Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-211 - Proposed settlement report - Payment refunds - Overpayments - Determination of unused rate funds - Total and component payment rates

Current through Register Vol. 24-14, July 15, 2024
(1)  Contractors
				must submit with each annual nursing facility cost report a proposed settlement
				report showing underspending or overspending in each component rate during the
				cost report year on a per-resident day basis. The department must accept or
				reject the proposed settlement report, explain any adjustments, and if needed,
				issue a revised settlement report.
(2)
				 Contractors are not required to refund payments made to cost
				components not identified in WAC
				388-96-208(7) or
				(8) in excess of the adjusted costs of
				providing services corresponding to these components.
(3)  The facility must return to the
				department any overpayment amounts identified in WAC
				388-96-208(7) or
				(8) that the department identifies following
				the examination and settlement procedures as described in this chapter,
				provided that the contractor may retain any overpayment that does not exceed
				one percent of the facility's component rate identified in WAC
				388-96-208(7) or
				(8). However, no overpayments may be retained
				in a cost center to which savings have been shifted to cover a deficit, as
				provided in subsection (5) of this section. Facilities that are not in
				substantial compliance for more than ninety days and facilities that provide
				substandard quality of care at any time during the period for which settlement
				is calculated, will not be allowed to retain any amount of overpayment in the
				facility's cost components identified in WAC
				388-96-208(7) or
				(8). The terms "not in substantial
				compliance" and "substandard quality of care" must be defined by federal survey
				regulations.
(4)  Total and
				component payment rates assigned to a nursing facility, as calculated and
				revised, if needed, under the provisions of this chapter and chapter 74.46 RCW
				represent the maximum payment for nursing facility services rendered to
				medicaid recipients for the period the rates are in effect. No increase in
				payment to a contractor shall result from spending above the total payment rate
				or in any rate component.
(5)  For
				cost reports ending on or before December 31, 2016, determination of unused
				rate funds, including the amounts of direct care, therapy, and support services
				to be recovered, must be done separately for each rate component and, except as
				otherwise provided in this subsection, neither costs nor rate payments may be
				shifted from one component rate or corresponding services are to another in
				determining the degree of underspending or recover, if any. In calculating a
				preliminary or final settlement, savings in the support services cost center
				must be shifted to cover a deficit in the direct care or therapy cost centers
				up to the amount of any savings but no more than twenty percent of the support
				services component rate may be shifted. In calculating a preliminary or final
				settlement, savings in direct care and therapy may be shifted to cover a
				deficit in these two cost centers up to the amount of savings in each,
				regardless of the percentage of either component rate shifted. Contractor
				retained overpayments up to one percent of direct care, therapy, and support
				services rate components, as authorized in subsection (4) of this section, must
				be calculated and applied after all shifting is completed.
(6)  For the 2016 calendar year cost report,
				the following components must be combined for settlement purposes in the
				following manner:
(a)  The direct care,
				therapy, and support services costs for services provided on or before June 30,
				2016 must be combined with the direct care costs for services provided on or
				after July 1, 2016 and compared to the total combined weighted rate for direct
				care, therapy, and support services.
(b)
				 The operations rate for services provided on or before June 30,
				2016 must be combined with the indirect care rate for services provided on or
				after July 1, 2016.
(c)  The
				property rate for services provided on or before June 30, 2016 must be combined
				with the fair market rental rate for services provided on or after July 1,
				2016.