| PURPOSE |
| 388-835-0005 | What is the purpose of this chapter? |
| DEFINITIONS |
| 388-835-0010 | What terms and definitions are important to understanding this chapter? |
| 388-835-0015 | What is a "beneficial owner"? |
| 388-835-0020 | What is a "change in ownership"? |
| 388-835-0025 | How can lease agreements be terminated? |
| 388-835-0030 | What is a "qualified therapist"? |
| EXEMPTIONS |
| 388-835-0035 | Does DSHS grant exemptions to these rules? |
| GENERAL REQUIREMENTS |
| 388-835-0040 | What general requirements apply to ICF/MR care facilities? |
| 388-835-0045 | What are the minimum staff requirements for an ICF/MR facility? |
| 388-835-0050 | What general requirements apply to the quality of ICF/MR services? |
| 388-835-0055 | What are the resident's rights if DSHS decides that they are no longer eligible for ICF/MR services? |
| 388-835-0060 | What are DSHS responsibilities when it decides to re-determine a resident eligibility for ICF/MR services? |
| 388-835-0065 | Do residents always have a right to a hearing? |
| PLACEMENT -- TRANSFER -- RELOCATION -- DISCHARGE |
| 388-835-0070 | What requirements apply to the placement of individuals in an ICF/MR facility? |
| 388-835-0075 | What if an individual is transferred between facilities? |
| 388-835-0080 | What if an ICF/MR facility is closed? |
| 388-835-0085 | Why is an individual transferred or discharged? |
| 388-835-0090 | What is the basis of the decision to transfer or discharge an individual? |
| 388-835-0095 | Is a transfer plan required for each resident? |
| 388-835-0100 | Why would an individual move? |
| 388-835-0105 | What are DSHS' responsibilities for placing individuals? |
| 388-835-0110 | Is DSHS required to give written notice when it intends to transfer an individual? |
| 388-835-0115 | Can a facility request that an individual be transferred? |
| 388-835-0120 | What steps must be followed when a facility makes a transfer request? |
| 388-835-0125 | Can residents request a transfer? |
| 388-835-0130 | What rights are available to a resident regarding a proposed transfer? |
| 388-835-0140 | Do residents always have a right to a hearing? |
| DISCHARGE/READMISSION AND INCIDENT REPORTING |
| 388-835-0145 | Does a facility have a responsibility to report incidents involving residents? |
| 388-835-0150 | When does DSHS require discharge and readmission of a resident? |
| SOCIAL LEAVE FOR ICF/MR RESIDENTS |
| 388-835-0155 | What requirements apply to social leaves for ICF/MR residents? |
| SUPERINTENDENT'S AUTHORITY TO DETAIN A RESIDENT |
| 388-835-0160 | Can residential habilitation center (RHC) superintendents involuntarily detain residents? |
| 388-835-0165 | Is a superintendent required to give notice when they detain a resident? |
| 388-835-0170 | What is a superintendent's responsibility when a resident voluntarily leaves an RHC? |
| ICR/MR CONTRACTS |
| 388-835-0175 | What if a facility violates its ICF/MR contract? |
| 388-835-0180 | What if an ICF/MR contract is terminated? |
| 388-835-0185 | Does DSHS withhold payment for services when a contract is terminated? |
| 388-835-0190 | What happens to withheld payments and security from a provider when a final settlement is determined? |
| 388-835-0195 | What requirements apply to surety bonds or assigned funds used as security by a provider? |
| 388-835-0200 | Does de-certification, termination or nonrenewal of a contract stop payment of Title XIX funds? |
| 388-835-0205 | How does a change in ownership affect an ICF/MR contract with DSHS? |
| PROSPECTIVE COST RELATED REIMBURSEMENT SYSTEM |
| 388-835-0210 | What is the prospective cost related reimbursement system (PCRRS)? |
| 388-835-0215 | What are the requirements for participating in PCRRS? |
| 388-835-0220 | What are the projected budget requirements for new providers? |
| FILING COST REPORTS |
| 388-835-0225 | How should cost reports be prepared? |
| 388-835-0230 | Must a cost report be certified? |
| 388-835-0235 | When are cost reports due to DSHS? |
