the Medicare
						principles of reimbursement, except as specifically modified in the Plan and as
						may be subject to individual or ceiling cost limitations and which are
						classified in accordance with the DMAS uniform chart of accounts (see Appendix
						I (12VAC30-90-270 through
						12VAC30-90-276 ) of Part III of
						this chapter).
B. Certification.
						The cost of meeting all certification standards for NF requirements as required
						by the appropriate state agencies, by state laws, or by federal legislation or
						regulations.
C. Operating costs.
1. Direct patient care operating costs shall
						be defined in
						12VAC30-90-271.
2. Allowable direct patient care operating
						costs shall exclude (i) personal physician fees, and (ii) pharmacy services and
						prescribed legend and nonlegend drugs provided by nursing facilities which
						operate licensed in-house pharmacies. These services shall be billed directly
						to DMAS through separate provider agreements and DMAS shall pay directly in
						accordance with
						12VAC30-80-10 et seq.
3. Indirect patient care operating costs
						include all other operating costs, not identified as direct patient care
						operating costs and NATCEPs costs in Appendix I (12VAC30-90-270 through
						12VAC30-90-276 ) of Part III of
						this chapter, which are allowable under the Medicare principles of
						reimbursement, except as specifically modified herein and as may be subject to
						individual cost or ceiling limitations.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 5 - Allowable Cost Identification › Section 12VAC30-90-51 - Purchases/related organizations

Current through Register Vol. 40, No. 24, July 15, 2024
A.
						Costs applicable to services, facilities, and supplies furnished to the
						provider by organizations related to the provider by common ownership or
						control shall be included in the allowable cost of the provider at the cost to
						the related organization, provided that such costs do not exceed the price of
						comparable services, facilities or supplies. Purchases of existing NFs by
						related parties shall be governed by the provisions of
						12VAC30-90-34 B 1.
Allowable cost applicable to management services
						  furnished to the provider by organizations related to the provider by common
						  ownership or control shall be lesser of the cost to the related organization or
						  the per patient day ceiling limitation established for management services
						  cost. (See
						  12VAC30-90-290.)
B. "Related to the provider" shall mean that
						the provider is related by reasons of common ownership or control by the
						organization furnishing the services, facilities, or supplies.
C. Common ownership exists when an individual
						or individuals or entity or entities possess significant ownership or equity in
						the parties to the transaction. Control exists where an individual or
						individuals or entity or entities have the power, directly or indirectly,
						significantly to influence or direct the actions or policies of the parties to
						the transaction. Significant ownership or control shall be deemed to exist
						where an individual is a "person with an ownership or control interest" within
						the meaning of 42 CFR
						455.101. If the parties to the transaction
						are members of an immediate family, as defined below, the transaction shall be
						presumed to be between related parties if the ownership or control by immediate
						family members, when aggregated together, meets the definitions of "common
						ownership" or "control," as set forth above. Immediate family shall be defined
						to include, but not be limited to, the following:
(i) husband and wife;
(ii) natural parent; child and sibling;
(iii) adopted child and adoptive
						parent;
(iv) step-parent,
						step-child, step-sister, and step-brother;
(v) father-in-law, mother-in-law,
						sister-in-law, brother-in-law, son-in-law and daughter-in-law; and
(vi) grandparent and grandchild.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 5 - Allowable Cost Identification › Section 12VAC30-90-52 - Administrator/owner compensation

