State Plan Amendment (SPA) 18-0001 Long Term Care (LTC) Updates is being submitted by the Division of Medicaid (DOM) to:
- Modify the reimbursement methodology by adding respiratory therapy expenses as an allowable cost pursuant to 42 C.F.R. § 483.65.
- Clarify DOM’s intent to exclude reimbursement of hospital taxes through long-term care facility (LTC) rates.
- Clarify the appropriate timing for LTC facilities to claim for reimbursement for (a) the cost of tuition paid for employees to attain a certification/license not related to, or to enhance, their current licensed/certified position of employment and (b) the cost of legal and accounting fees incurred during legal proceedings against agencies administering the Medicaid program.
- Clarify the allocations of shared expense between a hospital and the affiliated LTC facility should only include reasonable and necessary expense applicable to the nursing facility.
- Revise the error threshold for expanded casemix nurse reviews from “greater than twenty-five percent (25%)” to “twenty-five percent (25%) and greater”.
- Revise the verbiage of when a hospital leave ends to be consistent with the definition of patient days. Currently, language is not consistent within the state plan for reporting and billing purposes and this revision will correct this inconsistency.