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Chapter 388-835 WAC

|Show DispositionsLast Update: 4/30/18

ICF/ID PROGRAM AND REIMBURSEMENT SYSTEM

(Formerly chapter 275-38 WAC)

WAC Sections

PURPOSE
HTMLPDF388-835-0005What is the purpose of this chapter?
DEFINITIONS
HTMLPDF388-835-0010What terms and definitions are important to understanding this chapter?
HTMLPDF388-835-0015What is a "beneficial owner"?
HTMLPDF388-835-0020What is a "change in ownership"?
HTMLPDF388-835-0025How can lease agreements be terminated?
HTMLPDF388-835-0030What is a "qualified therapist"?
EXEMPTIONS
HTMLPDF388-835-0035Does DSHS grant exemptions to these rules?
GENERAL REQUIREMENTS
HTMLPDF388-835-0040What general requirements apply to ICF/MR care facilities?
HTMLPDF388-835-0045What are the minimum staff requirements for an ICF/ID facility?
HTMLPDF388-835-0050What general requirements apply to the quality of ICF/ID services?
HTMLPDF388-835-0055What are the resident's rights if DSHS decides that they are no longer eligible for ICF/ID services?
HTMLPDF388-835-0060What are DSHS responsibilities when it decides to redetermine a resident eligibility for ICF/ID services?
HTMLPDF388-835-0065Do residents always have a right to a hearing?
PLACEMENT—TRANSFER—RELOCATION—DISCHARGE
HTMLPDF388-835-0070What requirements apply to the placement of individuals in an ICF/ID facility?
HTMLPDF388-835-0075What if an individual is transferred between facilities?
HTMLPDF388-835-0080What if an ICF/ID facility is closed?
HTMLPDF388-835-0085Why is an individual transferred or discharged?
HTMLPDF388-835-0090What is the basis of the decision to transfer or discharge an individual?
HTMLPDF388-835-0095Is a transfer plan required for each resident?
HTMLPDF388-835-0100Why would an individual move?
HTMLPDF388-835-0105What are DSHS' responsibilities for placing individuals?
HTMLPDF388-835-0110Is DSHS required to give written notice when it intends to transfer an individual?
HTMLPDF388-835-0115Can a facility request that an individual be transferred?
HTMLPDF388-835-0120What steps must be followed when a facility makes a transfer request?
HTMLPDF388-835-0125Can residents request a transfer?
HTMLPDF388-835-0130What rights are available to a resident regarding a proposed transfer?
HTMLPDF388-835-0140Do residents always have a right to a hearing?
DISCHARGE/READMISSION AND INCIDENT REPORTING
HTMLPDF388-835-0145Does a facility have a responsibility to report incidents involving residents?
SOCIAL LEAVE FOR ICF/ID RESIDENTS
HTMLPDF388-835-0155What requirements apply to social leaves for ICF/ID residents?
SUPERINTENDENT'S AUTHORITY TO DETAIN A RESIDENT
HTMLPDF388-835-0160Can residential habilitation center (RHC) superintendents involuntarily detain residents?
HTMLPDF388-835-0165Is a superintendent required to give notice when they detain a resident?
HTMLPDF388-835-0170What is a superintendent's responsibility when a resident voluntarily leaves an RHC?
ICF/ID CONTRACTS
HTMLPDF388-835-0175What if a facility violates its ICF/ID contract?
HTMLPDF388-835-0180What if an ICF/ID contract is terminated?
HTMLPDF388-835-0185Does DSHS withhold payment for services when a contract is terminated?
HTMLPDF388-835-0190What happens to withheld payments and security from a provider when a final settlement is determined?
HTMLPDF388-835-0195What requirements apply to surety bonds or assigned funds used as security by a provider?
HTMLPDF388-835-0200Does decertification, termination or nonrenewal of a contract stop payment of Title XIX funds?
HTMLPDF388-835-0205How does a change in ownership affect an ICF/ID contract with DSHS?
PROSPECTIVE COST RELATED REIMBURSEMENT SYSTEM
HTMLPDF388-835-0210What is the prospective cost related reimbursement system (PCRRS)?
HTMLPDF388-835-0215What are the requirements for participating in PCRRS?
HTMLPDF388-835-0220What are the projected budget requirements for new providers?
