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Chapter 388-835 WAC

Last Update: 7/23/04

ICF/MR PROGRAM AND REIMBURSEMENT SYSTEM

WAC Sections

PURPOSE
What is the purpose of this chapter?
DEFINITIONS
What terms and definitions are important to understanding this chapter?
What is a "beneficial owner"?
What is a "change in ownership"?
How can lease agreements be terminated?
What is a "qualified therapist"?
EXEMPTIONS
Does DSHS grant exemptions to these rules?
GENERAL REQUIREMENTS
What general requirements apply to ICF/MR care facilities?
What are the minimum staff requirements for an ICF/MR facility?
What general requirements apply to the quality of ICF/MR services?
What are the resident's rights if DSHS decides that they are no longer eligible for ICF/MR services?
What are DSHS responsibilities when it decides to re-determine a resident eligibility for ICF/MR services?
Do residents always have a right to a hearing?
PLACEMENT—TRANSFER—RELOCATION—DISCHARGE
What requirements apply to the placement of individuals in an ICF/MR facility?
What if an individual is transferred between facilities?
What if an ICF/MR facility is closed?
Why is an individual transferred or discharged?
What is the basis of the decision to transfer or discharge an individual?
Is a transfer plan required for each resident?
Why would an individual move?
What are DSHS' responsibilities for placing individuals?
Is DSHS required to give written notice when it intends to transfer an individual?
Can a facility request that an individual be transferred?
What steps must be followed when a facility makes a transfer request?
Can residents request a transfer?
What rights are available to a resident regarding a proposed transfer?
Do residents always have a right to a hearing?
DISCHARGE/READMISSION AND INCIDENT REPORTING
Does a facility have a responsibility to report incidents involving residents?
When does DSHS require discharge and readmission of a resident?
SOCIAL LEAVE FOR ICF/MR RESIDENTS
What requirements apply to social leaves for ICF/MR residents?
SUPERINTENDENT'S AUTHORITY TO DETAIN A RESIDENT
Can residential habilitation center (RHC) superintendents involuntarily detain residents?
Is a superintendent required to give notice when they detain a resident?
What is a superintendent's responsibility when a resident voluntarily leaves an RHC?
ICR/MR CONTRACTS
What if a facility violates its ICF/MR contract?
What if an ICF/MR contract is terminated?
Does DSHS withhold payment for services when a contract is terminated?
What happens to withheld payments and security from a provider when a final settlement is determined?
What requirements apply to surety bonds or assigned funds used as security by a provider?
Does decertification, termination or nonrenewal of a contract stop payment of Title XIX funds?
How does a change in ownership affect an ICF/MR contract with DSHS?
PROSPECTIVE COST RELATED REIMBURSEMENT SYSTEM
What is the prospective cost related reimbursement system (PCRRS)?
What are the requirements for participating in PCRRS?
What are the projected budget requirements for new providers?
FILING COST REPORTS
How should cost reports be prepared?
Must a cost report be certified?
When are cost reports due to DSHS?
Does DSHS grant extensions for cost reporting deadlines?
What if a provider fails to submit a final report?
What if a provider submits improperly completed or late reports?
What if a provider files a report containing false information?
Can providers amend annual cost reports filed with DSHS?
Can providers file amendments if a DSHS field audit has been scheduled?
Can providers file amendments if DSHS does not conduct a field audit?
What requirements apply when amendments are filed?
MAINTAINING COST REPORT RECORDS
Do ICF/MR providers have to maintain records related to their contracts?
What if a provider fails to maintain records or refuses to let them be reviewed?
Does DSHS have a responsibility to retain provider reports?
Are the reports submitted to DSHS by providers available to the public?
FIELD AUDITS
What is an ICF/MR field audit?
When does DSHS schedule a field audit?
When does DSHS complete a field audit?
How should a provider prepare for a field audit?
What is the scope of a field audit?
What if an auditor discovers that provider reports are inadequately documented?
Are final audit narratives and summaries available to the public?
RESIDENT TRUST ACCOUNTS
What general requirements apply to accounting for resident trust accounts?
What specific accounting procedures apply to resident trust accounts?
Can residents overdraw their trust account?
Can a resident trust account be charged for Title XIX services?
Can a resident trust account be charged for medical services, drugs, therapy and equipment?
Can providers create petty cash funds for residents?
Can providers create checking accounts for residents?
What controls must a provider use to ensure the safety of trust fund money?
Can a resident withdraw trust money?
What happens to resident funds when a change of ownership occurs?
How are trust fund moneys refunded?
How are trust funds liquidated?
How must a facility maintain resident property records?
ALLOWABLE AND UNALLOWABLE COSTS
What are allowable costs?
What are unallowable costs?
Can a provider offset miscellaneous revenues against allowable costs?
Are the costs of meeting required standards allowable costs?
Are costs associated with related organizations allowable costs?
Are start-up costs allowable costs?
Are organizational costs allowable costs?
Are education and training costs allowable costs?
Are operating lease costs allowable costs?
Are rental expenses paid to related organizations allowable costs?
What is allowable interest?
Can a provider offset interest income against allowable costs?
How does DSHS calculate total compensation for owners and relatives?
How does DSHS define owner or relative compensation?
CAPITALIZED COSTS AND DEPRECIATION
What requirements apply to capitalizing equipment, including furniture and furnishings?
What requirements apply to capitalizing buildings, other real property items, components, improvements and leasehold improvements?
How are the useful lives of leasehold improvements determined?
What are depreciable assets?
What are some examples of depreciable assets?
What is "minor equipment"?
