10A NCAC 22G .0108. REIMBURSEMENT METHODS FOR STATE‑OPERATED FACILITIES

(a)  A NC Division of Health Service Regulation certified State‑operated nursing facility shall be reimbursed for the reasonable costs that are necessary to efficiently meet the needs of its patients and to comply with federal and state laws and regulations.  The costs shall be determined in accordance with Rules .0103 and .0104 of this Section, except that annual cost reports shall be required for the fiscal year beginning on July 1 and ending on the following June 30 and must be submitted to the Division of Medical Assistance within 150 days after their fiscal year end.  Payments shall be suspended if reports are not filed.  The Division of Medical Assistance shall extend the deadline for filing the report if the Division determines good cause.  "Good cause" is an action uncontrollable by the provider.  The Medicare principles for the reimbursement of skilled nursing facilities shall be utilized for the cost principles that are not specifically addressed in this Section.

(b)  A per diem rate based on the providers estimated annual cost divided by patient days shall be used to make interim payments.  A desk audit and a tentative settlement shall be performed on each annual cost report to determine the amount of Medicaid reasonable cost and the amount of interim payments received by the provider.

(c)  Any payments in excess of costs shall be refunded to the Division. Any costs in excess of payments shall be paid to the provider.  An annual field audit shall be performed by a qualified independent auditor to determine the final settlement amounts.

 

History Note:        Authority G.S. 108A‑25(b); 108A‑54; 108A‑55; S.L. 1985, c. 479, s. 86; 42 C.F.R. 447, Subpart C;

Eff. January 1, 1992;

Temporary Amendment Eff. August 3, 2004;

Amended Eff. January 1, 2005.