Current through Register Vol. 40, No. 24, July 15, 2024
A.
						Administrators' compensation, whether administrators are owners or nonowners,
						shall be based on a schedule adopted by DMAS and varied according to facility
						bed size. The compensation schedule shall be adjusted annually to reflect
						cost-of-living increases and shall be published and distributed to providers
						annually. The administrator's compensation schedule covers only the position of
						administrator and assistants and does not include the compensation of owners
						employed in capacities other than the nursing facility administrator (see
						12VAC30-90-290, Cost reimbursement
						limitations).
B. Administrator
						compensation shall mean remuneration paid regardless of the form in which it is
						paid. This includes, but shall not be limited to, salaries, professional fees,
						insurance premiums (if the benefits accrue to the employee/owner or his
						beneficiary), director fees, personal use of automobiles, consultant fees,
						management fees, travel allowances, relocation expenses in excess of IRS
						guidelines, meal allowances, bonuses, pension plan costs, and deferred
						compensation plans. Management fees, consulting fees, and other services
						performed by owners shall be included in the total compensation if they are
						performing administrative duties regardless of how such services may be
						classified by the provider.
C.
						Compensation for all administrators (owner and nonowner) shall be based upon a
						40-hour week to determine reasonableness of compensation.
D. Owner/administrator employment
						documentation.
1. Owners who perform services
						for a nursing facility as an administrator and also perform additional duties
						must maintain adequate documentation to show that the additional duties were
						performed beyond the normal 40-hour week as an administrator. The additional
						duties must be necessary for the operation of the nursing facility and related
						to patient care.
2. Services
						provided by owners, whether in employee capacity, through management contracts,
						or through home office relationships shall be compared to the cost and services
						provided in arms-length transactions.
3. Compensation for such services shall be
						adjusted where such compensation exceeds that paid in such arms-length
						transactions or where there is a duplication of duties normally rendered by an
						administrator. No reimbursement shall be allowed for compensation where owner
						services cannot be documented and audited.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 5 - Allowable Cost Identification › Section 12VAC30-90-53 - Depreciation

Current through Register Vol. 40, No. 24, July 15, 2024
The allowance for depreciation shall be restricted to
						  the straight line method with a useful life in compliance with AHA guidelines.
						  If the item is not included in the AHA guidelines, reasonableness shall be
						  applied to determine useful life.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 5 - Allowable Cost Identification › Section 12VAC30-90-54 - Rent/Leases

Current through Register Vol. 40, No. 24, July 15, 2024
Rent or lease expenses shall be limited by the
						  provisions of
						  12VAC30-90-280.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 5 - Allowable Cost Identification › Section 12VAC30-90-55 - Provider payments

Current through Register Vol. 40, No. 24, July 15, 2024
A.
						Limitations and effective for dates of service beginning July 1, 2001, through
						June 30, 2014:
1. Payments to providers,
						shall not exceed charges for covered services except for (i) public providers
						furnishing services free of charge or at a nominal charge (ii) a nonpublic
						provider whose charges are 60% or less of the allowable reimbursement
						represented by the charges and that demonstrates its charges are less than
						allowable reimbursement because its customary practice is to charge patients
						based on their ability to pay. Nominal charge shall be defined as total charges
						that are 60% or less of the allowable reimbursement of services represented by
						these charges. Providers qualifying in this section shall receive allowable
						reimbursement as determined in this Plan.
2. Allowable reimbursement in excess of
						charges may be carried forward for payment in the two succeeding cost reporting
						periods. A new provider may carry forward unreimbursed allowable reimbursement
						in the five succeeding cost reporting periods.
3. Providers may be reimbursed the carry
						forward to a succeeding cost reporting period (i) if total charges for the
						services provided in that subsequent period exceed the total allowable
						reimbursement in that period (ii) to the extent that the accumulation of the
						carry forward and the allowable reimbursement in that subsequent period do not
						exceed the providers' direct and indirect care operating ceilings plus
						allowable plant cost.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 5 - Allowable Cost Identification › Section 12VAC30-90-56 - Legal fees/accounting

Current through Register Vol. 40, No. 24, July 15, 2024
A.
						Costs claimed for legal/accounting fees shall be limited to reasonable and
						customary fees for specific services rendered. Such costs must be related to
						patient care as defined by Medicare principles of reimbursement and subject to
						applicable regulations herein. Documentation for legal costs must be available
						at the time of audit.
B. Retainer
						fees shall be considered an allowable cost up to the limits established in
						12VAC30-90-290. C. As mandated by
						the Omnibus Budget Reconciliation Act of 1990, effective November 5, 1990,
						reimbursement of legal expenses for frivolous litigation shall be denied if the
						action is initiated on or after November 5, 1990. Frivolous litigation is any
						action initiated by the nursing facility that is dismissed on the basis that no
						reasonable legal ground existed for the institution of such action.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 5 - Allowable Cost Identification › Section 12VAC30-90-57 - Documentation