| 388-835-0240 | Does DSHS grant extensions for cost reporting deadlines? |
| 388-835-0245 | What if a provider fails to submit a final report? |
| 388-835-0250 | What if a provider submits improperly completed or late reports? |
| 388-835-0255 | What if a provider files a report containing false information? |
| 388-835-0260 | Can providers amend annual cost reports filed with DSHS? |
| 388-835-0265 | Can providers file amendments if a DSHS field audit has been scheduled? |
| 388-835-0270 | Can providers file amendments if DSHS does not conduct a field audit? |
| 388-835-0275 | What requirements apply when amendments are filed? |
| MAINTAINING COST REPORT RECORDS |
| 388-835-0280 | Do ICF/MR providers have to maintain records related to their contracts? |
| 388-835-0285 | What if a provider fails to maintain records or refuses to let them be reviewed? |
| 388-835-0290 | Does DSHS have a responsibility to retain provider reports? |
| 388-835-0295 | Are the reports submitted to DSHS by providers available to the public? |
| FIELD AUDITS |
| 388-835-0300 | What is an ICF/MR field audit? |
| 388-835-0305 | When does DSHS schedule a field audit? |
| 388-835-0310 | When does DSHS complete a field audit? |
| 388-835-0315 | How should a provider prepare for a field audit? |
| 388-835-0320 | What is the scope of a field audit? |
| 388-835-0325 | What if an auditor discovers that provider reports are inadequately documented? |
| 388-835-0330 | Are final audit narratives and summaries available to the public? |
| RESIDENT TRUST ACCOUNTS |
| 388-835-0335 | What general requirements apply to accounting for resident trust accounts? |
| 388-835-0340 | What specific accounting procedures apply to resident trust accounts? |
| 388-835-0345 | Can residents overdraw their trust account? |
| 388-835-0350 | Can a resident trust account be charged for Title XIX services? |
| 388-835-0355 | Can a resident trust account be charged for medical services, drugs, therapy and equipment? |
| 388-835-0360 | Can providers create petty cash funds for residents? |
| 388-835-0365 | Can providers create checking accounts for residents? |
| 388-835-0370 | What controls must a provider use to ensure the safety of trust fund money? |
| 388-835-0375 | Can a resident withdraw trust money? |
| 388-835-0380 | What happens to resident funds when a change of ownership occurs? |
| 388-835-0385 | How are trust fund moneys refunded? |
| 388-835-0390 | How are trust funds liquidated? |
| 388-835-0395 | How must a facility maintain resident property records? |
| ALLOWABLE AND UNALLOWABLE COSTS |
| 388-835-0400 | What are allowable costs? |
| 388-835-0405 | What are unallowable costs? |
| 388-835-0410 | Can a provider offset miscellaneous revenues against allowable costs? |
| 388-835-0415 | Are the costs of meeting required standards allowable costs? |
| 388-835-0420 | Are costs associated with related organizations allowable costs? |
| 388-835-0425 | Are start-up costs allowable costs? |
| 388-835-0430 | Are organizational costs allowable costs? |
| 388-835-0435 | Are education and training costs allowable costs? |
| 388-835-0440 | Are operating lease costs allowable costs? |
| 388-835-0445 | Are rental expenses paid to related organizations allowable costs? |
| 388-835-0450 | What is allowable interest? |
| 388-835-0455 | Can a provider offset interest income against allowable costs? |
| 388-835-0460 | How does DSHS calculate total compensation for owners and relatives? |
| 388-835-0465 | How does DSHS define owner or relative compensation? |
| CAPITALIZED COSTS AND DEPRECIATION |
| 388-835-0470 | What requirements apply to capitalizing equipment, including furniture and furnishings? |
| 388-835-0475 | What requirements apply to capitalizing buildings, other real property items, components, improvements and leasehold improvements? |
| 388-835-0480 | How are the useful lives of leasehold improvements determined? |
| 388-835-0485 | What are depreciable assets? |
| 388-835-0490 | What are some examples of depreciable assets? |
| 388-835-0495 | What is "minor equipment"? |
