C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-107, subsec. 144-101-III-107-30

Current through 2024-46, November 13, 2024

Subsection 144-101-III-107-30 - DEFICIENCY ROUTINE AND FIXED COSTS RATE

When a facility is found not to have provided the quality of service or level of care required, reimbursement will be made on ninety percent (90%) of the provider's per diem rate, unless otherwise specified. This "deficiency rate" will be applied following written notification to the facility of the effective date of the reduced rate for any of the following service deficiencies:

30.1 Specific, documented evidence that the care provided does not meet the Federal Certification and State Licensing requirements. Such penalty to be effective no sooner than thirty (30) days from written notification that such deficiencies exist;

30.2 Failure to correct, within the time frames of an accepted Plan of Remediation or Correction, deficiencies in meeting the Federal Certification, Accreditation and State Licensing requirements, which cause a threat to the health and safety of residents in a facility or the surrounding community;

30.3 Failure to submit a cost report, financial statements, and other schedules as requested by the Division of Audit and to maintain auditable records as required by these Principles and other relevant regulations may result in application of the deficiency routine and fixed costs rate. The deficiency routine and fixed costs rate for these items will go into effect immediately upon receipt of written notification from the Department.

A reduction in rate because of deficiencies shall remain in effect until the deficiencies have been corrected, as verified by representatives of the Department, following written notification by the provider that the deficiencies no longer exist. No retroactive adjustments to the full rate shall be made for the period that the deficiency rate is in effect unless the provider demonstrates to the satisfaction of the Department that there was no just cause for the reduction in payment.

C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-107, subsec. 144-101-III-107-30