Current through Register Vol. 40, No. 24, July 15, 2024
Adequate documentation supporting cost claims must be
						  provided at the time of interim settlement, cost settlement, audit, and final
						  settlement.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 5 - Allowable Cost Identification › Section 12VAC30-90-58 - Fraud and abuse

Current through Register Vol. 40, No. 24, July 15, 2024
Previously disallowed costs which are under appeal and
						  affect more than one cost reporting period shall be disclosed in subsequent
						  cost reports if the provider wishes to reserve appeal rights for such
						  subsequent cost reports. The reimbursement effect of such appealed costs shall
						  be computed by the provider and submitted to DMAS with the cost report. Where
						  such disclosure is not made to DMAS, the inclusion of previously disallowed
						  costs may be referred to the Medicaid Fraud Control Unit of the Office of the
						  Attorney General.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 5 - Allowable Cost Identification › Section 12VAC30-90-59 - Reserved

Current through Register Vol. 40, No. 24, July 15, 2024
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 6 - New Nursing Facilities › Section 12VAC30-90-60 - Interim rate

Current through Register Vol. 40, No. 24, July 15, 2024
A. A new
						facility shall be defined as follows:
1. A
						facility that is newly enrolled and new construction has taken place through
						the COPN process; or
2. A facility
						that is newly enrolled that was previously denied payments for new admissions
						and was subsequently terminated from the program.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 6 - New Nursing Facilities › Section 12VAC30-90-65 - Final rate and effective for dates of services beginning July 1, 2001, through June 30, 2014

Current through Register Vol. 40, No. 24, July 15, 2024
A. This section
						shall apply to dates of services beginning July 1, 2001, through June 30,
						2014.
B. DMAS shall reimburse the
						lower of the appropriate operating ceilings, charges or actual allowable cost
						for a new NF's first cost reporting period of operation, subject to the
						procedures outlined in subdivisions 4, 5, and 6 of
						12VAC30-90-60.
C. Upon determination of the actual allowable
						operating cost for direct patient care and indirect patient care the per diem
						amounts shall be used to determine if the provider is below the peer group
						ceiling used to set its interim rate. If indirect costs are below the ceiling,
						an efficiency incentive shall be paid at settlement of the first year cost
						report.
D. This incentive will
						allow a NF to be paid up to 25% of the difference between its actual allowable
						indirect operating cost and the peer group ceiling used to set the interim
						rate. (Refer to
						12VAC30-90-41 F.)
Statutory Authority: § 32.1-325 of the Code of
							 Virginia; 42 USC § 1396 et seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 7 - Cost Reports › Section 12VAC30-90-75 - Reporting form; accounting method; cost report extensions; fiscal year changes

Current through Register Vol. 40, No. 24, July 15, 2024
A. All cost
						reports shall be submitted on uniform reporting forms provided by the DMAS, or
						by Medicare if applicable. Such cost reports, subsequent to the initial cost
						report period, shall cover a 12-month period. Any exceptions must be approved
						by the DMAS.
B. The accrual method
						of accounting and cost reporting is mandated for all providers.
C. Extension for submission of a cost report
						may be granted if the provider can document extraordinary circumstances beyond
						its control. Extraordinary circumstances do not include:
1. Absence or changes of chief finance
						officer, controller or bookkeeper;
2. Financial statements not
						completed;
3. Office or building
						renovations;
4. Home office cost
						report not completed;
5. Change of
						stock ownership;
6. Change of
						intermediary;
7. Conversion to
						computer; or
8. Use of
						reimbursement specialist.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 8 - Prospective Rates › Section 12VAC30-90-80 - Time frames