| 388-835-0500 | Is land a depreciable asset? |
| 388-835-0505 | What costs are included in the capitalized cost of land? |
| 388-835-0510 | What is the depreciation base of a tangible asset? |
| 388-835-0515 | Can an appraisal be used to establish historical cost? |
| 388-835-0520 | What is the depreciation base of a donated or inherited asset? |
| 388-835-0525 | How is the useful life of a depreciable asset determined? |
| 388-835-0530 | What depreciation methods are approved by DSHS? |
| 388-835-0535 | What is depreciation expense? |
| 388-835-0540 | Can providers claim depreciation on assets that are abandoned, retired or disposed of in some other way? |
| GAINS AND LOSSES ON RETIRED ASSETS |
| 388-835-0545 | How must providers account for gains and losses on the retirement of tangible assets? |
| 388-835-0550 | How are gains and losses calculated when a tangible asset is retired? |
| 388-835-0555 | How must providers account for gains and losses on retired assets that are replaced? |
| 388-835-0560 | How must providers account for gains and losses on retired assets that are not replaced? |
| 388-835-0565 | How must providers account for gains and losses on retired assets if they terminate their contract with DSHS? |
| 388-835-0570 | Can DSHS recover reimbursements for depreciation expense? |
| REIMBURSEMENT RATES |
| 388-835-0575 | What requirements apply to calculating ICF/MR reimbursement rates? |
| 388-835-0580 | What program services are not covered by DSHS prospective reimbursement rates? |
| 388-835-0585 | What requirements apply to prospective reimbursement rates for new providers? |
| 388-835-0590 | How are reimbursement rates calculated? |
| 388-835-0595 | When does DSHS review a provider's annual cost report? |
| 388-835-0600 | What is the purpose of reviewing a provider's annual cost report? |
| 388-835-0605 | What is the scope of an annual cost report review? |
| 388-835-0610 | Can DSHS accumulate cost report information and use if for department purposes? |
| 388-835-0615 | What are component rates and cost centers? |
| 388-835-0620 | What reimbursement requirements apply to resident care and habilitation cost centers? |
| 388-835-0625 | What requirements apply to administration, operations and property cost center rates? |
| 388-835-0630 | What is the food rate component? |
| 388-835-0635 | Is there a limit to the allowable cost for administrative personnel? |
| 388-835-0640 | Can a provider hire an individual or firm to manage their ICF/MR facility? |
| 388-835-0645 | Are management fees allowable costs? |
| 388-835-0650 | Are all management fee's allowable? |
| 388-835-0655 | Are management fees involving a related organization allowable costs? |
| 388-835-0660 | How do overhead and indirect costs relate to allowable costs? |
| 388-835-0665 | Are travel and housing expenses of nonresident staff working at a provider's ICF/MR facility allowable costs? |
| 388-835-0670 | Are bonuses paid to a provider's employees allowable costs? |
| 388-835-0675 | Are fees paid to members of the board of directors or corporations allowable costs? |
| 388-835-0680 | How is the administration and operations rate component computed? |
| 388-835-0685 | How is the property rate component computed? |
| 388-835-0690 | Does DSHS pay a return on equity to providers? |
| 388-835-0695 | How is a return on equity calculated? |
| 388-835-0700 | What if a provider's cost report covers a period shorter than twelve months? |
| 388-835-0705 | Are return on equity calculations subject to field audits? |
| 388-835-0710 | How does DSHS use field audit results? |
| 388-835-0715 | Does DSHS place upper limits on the reimbursement rates it pays providers? |
| SETTLEMENTS |
| 388-835-0720 | What general requirements apply to settlements between DSHS and providers? |
| 388-835-0725 | What requirements apply to paying overpayments and underpayments? |
| 388-835-0730 | What if the amount of overpayment or underpayment is being disputed? |