FILING COST REPORTS
HTMLPDF388-835-0225How should cost reports be prepared?
HTMLPDF388-835-0230Must a cost report be certified?
HTMLPDF388-835-0235When are cost reports due to DSHS?
HTMLPDF388-835-0240Does DSHS grant extensions for cost reporting deadlines?
HTMLPDF388-835-0245What if a provider fails to submit a final report?
HTMLPDF388-835-0250What if a provider submits improperly completed or late reports?
HTMLPDF388-835-0255What if a provider files a report containing false information?
HTMLPDF388-835-0260Can providers amend annual cost reports filed with DSHS?
HTMLPDF388-835-0265Can providers file amendments if a DSHS field audit has been scheduled?
HTMLPDF388-835-0270Can providers file amendments if DSHS does not conduct a field audit?
HTMLPDF388-835-0275What requirements apply when amendments are filed?
MAINTAINING COST REPORT RECORDS
HTMLPDF388-835-0280Do ICF/ID providers have to maintain records related to their contracts?
HTMLPDF388-835-0285What if a provider fails to maintain records or refuses to let them be reviewed?
HTMLPDF388-835-0290Does DSHS have a responsibility to retain provider reports?
HTMLPDF388-835-0295Are the reports submitted to DSHS by providers available to the public?
FIELD AUDITS
HTMLPDF388-835-0300What is an ICF/ID field audit?
HTMLPDF388-835-0305When does DSHS schedule a field audit?
HTMLPDF388-835-0310When does DSHS complete a field audit?
HTMLPDF388-835-0315How should a provider prepare for a field audit?
HTMLPDF388-835-0320What is the scope of a field audit?
HTMLPDF388-835-0325What if an auditor discovers that provider reports are inadequately documented?
HTMLPDF388-835-0330Are final audit narratives and summaries available to the public?
RESIDENT TRUST ACCOUNTS
HTMLPDF388-835-0335What general requirements apply to accounting for resident trust accounts?
HTMLPDF388-835-0340What specific accounting procedures apply to resident trust accounts?
HTMLPDF388-835-0345Can residents overdraw their trust account?
HTMLPDF388-835-0350Can a resident trust account be charged for Title XIX services?
HTMLPDF388-835-0355Can a resident trust account be charged for medical services, drugs, therapy and equipment?
HTMLPDF388-835-0360Can providers create petty cash funds for residents?
HTMLPDF388-835-0365Can providers create checking accounts for residents?
HTMLPDF388-835-0370What controls must a provider use to ensure the safety of trust fund money?
HTMLPDF388-835-0375Can a resident withdraw trust money?
HTMLPDF388-835-0380What happens to resident funds when a change of ownership occurs?
HTMLPDF388-835-0385How are trust fund moneys refunded?
HTMLPDF388-835-0390How are trust funds liquidated?
HTMLPDF388-835-0395How must a facility maintain resident property records?
ALLOWABLE AND UNALLOWABLE COSTS
HTMLPDF388-835-0400What are allowable costs?
HTMLPDF388-835-0405What are unallowable costs?
HTMLPDF388-835-0410Can a provider offset miscellaneous revenues against allowable costs?
HTMLPDF388-835-0415Are the costs of meeting required standards allowable costs?
HTMLPDF388-835-0420Are costs associated with related organizations allowable costs?
HTMLPDF388-835-0425Are start-up costs allowable costs?
HTMLPDF388-835-0430Are organizational costs allowable costs?
HTMLPDF388-835-0435Are education and training costs allowable costs?
HTMLPDF388-835-0440Are operating lease costs allowable costs?
HTMLPDF388-835-0445Are rental expenses paid to related organizations allowable costs?
HTMLPDF388-835-0450What is allowable interest?
HTMLPDF388-835-0455Can a provider offset interest income against allowable costs?
HTMLPDF388-835-0460How does DSHS calculate total compensation for owners and relatives?
HTMLPDF388-835-0465How does DSHS define owner or relative compensation?
CAPITALIZED COSTS AND DEPRECIATION
HTMLPDF388-835-0470What requirements apply to capitalizing equipment, including furniture and furnishings?
HTMLPDF388-835-0475What requirements apply to capitalizing buildings, other real property items, components, improvements and leasehold improvements?