Current through Register Vol. 40, No. 24, July 15, 2024
A. For cost
						reports filed on or after August 1, 1992, a prospective rate shall be
						determined by DMAS within 180 days of the receipt of a complete cost report.
						(See 12VAC30-90-70 A.) Rate adjustments
						shall be made retroactive to the first day of the provider's new cost reporting
						year. Where a field audit is necessary to set a prospective rate, DMAS shall
						have an additional 120 days to determine any appropriate adjustments to the
						prospective rate as a result of such field audit. This time period shall be
						extended if delays are attributed to the provider.
B. Subsequent to establishing the prospective
						rate DMAS shall conclude the desk audit of a providers' cost report and
						determine if further field audit activity is necessary. DMAS will seek
						repayment or make retroactive settlements when audit adjustments are made to
						costs claimed for reimbursement.
Statutory Authority
§ 32.1-325 of the Code of Virginia and Item 319
							 (II) of Chapter 1073 of the 2000 Acts of Assembly.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 9 - Retrospective Rates › Section 12VAC30-90-90 - Retrospective rates

Current through Register Vol. 40, No. 24, July 15, 2024
The retrospective method of reimbursement shall be used
						  for mental health/mental retardation facilities.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 9 - Retrospective Rates › Section 12VAC30-90-100 - Reserved

Current through Register Vol. 40, No. 24, July 15, 2024
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 10 - Record Retention › Section 12VAC30-90-110 - Record retention

Current through Register Vol. 40, No. 24, July 15, 2024
A. Time
						frames. All of the NF's accounting and related records, including the general
						ledger, books of original entry, and statistical data must be maintained for a
						minimum of five years, or until all affected cost reports are final settled.
Certain information must be maintained for the duration
						  of the provider's participation in the Medicaid program and until such time as
						  all cost reports are settled. Examples of such information are set forth in
						  subsection B of this section.
B. Types of records to be maintained.
						Information which must be maintained for the duration of the provider's
						participation in the Medicaid program includes, but is not limited to:
1. Real and tangible property records,
						including leases and the underlying cost of ownership;
2. Itemized depreciation schedules;
						and
3. Mortgage documents, loan
						agreements, and amortization schedules;
4. Copies of all cost reports filed with DMAS
						together with supporting financial statements.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 11 - Audits › Section 12VAC30-90-120 - Audit overview; scope of audit

Current through Register Vol. 40, No. 24, July 15, 2024
A. Desk audits shall be performed to verify
						the completeness and accuracy of the cost report, and reasonableness of costs
						claimed for reimbursement. Field audits, as determined necessary by DMAS, shall
						be performed on the records of each participating provider to determine that
						costs included for reimbursement were accurately determined and reasonable, and
						do not exceed the ceilings or other reimbursement limitations established by
						DMAS.
B. The scope of the audit
						includes, but shall not be limited to: trial balance verification, analysis of
						fixed assets, schedule of assets, indebtedness, selected revenues, leases and
						the underlying cost of ownership, rentals and other contractual obligations,
						and costs to related organizations. The audit scope may also include various
						other analyses and studies relating to issues and questions unique to the NF
						and identified by DMAS. Census and related statistics, patient trust funds, and
						billing procedures are also subject to audit.
Statutory Authority
§ 32.1-325 of the Code of Virginia and Item 319
							 (II) of Chapter 1073 of the 2000 Acts of Assembly.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 11 - Audits › Section 12VAC30-90-121 - Field audit requirements

Current through Register Vol. 40, No. 24, July 15, 2024
Field audits shall be required as follows:
1. For the first cost report on all new
						NF's.
2. For the first cost report
						in which costs for bed additions or other expansions are included.
3. When a NF is sold, purchased, or
						leased.
4. As determined by DMAS
						desk audit.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 11 - Audits › Section 12VAC30-90-122 - Provider notification

Current through Register Vol. 40, No. 24, July 15, 2024
The provider shall be notified in writing of all
						  adjustments to be made to a cost report resulting from desk or field audit with
						  stated reasons and references to the appropriate principles of reimbursement or
						  other appropriate regulatory cites.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 11 - Audits › Section 12VAC30-90-123 - Field audit exit conference

