Last Update: 10/24/17

Chapter 388-96 WAC

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 auditsExaminationIncomplete or incorrect reportsContractor's dutiesAccess to facilityFinesAdverse rate actions.
Reconciliation of medicaid resident days to billed days and medicaid paymentsPayments dueAccrued interestWithholding funds.
Proposed settlement reportPayment refundsOverpaymentsDetermination 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.
Secondary and overhead costs.
Offset of miscellaneous revenues.
Education and training.
Payments to related organizationsLimitsDocumentation.
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?
Management agreements, management fees, and central office services.
Does the department limit the allowable compensation for an owner or relative of an owner?
Home office or central office.
Equipment.
Initial cost of operation.
Land.
Operating leases of office equipment.
Unallowable costs.
Prospective payment rates.
Payment for services after settlement.
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?
Payment for veterans' homes.
Add-on for low-wage workers.
Standards for low-wage worker add-on.
Upper limits to the payment rate.
Notification.
Receivership.
Add-ons to the prospective rateInitiated by the department.
Exceptional care rate add-onCovered medicaid residents.
Exceptional direct care—Payment.
Supplemental payments.
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.
Capital componentSquare footage.
Capital componentFacility age.
Direct careCounty wage information.
Site Contents
Selected content listed in alphabetical order under each group