10A NCAC 22G .0307. REIMBURSEMENT METHODS FOR STATE‑OPERATED FACILITIES

(a)  A certified State‑operated ICF‑MR facility is reimbursed for the reasonable costs that are necessary to efficiently meet the needs of its clients and to comply with federal and state laws and regulations.  Payments shall be suspended if annual reports are not filed.  The Division of Medical Assistance may extend the deadline for filing the report if in its view good cause exists for the delay.  The reasonableness and allowability of costs incurred by state‑operated facilities shall be determined by the Division of Medical Assistance.

(b)  A per diem rate based on the provider's estimated annual cost divided by patient days shall be used to make interim payments.  A tentative settlement shall be issued based on the desk audit 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 of Medical Assistance.  Any reasonable costs in excess of payments shall be paid to the provider.  An annual field audit may be performed by a qualified independent auditor to determine the final settlement amounts.

(d)  Subject to the availability of funds, supplemental payments shall be made to state government-owned or operated ICF-MR facilities in accordance with North Carolina's federally approved Medicaid State Plan at Attachment 4.19-D, Addendum ICF-MR, Page 30, Section .0307(d).  This Attachment is hereby incorporated by reference, including subsequent amendments and editions.  This Attachment is available for inspection and copies may be obtained from the Division of Medical Assistance, 1985 Umstead Drive, Raleigh, North Carolina 27603 at a cost of twenty cents ($.20) per page.

 

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;

Temporary Adoption Eff. July 8, 1993 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner;

Eff. November 1, 1993;

Temporary Amendment Eff. June 26, 2003.