Iowa Admin. Code r. 441-36.2

Current through Regsiter Vol. 46, No. 26, June 12, 2024

Rule 441-36.2 - Determination and payment of fee

For all ICFs/ID licensed in Iowa under 481-Chapter 64, including facilities not certified to participate in the Medicaid program, the fee shall be determined and paid as follows:

(1) Each facility shall pay the assessment to the department on a quarterly basis. The facility shall:

a. Use Form 470-5422 to calculate the quarterly fee due.

b. Submit Form 470-5422 and the quarterly fee no later than 30 days following the end of each calendar quarter.

(2) The facility shall calculate the amount of the quarterly fee due by multiplying 5.5 percent by the facility's total ICF/ID payments for services received from all sources during the preceding quarter, including but not limited to:

a. Medicaid managed care payments.

b. Client participation payments.

c. Medicaid fee-for-service payments.

d. Private pay/insurance payments.

e. Ancillary service payments.

(3) If the department determines that an ICF/ID has underpaid or overpaid the fee, the department shall notify the ICF/ID of the amount of the unpaid fee or refund due. Such amount shall be due or refunded within 30 days of the issuance of the notice.

(4) An ICF/ID that fails to pay the fee within the time frame specified in subrule 36.2(3) shall pay a penalty in the amount of 1.5 percent of the unpaid fee due for each month or portion of a month that the unpaid fee is overdue.

a. If the ICF/ID substantiates good cause beyond the facility's control for failure to make timely payment of the fee, the department shall waive the penalty or a portion of the penalty. For purposes of this subrule, "good cause" shall have the same meaning as "good cause" for setting aside a default judgment under Iowa Rule of Civil Procedure 1.977.

b. Requests for a good cause waiver must be submitted to the Iowa Medicaid provider cost audit and rate setting unit within 30 days of notice to the facility that the penalty is due.

(5) If a fee has not been received by the department by the last day of the third month after the fee is due, the department shall suspend payment due the ICF/ID under the medical assistance program, including payments made on behalf of the medical assistance program by a contracted managed care organization.

Iowa Admin. Code r. 441-36.2

Amended by IAB January 4, 2017/Volume XXXIX, Number 14, effective 2/8/2017

Amended by IAB October 5, 2022/Volume XLV, Number 7, effective 12/1/2022