Current through Register Vol. 40, No. 24, July 15, 2024
A. The provider shall be offered an exit
						conference to be executed within 15 days following completion of the on-site
						audit activities, unless other time frames are mutually agreed to by DMAS and
						the provider. Where two or more providers are part of a chain organization or
						under common ownership, DMAS shall have up to 90 days after completion of all
						related on-site audit activities to offer an exit conference for all such NFs.
						The exit conference shall be conducted at the site of the audit or at a
						location mutually agreeable to DMAS and the provider.
B. The purpose of the exit conference shall
						be to enable the DMAS auditor to discuss such matters as the auditor deems
						necessary, to review the proposed field audit adjustments, and to present
						supportive references. The provider will be given an opportunity during the
						exit conference to present additional documentation and agreement or
						disagreement with the audit adjustments.
C. All remaining adjustments, including those
						for which additional documentation is insufficient or not accepted by DMAS,
						shall be applied to the applicable cost report or reports regardless of the
						provider's approval or disapproval.
D. The provider shall sign an exit conference
						form that acknowledges the review of proposed adjustments.
E. After the exit conference DMAS shall
						perform a review of all remaining field audit adjustments. Within a reasonable
						time and after all documents have been submitted by the provider, DMAS shall
						transmit in writing to the provider a final field audit adjustment report
						(FAAR), if revised, which will include all remaining adjustments not resolved
						during the exit conference. The provider shall have 15 days from the date of
						the letter which transmits the FAAR, to submit any additional documentation
						which may affect adjustments in the FAAR.
Statutory Authority
§ 32.1-325 of the Code of Virginia and Item 319
							 (II) of Chapter 1073 of the 2000 Acts of Assembly.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 11 - Audits › Section 12VAC30-90-124 - Audit delay

Current through Register Vol. 40, No. 24, July 15, 2024
In the event the provider delays or refuses to permit
						  an audit to occur or to continue or otherwise interferes with the audit
						  process, payments to the provider shall be reduced as stated in
						  12VAC30-90-70 B.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 11 - Audits › Section 12VAC30-90-125 - Field audit time frames

Current through Register Vol. 40, No. 24, July 15, 2024
A.
						If a field audit is necessary after receipt of a complete cost report, such
						audit shall be initiated within three years following the date of the last
						notification of program reimbursement and the on site activities, including
						exit conferences, shall be concluded within 180 days from the date the field
						audit begins. Where audits are performed on cost reports for multiple years or
						providers, the time frames shall be reasonably extended for the benefit of the
						DMAS and subject to the provisions of
						12VAC30-90-123.
B. Documented delays on the part of the
						provider will automatically extend the above time frames to the extent of the
						time delayed.
C. Extensions of the
						time frames shall be granted to the department for good cause shown.
D. Disputes relating to the timeliness
						established in
						12VAC30-90-123 and
						12VAC30-90-124, or to the grant of
						extensions to the DMAS, shall be resolved by application to the Director of the
						DMAS or his designee.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 11 - Audits › Section 12VAC30-90-126 to 12VAC30-90-129 - Reserved

Current through Register Vol. 40, No. 24, July 15, 2024
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart II - Rate Determination Procedures › Article 11 - Audits › Section 12VAC30-90-130 to 12VAC30-90-135

Current through Register Vol. 40, No. 24, July 15, 2024
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart III - Appeals › Section 12VAC30-90-136 - Elements of capital payment methodology not subject to appeal

Current through Register Vol. 40, No. 24, July 15, 2024
Elements of the capital payment methodology that shall
						not be subject to appeal shall be:
1.
					 The definitions provided in Article 3 (12VAC30-90-35 et seq.) of Subpart
					 II of this chapter, and the application of those definitions to the FRV rate
					 calculation.
2. The transition
					 policy described in
					 12VAC30-90-29.
3. The formula for determining the FRV per
					 diem rate described in Article 3 of Subpart II of this chapter.
4. The calculation of the FRV rental amount
					 described in Article 3 of Subpart II of this chapter.
5. The exclusion of certain beds from the
					 transition policy as provided in Article 3 of Subpart II of this
					 chapter.
Statutory Authority
§ 32.1-325 of the Code of Virginia and Item 319
						  (II) of Chapter 1073 of the 2000 Acts of Assembly.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart III - Appeals › Section 12VAC30-90-137 to 12VAC30-90-139 - Reserved

