Chapter 350-7 INDIGENT CARE TRUST FUND - NURSING HOME PROVIDER FEE
| (1) |
"Medically indigent" means a person who meets the
state-wide standards of indigency adopted by the Department which is a person
with an income no greater than 200 percent of the federal poverty level
guidelines as published by the United States Department Health and Human
Services. |
| (2) |
"Nursing home" means a freestanding facility or distinct
part or unit of a hospital required to be licensed or permitted as a nursing
home under the provisions of O.C.G.A. Title 31, Chapter 8, Article 5, which is
not owned or operated by the state or federal government. |
| (3) |
"Nursing Home that disproportionately serves the medically
indigent" means a nursing home for which the patient days attributable to
medically indigent residents account for more than 15 percent of the nursing
home's total patient days during a 12-month period. For purposes of this
computation, Medicare program patient days shall not be included in the nursing
home's total patient days. |
| (4) |
"Patient day" means a day of care provided to an individual
resident of a nursing home by the nursing home. A patient day includes the date
of admission but does not include the date of discharge, unless the dates of
admission and discharge occur on the same day. |
| (5) |
"Provider fee" means the fee imposed pursuant to these
rules for the privilege of operating a nursing home. |
| (6) |
"Segregated account" means an account for the dedication
and deposit of provider fees which is established within the Indigent Care
Trust Fund. |
| (7) |
"State plan" means all documentation submitted by the
Commissioner of the Department of Community Health to the United States
Department of Health and Human Services, Center for Medicare and Medicaid
Services, pursuant to Title XIX of the federal Social Security Act. |
| (8) |
"Trust fund" means the Indigent Care Trust Fund created
pursuant to O.C.G.A. Title 31, Chapter 8, Article 6. |
| (9) |
"Waiver" means a waiver of the uniform tax requirement for
permissible health care related taxes, as provided for in 42 C.F.R. § 433.68 (e)(2)(i)(ii). |
| (1) |
There is established within the Indigent Care Trust Fund a
segregated account for revenues raised through imposition of the provider fee.
All revenues raised through the nursing home provider fees shall be credited to
the segregated account. All said revenues raised shall be dedicated and used
for the sole purpose of obtaining federal financial participation for medical
assistance payments to nursing homes that disproportionately serve the
medically indigent. Payments to the segregated nursing home provider fee
account shall be made by any nursing home required to do so pursuant to
O.C.G.A. Section 31-8-164. Such payments to the segregated account shall be
irrevocable and shall not include any limitation upon use of such contributions
except as permitted in this article or by the Department. Payments shall only
be used for the purposes contained in O.C.G.A. Section 31-8-165. Contributions
and transfers to the Indigent Care Trust Fund pursuant to O.C.G.A. Section
31-8-153 and 31-8-153.1 shall not be deposited into the segregated
account. |
| (2) |
Each nursing home shall be assessed a provider fee with
respect to each patient day for the preceding quarter, excluding Medicare
program patient days. The provider fee shall be assessed uniformly upon all
nursing homes except with respect to the waiver to be applied for pursuant to
O.C.G.A. Section 31-8-168. The aggregate provider fees imposed shall not exceed
the maximum amount that may be assessed pursuant to the 6 percent indirect
guarantee threshold set forth in 42 C.F.R. Section 433.68(f)(3)(i). Such
provider fee payments may be deposited to the segregated account by means of
electronic funds transfer, when pre-authorized by the Department. |
| (3) |
The provider fee shall be paid quarterly by each nursing
home to the Department. A nursing home shall calculate and report the provider
fee due upon a form prepared and distributed by the Department. The payments
shall be submitted no later than the thirtieth day following the end of each
calendar quarter. The initial provider fee report shall be filed and the
initial provider fee payment shall be submitted no later than July 30, 2003.
The initial provider fee payment for July 30, 2003 shall be calculated using
the patient day information for the calendar quarter ending June 30,
2003. |
| (4) |
Each nursing home shall keep and preserve for a period of
three years such books and records as may be necessary to determine the amount
for which it is liable for a provider fee pursuant to these rules. The
Department shall have the authority to inspect and copy the records of a
nursing home for purposes of auditing the calculation of the provider fee. All
information obtained by the Department for this purpose shall be confidential
and shall not constitute a public record. |
| (5) |
In the event the Department determines that a nursing home
has underpaid or overpaid the provider fee, the Department shall notify the
nursing home of the balance of the provider fee or refund that is due. Such
payment or refund shall be due within 30 days of the Department's notice to the
nursing home. |
| (6) |
Any nursing home that fails to pay the provider fee
pursuant to these rules within the time periods specified by these rules shall
pay, in addition to the outstanding provider fee, a 6 percent penalty for each
month or fraction thereof that the payment is overdue. If a provider fee has
not been received by the Department by the last day of the month, the
Department shall withhold an amount equal to the provider fee and penalty owed
from any Medicaid payment due the nursing home in question. The provider fee
levied by this article shall constitute a debt due the state and may be
collected by civil action and the filing of tax liens in addition to such
methods provided for by these rules. Any penalty that accrues as a result of
late payments shall be credited to the segregated account. |
| (1) |
The General Assembly is authorized to appropriate as state
funds to the Department for use in any fiscal year all revenues dedicated and
credited to the segregated account. These appropriations shall be made for the
sole purpose of obtaining federal financial participation in the provision of
support to nursing homes that disproportionately serve the medically indigent.
Any appropriation from the segregated account for any purpose other than
Medicaid payments to nursing homes shall be null and void. |
| (2) |
Revenues appropriated to the Department pursuant to these
rules shall be used to match federal funds that are available for the purpose
for which such trust funds have been appropriated. |
| (3) |
Appropriations from the segregated account to the
Department shall not lapse to the general fund at the end of the fiscal
year. |
| (4) |
The Department shall annually report to the General
Assembly on the use of revenues credited to the segregated account and
appropriated to the Department for the purposes outlined in these rules. Such
report shall be submitted to the Lieutenant Governor, Speaker, legislative
counsel and legislative budget officer no later than January 31 of each
calendar year. Such reports shall be made available to the public as a public
record. |
All Department records related to the Indigent Care Trust Fund
segregated account, except as provided for in Rule 350-7-.02(4) shall be open
for public inspection in accordance with the Open Records Act, O.C.G.A. § 50-18-70et seq.
Except where inconsistent with O.C.G.A., Title 31, Chapter 8,
Article 6A, the provisions of O.C.G.A., Title 49, Chapter 4, Article 7 (Georgia
Medical Assistance Act of 1977) shall apply to the Department in carrying out
the purposes of the nursing home provider fee.