HTMLPDF388-835-0480How are the useful lives of leasehold improvements determined?
HTMLPDF388-835-0485What are depreciable assets?
HTMLPDF388-835-0490What are some examples of depreciable assets?
HTMLPDF388-835-0495What is "minor equipment"?
HTMLPDF388-835-0500Is land a depreciable asset?
HTMLPDF388-835-0505What costs are included in the capitalized cost of land?
HTMLPDF388-835-0510What is the depreciation base of a tangible asset?
HTMLPDF388-835-0515Can an appraisal be used to establish historical cost?
HTMLPDF388-835-0520What is the depreciation base of a donated or inherited asset?
HTMLPDF388-835-0525How is the useful life of a depreciable asset determined?
HTMLPDF388-835-0530What depreciation methods are approved by DSHS?
HTMLPDF388-835-0535What is depreciation expense?
HTMLPDF388-835-0540Can providers claim depreciation on assets that are abandoned, retired or disposed of in some other way?
GAINS AND LOSSES ON RETIRED ASSETS
HTMLPDF388-835-0545How must providers account for gains and losses on the retirement of tangible assets?
HTMLPDF388-835-0550How are gains and losses calculated when a tangible asset is retired?
HTMLPDF388-835-0555How must providers account for gains and losses on retired assets that are replaced?
HTMLPDF388-835-0560How must providers account for gains and losses on retired assets that are not replaced?
HTMLPDF388-835-0565How must providers account for gains and losses on retired assets if they terminate their contract with DSHS?
HTMLPDF388-835-0570Can DSHS recover reimbursements for depreciation expense?
REIMBURSEMENT RATES
HTMLPDF388-835-0575What requirements apply to calculating ICF/ID reimbursement rates?
HTMLPDF388-835-0580What program services are not covered by DSHS prospective reimbursement rates?
HTMLPDF388-835-0585What requirements apply to prospective reimbursement rates for new providers?
HTMLPDF388-835-0590How are reimbursement rates calculated?
HTMLPDF388-835-0595When does DSHS review a provider's annual cost report?
HTMLPDF388-835-0600What is the purpose of reviewing a provider's annual cost report?
HTMLPDF388-835-0605What is the scope of an annual cost report review?
HTMLPDF388-835-0610Can DSHS accumulate cost report information and use if for department purposes?
HTMLPDF388-835-0615What are component rates and cost centers?
HTMLPDF388-835-0620What reimbursement requirements apply to resident care and habilitation cost centers?
HTMLPDF388-835-0625What requirements apply to administration, operations and property cost center rates?
HTMLPDF388-835-0630What is the food rate component?
HTMLPDF388-835-0635Is there a limit to the allowable cost for administrative personnel?
HTMLPDF388-835-0640Can a provider hire an individual or firm to manage their ICF/ID facility?
HTMLPDF388-835-0645Are management fees allowable costs?
HTMLPDF388-835-0650Are all management fees allowable?
HTMLPDF388-835-0655Are management fees involving a related organization allowable costs?
HTMLPDF388-835-0660How do overhead and indirect costs relate to allowable costs?
HTMLPDF388-835-0665Are travel and housing expenses of nonresident staff working at a provider's ICF/ID facility allowable costs?
HTMLPDF388-835-0670Are bonuses paid to a provider's employees allowable costs?
HTMLPDF388-835-0675Are fees paid to members of the board of directors or corporations allowable costs?
HTMLPDF388-835-0680How is the administration and operations rate component computed?
HTMLPDF388-835-0685How is the property rate component computed?
HTMLPDF388-835-0690Does DSHS pay a return on equity to providers?
HTMLPDF388-835-0695How is a return on equity calculated?
HTMLPDF388-835-0700What if a provider's cost report covers a period shorter than twelve months?
HTMLPDF388-835-0705Are return on equity calculations subject to field audits?
HTMLPDF388-835-0710How does DSHS use field audit results?
HTMLPDF388-835-0715Does DSHS place upper limits on the reimbursement rates it pays providers?
SETTLEMENTS
HTMLPDF388-835-0720What general requirements apply to settlements between DSHS and providers?
HTMLPDF388-835-0725What requirements apply to paying overpayments and underpayments?