Current through Register Vol. 40, No. 24, July 15, 2024
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart IV - Individual Expense Limitation › Section 12VAC30-90-140 - Individual expense limitation

Current through Register Vol. 40, No. 24, July 15, 2024
In addition to operating costs being subject to peer
						group ceilings, costs are further subject to maximum limitations as defined in
						12VAC30-90-290, Cost Reimbursement
						Limitations.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart V - Cost Report Preparation Instructions › Section 12VAC30-90-150 - Cost report preparation instructions

Current through Register Vol. 40, No. 24, July 15, 2024
Instructions for preparing NF cost reports will be
						provided by the DMAS.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart VI - Stock Transactions › Article 1 - Plant Cost Applicable › Section 12VAC30-90-160 - Stock acquisition; merger of unrelated and related parties

Current through Register Vol. 40, No. 24, July 15, 2024
A. The acquisition
						of the capital stock of a provider does not constitute a basis for revaluation
						of the provider's assets. Any cost associated with an acquisition of capital
						stock shall not be an allowable cost. The provider selling its stock continues
						as a provider after the sale, and the purchaser is only a stockholder of the
						provider.
B. In the case of a
						merger which combines two or more unrelated corporations under the regulations
						of the Code of Virginia, there will be only one surviving corporation. If the
						surviving corporation, which will own the assets and liabilities of the merged
						corporation, is not a provider, a Certificate of Public Need, if applicable,
						must be issued to the surviving corporation.
The nonsurviving corporation shall be subject to the
						  policies applicable to terminated providers, including those relating to gain
						  or loss on sales of NFs.
C.
						The statutory merger of two or more related parties or the consolidation of two
						or more related providers resulting in a new corporate entity shall be treated
						as a transaction between related parties. No revaluation shall be permitted for
						the surviving corporation.
Statutory Authority
§ 32.1-325 of the Code of Virginia and Item 319
							 (II) of Chapter 1073 of the 2000 Acts of Assembly.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart VI - Stock Transactions › Article 2 - Capital Cost Applicable › Section 12VAC30-90-165 - Stock acquisition; merger of unrelated and related parties

Current through Register Vol. 40, No. 24, July 15, 2024
A. The acquisition
						of the capital stock of a provider does not constitute a basis for revaluation
						of the provider's assets. Any cost associated with an acquisition of capital
						stock shall not be an allowable cost. The provider selling its stock continues
						as a provider after the sale, and the purchaser is only a stockholder of the
						provider.
B. In the case of a
						merger that combines two or more unrelated corporations under the Code of
						Virginia, there will be only one surviving corporation. If the surviving
						corporation that will own the assets and liabilities of the merged corporation
						is not a provider, a Certificate of Public Need, if applicable, must be issued
						to the surviving corporation.
The nonsurviving corporation shall be subject to the
						  policies applicable to terminated providers, including those relating to gain
						  or loss on sales of NFs.
C.
						The statutory merger of two or more related parties or the consolidation of two
						or more related providers resulting in a new corporate entity shall be treated
						as a transaction between related parties. No revaluation shall be permitted for
						the surviving corporation.
Statutory Authority
§ 32.1-325 of the Code of Virginia and Item 319
							 (II) of Chapter 1073 of the 2000 Acts of Assembly.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart VII - Nurse Aide Training and Competency Evaluation Programs (NATCEPs) › Section 12VAC30-90-170 - NATCEPs costs

