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Chapter 388-96 WAC

Last Update: 1/23/12

NURSING FACILITY MEDICAID PAYMENT SYSTEM

WAC Sections

Definitions.
Conditions of participation.
Public disclosure.
Prospective cost-related payment.
Due dates for cost reports.
New contractors.
Completing cost reports and maintaining records.
Requirements for retention of records by the contractor.
Retention of cost reports and resident assessment information by the department.
Requests for extensions.
Failure to submit final reports.
Certification requirement.
ReportsFalse information.
Amendments to reports.
Purposes of department audits—Examination—Incomplete or incorrect reportsContractor's dutiesAccess to facility—Fines—Adverse rate actions.
Reconciliation of medicaid resident days to billed days and medicaid paymentsPayments dueAccrued interestWithholding funds.
Proposed settlement reportPayment refunds—Overpayments—Determination of unused rate fundsTotal and component payment rates.
Civil fines.
Proposed, preliminary, and final settlements.
Interest on other excess payments.
Facility records and handling of resident moneys.
The nursing facility shall maintain a subsidiary ledger with an account for each resident for whom the facility holds money.
The nursing facility may maintain a petty cash fund originating from resident personal funds of an amount reasonable and necessary for the size of the facility and the needs of the residents.
Resident personal funds control/disbursement.
Resident personal funds availability.
Procedure for refunding resident personal funds.
Liquidation or transfer of resident personal funds.
Principles of allowable costs.
Indirect and overhead costs.
Offset of miscellaneous revenues.
Education and training.
Payments to related organizations—Limits—Documentation.
What will be allowable compensation for owners, relatives, licensed administrator, assistant administrator, and/or administrator-in-training?
Does the contractor have to maintain time records?
Joint cost allocation disclosure (JCAD).
Management agreements, management fees, and central office services.
Does the department limit the allowable compensation for an owner or relative of an owner?
Will the department allow the cost of an administrator-in-training?
Home office or central office.
Depreciable assets.
Capitalization.
Expensing.
Initial cost of operation.
Depreciation expense.
Cost basis of land and depreciation base.
Land, improvementsDepreciation.
Cost basis of land and depreciation baseDonated or inherited assets.
Depreciable assets—Disposed—Retired.
Methods of depreciation.
Lives.
Handling of gains and losses upon retirement of depreciable assetsOther periods.
New or replacement constructionProperty tax increases.
Operating leases of office equipment.
Unallowable costs.
Prospective payment rates.
Payment for services after settlement.
Beds removed from service under chapter 70.38 RCW, new beds approved under chapter 70.38 RCW, and beds permanently relinquishedEffect on prospective payment rate.
Prospective rate revisionsReduction in licensed beds by means other than "banking" pursuant to chapter 70.38 RCW.
Prospective payment rate for new contractors.
Rate determination.
Public process for determination of rates.
Comparison of the statewide weighted average payment rate for all nursing facilities with the weighted average payment rate identified in the Biennial Appropriations Act.
Advance noticeNursing facility component rate reduction taken under RCW 74.46.421.
RCW 74.46.421 rate reductionA nursing facility's rates.
RCW 74.46.421 nursing facility component rates below the statewide weighted average payment rate identified in the Biennial Appropriations Act.
Methodology for reducing a nursing facility's medicaid payment rate in order to reduce the statewide weighted average nursing facility medicaid payment rate to equal or be less than the weighted average payment rate identified in the Biennial Appropriations Act.
Nursing facilities' rate reductions pursuant to RCW 74.46.421.
What default case mix group and weight must the department use for case mix grouping when there is no minimum data set resident assessment for a nursing facility resident?
How will the department determine which resident assessments are medicaid resident assessments?
How will the department set the therapy care rate and determine the median cost limit per unit of therapy?
How much therapy consultant expense for each therapy type will the department allow to be added to the total allowable one-on-one therapy expense?
Constructed, remodeled or expanded facilities.
Financing allowance component rate allocation.
Payment for veterans' homes.
Add-on for low-wage workers.
Standards for low-wage workers add-on.
Upper limits to the payment rate.
Allowable land.
Notification.
Appraisal values.
Receivership.
Add-ons to the property and financing allowance payment rateCapital improvements.
Add-ons to the prospective rateInitiated by the department.
Exceptional care rate add-onCovered medicaid residents.
Exceptional therapy care and exceptional direct carePayment.
Certificate of capital authorization (CCA).
Expense for construction interest.
Supplemental payments.
Pay for performance add-on.
Billing/payment.
Notification of participationResponsibility to collectReporting medicaid recipient's changes in income/resourcesRate payment in full for services.
Suspension of payments.
Change of ownershipAssignment of department's contract.
Change of ownershipFinal reportsSettlement securities.
Disputes.
Administrative reviewAdjudicative proceeding.
Case mix accuracy review of MDS nursing facility resident assessments.
Section captions.
Safety net assessment.