HTMLPDF388-835-0730What if the amount of overpayment or underpayment is being disputed?
HTMLPDF388-835-0735What requirements apply to a provider's proposed preliminary settlement?
HTMLPDF388-835-0740How must DSHS respond to a provider's proposed preliminary settlement?
HTMLPDF388-835-0745What recourse does a provider have if DSHS rejects their proposed preliminary settlement?
HTMLPDF388-835-0750What requirements apply to final settlements?
HTMLPDF388-835-0755Can a provider disagree with a final settlement report?
HTMLPDF388-835-0760What if DSHS conducts an audit during the final settlement process?
HTMLPDF388-835-0765Why is a state facility settlement important?
HTMLPDF388-835-0770How is a state facility settlement calculated?
HTMLPDF388-835-0775How is a state facility settlement implemented?
HTMLPDF388-835-0780Does DSHS have a responsibility to notify each provider regarding prospective reimbursement rates?
HTMLPDF388-835-0785Can DSHS increase prospective reimbursement rates?
HTMLPDF388-835-0790How does a provider request a rate increase?
HTMLPDF388-835-0795What requirements apply to providers who receive rate increases?
ERRORS AND OMISSIONS
HTMLPDF388-835-0800What if DSHS discovers that a prospective rate calculation was affected by an error or omission?
HTMLPDF388-835-0805What if a provider discovers an error or omission that affected their cost report?
HTMLPDF388-835-0810What other requirements apply to rate adjustments resulting from errors or omissions?
HTMLPDF388-835-0815What requirements apply to repayment of amounts owed due to errors or omissions?
PUBLIC REVIEW—PUBLIC DISCLOSURE
HTMLPDF388-835-0820What role does the public play in setting prospective reimbursement rates?
HTMLPDF388-835-0825What is DSHS' public disclosure responsibility regarding rate setting methodology?
BILLING PROCEDURES AND PAYMENTS
HTMLPDF388-835-0830How does a provider bill DSHS for services provided?
HTMLPDF388-835-0835How does DSHS pay a provider?
HTMLPDF388-835-0840Can DSHS withhold provider payments?
HTMLPDF388-835-0845Can DSHS terminate medicaid Title XIX payments to providers?
HTMLPDF388-835-0850Who is responsible for collecting from residents any amounts they may own for their care?
HTMLPDF388-835-0855What if a resident's circumstances change causing a provider to contribute more to the resident's care?
RECEIVERSHIP
HTMLPDF388-835-0860What is the role of a receiver when an ICF/ID facility is placed in receivership?
HTMLPDF388-835-0865How does DSHS determine prospective reimbursement rates during receivership?
HTMLPDF388-835-0870What if the court asks DSHS to recommend a receiver's compensation?
HTMLPDF388-835-0875Can DSHS give emergency or transitional financial assistance to a receiver?
HTMLPDF388-835-0880What happens when a receivership ends?
DISPUTE RESOLUTION
HTMLPDF388-835-0885What disputes between providers and DSHS can be resolved through the administrative review process?
HTMLPDF388-835-0890What disputes cannot be resolved through the administrative review and fair hearing processes?
HTMLPDF388-835-0900How does a provider request an administrative review?
HTMLPDF388-835-0905What happens after a provider requests an administrative review?
HTMLPDF388-835-0910What if a provider disagrees with the administrative review decision?
HTMLPDF388-835-0915Can DSHS withhold an undisputed overpayment amount from a current ICF/ID payment?
HTMLPDF388-835-0920Can DSHS withhold a disputed overpayment amount from a current ICF/ID payment?
COST OF CARE OF MENTALLY DEFICIENT PERSONS RESIDING IN STATE INSTITUTIONS
HTMLPDF388-835-0925What is the purpose of this section?
HTMLPDF388-835-0930How is the payment for residential facilities set?
HTMLPDF388-835-0935How much of a resident's income is exempt from paying their care?
HTMLPDF388-835-0940What if the estate of a resident is able to pay all or a portion of their monthly cost?
HTMLPDF388-835-0945If a resident or guardian is served by DSHS with a NFR when is payment due?
HTMLPDF388-835-0950May a resident or guardian request a hearing if they disagree with the NFR?
HTMLPDF388-835-0955What information must be included in the request for a hearing?
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