Current through Register Vol. 40, No. 24, July 15, 2024
A. The Omnibus
					 Budget Reconciliation Act of 1989 (OBRA 89) amended § 1903(a)(2)(B) of the
					 Social Security Act to fund actual NATCEPs costs incurred by NFs separately
					 from the NF's medical assistance services reimbursement rates.
B. NATCEPs costs shall be as defined in
					 Appendix I (12VAC30-90-270 through
					 12VAC30-90-276 ).
C. To calculate the reimbursement rate,
					 NATCEPs costs contained in the most recently filed cost report shall be
					 converted to a per diem amount by dividing allowable NATCEPs costs by the
					 actual number of NF's patient days.
D. The NATCEPs interim reimbursement rate
					 determined in subsection C of this section shall be added to the prospective
					 operating cost and plant cost components or charges, whichever is lower, to
					 determine the NF's prospective rate. The NATCEPs interim reimbursement rate
					 shall not be adjusted for inflation.
E. Reimbursement of NF costs for training and
					 competency evaluation of nurse aides must take into account the NF's use of
					 trained nurse aides in caring for Medicaid, Medicare and private pay patients.
					 Medicaid shall not be charged for that portion of NATCEPs costs that is
					 properly charged to Medicare or private pay services. The final retrospective
					 reimbursement for NATCEPs costs shall be the reimbursement rate as calculated
					 from the most recently filed cost report by the methodology in subsection C of
					 this section times the Medicaid patient days from the DMAS MMR-240.
F. Disallowance of nonreimbursable NATCEPs
					 costs shall be reflected in the year in which the nonreimbursable costs were
					 claimed.
G. Payments to providers
					 for allowable NATCEPs costs shall not be considered in the comparison of the
					 lower allowable reimbursement or charges for covered services, as outlined in
					 12VAC30-90-55 A.
H. Effective July 1, 2014, prospective
					 NATCEPs per diem rates for each facility shall be the NATCEPs per diem rate in
					 the base year inflated to the rate year based on inflation in 12VAC30-90-44. To
					 calculate the NATCEPs per diem rate, NATCEPs costs in the base year shall be
					 converted to a per diem amount by dividing allowable NATCEPs costs by the
					 actual number of NF's patient days. In non-rebasing years, the prospective rate
					 calculation shall be revised annually using costs from the next available year.
					 The NATCEPs reimbursement rate determined in this subsection shall be added to
					 the prospective operating cost, criminal records checks, and plant cost
					 components.
Statutory Authority: § 32.1-325 of the Code of
						  Virginia; 42 USC § 1396 et seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart VIII - Criminal Records Checks for Nursing Facility Employees › Section 12VAC30-90-180 - Criminal records checks

Current through Register Vol. 40, No. 24, July 15, 2024
A. This
					 section implements the requirements of § 32.1-126.01 of the Code of
					 Virginia and Chapter 994 of the Acts of Assembly of 1993 (Item 313
					 T).
B. A licensed nursing facility
					 shall not hire for compensated employment persons who have been convicted of:
1. Murder;
2. Abduction for immoral purposes as set out
					 in § 18.2-48 of the Code of Virginia;
3. Assaults and bodily woundings as set out
					 in Article 4 (§ 18.2-51 et seq.) of Chapter 4 of Title 18.2 of the Code of
					 Virginia;
4. Arson as set out in
					 Article 1 (§ 18.2-77 et seq.) of Chapter 5 of Title 18.2 of the Code of
					 Virginia;
5. Pandering as set out
					 in § 18.2-355 of the Code of Virginia;
6. Crimes against nature involving children
					 as set out in § 18.2-361 of the Code of Virginia;
7. Taking indecent liberties with children as
					 set out in §§ 18.2-370 or 18.2-370.1 of the Code of
					 Virginia;
8. Abuse and neglect of
					 children as set out in § 18.2-371.1 of the Code of Virginia;
9. Failure to secure medical attention for an
					 injured child as set out in § 18.2-314 of the Code of Virginia;
10. Obscenity offenses as set out in §
					 18.2-374.1 of the Code of Virginia; or
11. Abuse or neglect of an incapacitated
					 adult as set out in § 18.2-369 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart IX - Use of MMR-240 › Section 12VAC30-90-190 - Use of MMR-240

Current through Register Vol. 40, No. 24, July 15, 2024
All providers must use the data from computer printout
						MMR-240 based upon a 60-day accrual period.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart X - Commingled Investment Income › Section 12VAC30-90-200 - Commingled investment income

Current through Register Vol. 40, No. 24, July 15, 2024
DMAS shall treat funds commingled for investment purposes
						in accordance with PRM-15, § 202.6.
Statutory Authority
§ 32.1-325 of the Code of Virginia.