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2001 SESSION

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SB 1249 Medical assistance services.

Introduced by: W. Roscoe Reynolds | all patrons    ...    notes | add to my profiles

SUMMARY AS INTRODUCED:

Medical assistance services. Requires the Board of Medical Assistance Services to amend the state plan for medical assistance services to include (i) a provision allowing the Director to make exceptions to the payment system for nursing facility reimbursement to allow an increase in the direct patient care payment rate for a nursing facility based upon extraordinary circumstances and a provision allowing a nursing facility that expands its bed capacity by 60 beds to have the option of retaining its prospective rate or being treated as a new nursing facility without having to comply with the occupancy requirements. The Director will be authorized to make an exception to the payment methodology to allow the reimbursement of allowable direct patient care operating costs in excess of direct patient care operating cost limits and or ceilings or both established under the payment system when a nursing facility incurs such costs due to extraordinary circumstances beyond the control of the administrator or owner of the nursing facility. The nursing facility must demonstrate that the extraordinary costs were caused by factors beyond its control, that these costs have a major negative effect on its fiscal stability, and that the costs are necessary in order to assure compliance with licensure and certification requirements. The nursing facility will have the right to file a cost report addendum and supporting documents to justify an increase in its direct patient care payment rate. The Director is required to act on the request within 30 days and any authorized increase in the direct payment rate will be retroactive to the date of the filing of the request for the increase. The increased payment will be subject to time limits, periodic reporting, and retroactive audit.


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