| 388-835-0735 | What requirements apply to a provider's proposed preliminary settlement? |
| 388-835-0740 | How must DSHS respond to a provider's proposed preliminary settlement? |
| 388-835-0745 | What recourse does a provider have if DSHS rejects their proposed preliminary settlement? |
| 388-835-0750 | What requirements apply to final settlements? |
| 388-835-0755 | Can a provider disagree with a final settlement report? |
| 388-835-0760 | What if DSHS conducts an audit during the final settlement process? |
| 388-835-0765 | Why is a state facility settlement important? |
| 388-835-0770 | How is a state facility settlement calculated? |
| 388-835-0775 | How is a state facility settlement implemented? |
| 388-835-0780 | Does DSHS have a responsibility to notify each provider regarding prospective reimbursement rates? |
| 388-835-0785 | Can DSHS increase prospective reimbursement rates? |
| 388-835-0790 | How does a provider request a rate increase? |
| 388-835-0795 | What requirements apply to providers who receive rate increases? |
| ERRORS AND OMISSIONS |
| 388-835-0800 | What if DSHS discovers that a prospective rate calculation was affected by an error or omission? |
| 388-835-0805 | What if a provider discovers an error or omission that affected their cost report? |
| 388-835-0810 | What other requirements apply to rate adjustments resulting from errors or omissions? |
| 388-835-0815 | What requirements apply to repayment of amounts owed due to errors or omissions? |
| PUBLIC REVIEW -- PUBLIC DISCLOSURE |
| 388-835-0820 | What role does the public play in setting prospective reimbursement rates? |
| 388-835-0825 | What is DSHS' public disclosure responsibility regarding rate setting methodology? |
| BILLING PROCEDURES AND PAYMENTS |
| 388-835-0830 | How does a provider bill DSHS for services provided? |
| 388-835-0835 | How does DSHS pay a provider? |
| 388-835-0840 | Can DSHS withhold provider payments? |
| 388-835-0845 | Can DSHS terminate medicaid Title XIX payments to providers? |
| 388-835-0850 | Who is responsible for collecting from residents any amounts they may own for their care? |
| 388-835-0855 | What if a resident's circumstances change causing a provider to contribute more to the resident's care? |
| RECEIVERSHIP |
| 388-835-0860 | What is the role of a receiver when an ICF/MR facility is placed in receivership? |
| 388-835-0865 | How does DSHS determine prospective reimbursement rates during receivership? |
| 388-835-0870 | What if the court asks DSHS to recommend a receiver's compensation? |
| 388-835-0875 | Can DSHS give emergency or transitional financial assistance to a receiver? |
| 388-835-0880 | What happens when a receivership ends? |
| DISPUTE RESOLUTION |
| 388-835-0885 | What disputes between providers and DSHS can be resolved through the administrative review process? |
| 388-835-0890 | What disputes cannot be resolved through the administrative review and fair hearing processes? |
| 388-835-0900 | How does a provider request an administrative review? |
| 388-835-0905 | What happens after a provider requests an administrative review? |
| 388-835-0910 | What if a provider disagrees with the administrative review decision? |
| 388-835-0915 | Can DSHS withhold an undisputed overpayment amount from a current ICF/MR payment? |
| 388-835-0920 | Can DSHS withhold a disputed overpayment amount from a current ICF/MR payment? |
| COST OF CARE OF MENTALLY DEFICIENT PERSONS RESIDING IN STATE INSTITUTIONS |
| 388-835-0925 | What is the purpose of this section? |
| 388-835-0930 | How is the payment for residential facilities set? |
| 388-835-0935 | How much of a resident's income is exempt from paying their care? |
| 388-835-0940 | What if the estate of a resident is able to pay all or a portion of their monthly cost? |
| 388-835-0945 | If a resident or guardian is served by DSHS with a NFR when is payment due? |
| 388-835-0950 | May a resident or guardian request a hearing if they disagree with the NFR? |
| 388-835-0955 | What information must be included in the request for a hearing? |