Is land a depreciable asset?
What costs are included in the capitalized cost of land?
What is the depreciation base of a tangible asset?
Can an appraisal be used to establish historical cost?
What is the depreciation base of a donated or inherited asset?
How is the useful life of a depreciable asset determined?
What depreciation methods are approved by DSHS?
What is depreciation expense?
Can providers claim depreciation on assets that are abandoned, retired or disposed of in some other way?
GAINS AND LOSSES ON RETIRED ASSETS
How must providers account for gains and losses on the retirement of tangible assets?
How are gains and losses calculated when a tangible asset is retired?
How must providers account for gains and losses on retired assets that are replaced?
How must providers account for gains and losses on retired assets that are not replaced?
How must providers account for gains and losses on retired assets if they terminate their contract with DSHS?
Can DSHS recover reimbursements for depreciation expense?
REIMBURSEMENT RATES
What requirements apply to calculating ICF/MR reimbursement rates?
What program services are not covered by DSHS prospective reimbursement rates?
What requirements apply to prospective reimbursement rates for new providers?
How are reimbursement rates calculated?
When does DSHS review a provider's annual cost report?
What is the purpose of reviewing a provider's annual cost report?
What is the scope of an annual cost report review?
Can DSHS accumulate cost report information and use if for department purposes?
What are component rates and cost centers?
What reimbursement requirements apply to resident care and habilitation cost centers?
What requirements apply to administration, operations and property cost center rates?
What is the food rate component?
Is there a limit to the allowable cost for administrative personnel?
Can a provider hire an individual or firm to manage their ICF/MR facility?
Are management fees allowable costs?
Are all management fee's allowable?
Are management fees involving a related organization allowable costs?
How do overhead and indirect costs relate to allowable costs?
Are travel and housing expenses of nonresident staff working at a provider's ICF/MR facility allowable costs?
Are bonuses paid to a provider's employees allowable costs?
Are fees paid to members of the board of directors or corporations allowable costs?
How is the administration and operations rate component computed?
How is the property rate component computed?
Does DSHS pay a return on equity to providers?
How is a return on equity calculated?
What if a provider's cost report covers a period shorter than twelve months?
Are return on equity calculations subject to field audits?
How does DSHS use field audit results?
Does DSHS place upper limits on the reimbursement rates it pays providers?
SETTLEMENTS
What general requirements apply to settlements between DSHS and providers?
What requirements apply to paying overpayments and underpayments?
What if the amount of overpayment or underpayment is being disputed?
What requirements apply to a provider's proposed preliminary settlement?
How must DSHS respond to a provider's proposed preliminary settlement?
What recourse does a provider have if DSHS rejects their proposed preliminary settlement?
What requirements apply to final settlements?
Can a provider disagree with a final settlement report?
What if DSHS conducts an audit during the final settlement process?
Why is a state facility settlement important?
How is a state facility settlement calculated?
How is a state facility settlement implemented?
Does DSHS have a responsibility to notify each provider regarding prospective reimbursement rates?
Can DSHS increase prospective reimbursement rates?
How does a provider request a rate increase?
What requirements apply to providers who receive rate increases?
ERRORS AND OMISSIONS
What if DSHS discovers that a prospective rate calculation was affected by an error or omission?
What if a provider discovers an error or omission that affected their cost report?
What other requirements apply to rate adjustments resulting from errors or omissions?
What requirements apply to repayment of amounts owed due to errors or omissions?
PUBLIC REVIEWPUBLIC DISCLOSURE
What role does the public play in setting prospective reimbursement rates?
What is DSHS' public disclosure responsibility regarding rate setting methodology?
BILLING PROCEDURES AND PAYMENTS
How does a provider bill DSHS for services provided?
How does DSHS pay a provider?
Can DSHS withhold provider payments?
Can DSHS terminate medicaid Title XIX payments to providers?
Who is responsible for collecting from residents any amounts they may own for their care?
What if a resident's circumstances change causing a provider to contribute more to the resident's care?
RECEIVERSHIP
What is the role of a receiver when an ICF/MR facility is placed in receivership?
How does DSHS determine prospective reimbursement rates during receivership?
What if the court asks DSHS to recommend a receiver's compensation?
Can DSHS give emergency or transitional financial assistance to a receiver?
What happens when a receivership ends?
DISPUTE RESOLUTION
What disputes between providers and DSHS can be resolved through the administrative review process?
What disputes cannot be resolved through the administrative review and fair hearing processes?
How does a provider request an administrative review?
What happens after a provider requests an administrative review?
What if a provider disagrees with the administrative review decision?
Can DSHS withhold an undisputed overpayment amount from a current ICF/MR payment?
Can DSHS withhold a disputed overpayment amount from a current ICF/MR payment?
COST OF CARE OF MENTALLY DEFICIENT PERSONS RESIDING IN STATE INSTITUTIONS
What is the purpose of this section?
How is the payment for residential facilities set?
How much of a resident's income is exempt from paying their care?
What if the estate of a resident is able to pay all or a portion of their monthly cost?
If a resident or guardian is served by DSHS with a NFR when is payment due?
May a resident or guardian request a hearing if they disagree with the NFR?
What information must be included in the request for a hearing?