Or. Admin. R. 411-070-0470 - Nursing Assistant Training and Competency Evaluation Programs Request for Reimbursement
(1) The
Omnibus Budget Reconciliation Act (OBRA) of 1987 and 1990 requires that any
nursing assistant employed in a nursing facility completes a competency
evaluation program. Medicaid reimburses a Medicaid certified nursing facility
for the Medicaid share of the allowable cost directly related to meeting the
nursing assistant training and competency evaluation requirement.
(2) A facility must notify, in writing, the
nursing assistants upon hire that the nursing assistant may receive
reimbursement up to 12 months after completing a Nursing Assistant Training and
Competency Evaluation Program (NATCEP) training program. Failure to notify or
failure to reimburse an eligible nursing assistant, shall result in an
assessment for imposition of sanctions.
(3) The nursing facility must reimburse newly
employed Certified Nursing Assistants who have personally paid for NATCEP
costs. The facility is not required to reimburse the nursing assistant in cases
where the expenses were paid by an employer or education training program or
reimbursed by a previous employer.
(4) REQUEST FOR REIMBURSEMENT. Medicaid
certified nursing facilities must file a NATCEP request for reimbursement with
the Department that meets the following standards:
(a) As of January 1, 2013, all requests for
reimbursement must be submitted electronically. A facility must submit a
request for reimbursement within 12 months after completing a NATCEP training
program or reimbursing a nursing assistant as described in section (3) of this
rule. The request for reimbursement must identify all costs incurred and
related revenues (not including NATCEP payments from the Department) received
during the reporting period.
(b) A
request for reimbursement must:
(A) Be
submitted electronically on a system provided by the Department.
(B) Include actual costs incurred and paid by
the facility. The Department may not reimburse a facility prospectively.
(C) Include all revenue (not
including NATCEP payments from the Department) received by the facility for
conducting the approved nursing assistant training. All revenue must be used to
offset the costs incurred and paid in the reporting period.
(D) The facility must maintain and have
available for review the appropriate documentation, as described in section (8)
of this rule, to support each specific area identified for payment by the
Department. Failure to provide required documentation, when requested, shall
result in an overpayment to the facility. The facility must repay any
overpayment to the Department within 60 days of receipt of notification.
(E) Include all appropriate NATCEP
costs and revenues only. NATCEP costs, including costs disallowed, must not be
reimbursed as part of the facility's bundled rate. However, NATCEP costs,
revenues, and reimbursement must be included on the facility's annual Nursing
Facility Financial Statement (NFFS).
(F) Include only true and accurate
information. If a facility knowingly, or with reason to know, files a request
for reimbursement containing false information, such action must constitute
cause for termination of the facility's provider agreement with the Department.
Providers filing false requests for reimbursements may be referred for
prosecution under applicable statutes.
(5) CHARGING OF FEES PROHIBITED. The nursing
facility must not charge a trainee any fee for participation in NATCEP or for
any textbooks or other materials required for NATCEP if the trainee is employed
by or has an offer of employment from a nursing facility on the date on which
the NATCEP begins.
(6) FEES PAID BY
EMPLOYER.
(a) All charges and materials
required for NATCEP and fees for nursing assistant certification must be paid
by the nursing facility if it offered employment at the facility on the date
training began.
(b) If a nursing
assistant who is not employed by a Medicaid certified facility or does not have
an offer of employment by a Medicaid nursing facility on the date on which the
NATCEP began becomes employed by, or receives an offer for employment from a
nursing facility within 12 months after completing a NATCEP, the employing
facility must reimburse the nursing assistant within the first three months of
employment. Reimbursement must include any NATCEP fees for tuition, enrollment
and textbook costs, testing fees, or other required course materials up to the
amount determined by the Department that was paid by the nursing assistant.
Evidence the nursing assistant paid for training must include receipt of
payment and the graduation certificate from the school.
(c) Such reimbursement must be calculated on
a pro rata basis. The reimbursement must be determined by dividing the cost
paid by the nursing assistant by 12 and multiplying by the number of months
during this 12-month period that the nursing assistant worked for the facility.
The facility must claim the appropriate pro rata amount on each request for
reimbursement it submits not to exceed the lesser of 12 months or the total
number of months the nursing assistant was employed at that facility. The
facility must maintain evidence provided by the nursing assistant of the
training costs incurred at an approved training facility.
(d) A facility shall reimburse a nursing
assistant before submitting a request for reimbursement from the Department.
(7) FACILITY
REIMBURSEMENT BY THE DEPARTMENT. The Department shall reimburse the facility
for the Medicaid portion of the costs described in this section unless limited
by the application of section (4) of this rule. This portion is calculated by
multiplying the eligible costs paid by the facility by the percentage of
resident days that are attributable to Medicaid residents during the reporting
period. The Department's payment to the facility for the NATCEP cost is in
addition to payments based upon the facility's bundled rate.
(a) EMPLOYEE COMPENSATION. Reimbursement for
trainer hours must not exceed one and a one-third times the number of hours
required for certification. A facility may claim reimbursement for the portion
of an employee's compensation attributable to nursing assistant training if:
(A) The employee meets the qualifications of
42
CFR 483.152 and OAR chapter 851, division
061;
(B) The employee directly
conducts training or testing in an approved program;
(C) The employee's compensation, including
benefits, is commensurate with other licensed nurse compensation paid by the
facility;
(D) The employee's total
compensated hours do not exceed 40 in any week during which NATCEP
reimbursement is claimed;
(E) No
portion of the claimed reimbursement is for providing direct care services
while assisting in the training of nursing assistants if providing direct care
services is within the normal duties of the employee; and
(F) The facility provides the Department with
satisfactory documentation to support the methodology for allocating costs
between facility operation and NATCEP.
(b) TRAINING SPACE AND UTILITIES. Costs
associated with space and utilities are eligible only if the space and
utilities are devoted 100 percent to the NATCEP. The facility must provide
documentation satisfactory to the Department to support the need for, and use
of, the space and utilities.
(c)
TEXTBOOKS AND COURSE MATERIALS. A portion of the cost of textbooks and
materials is eligible if textbooks and materials are used primarily for NATCEP.
The portion reimbursable is equal to the percentage of use attributable to
NATCEP. "Primarily" means more than 50 percent. The facility must provide
satisfactory documentation supporting the NATCEP need for and percentage of use
of textbooks and materials.
(d)
EQUIPMENT. A portion of the cost of equipment is eligible if used primarily for
NATCEP. However, equipment purchased for $500 or more per item, must be prior
approved by the Department to qualify for reimbursement. The portion
reimbursable is equal to the percentage of use attributable to NATCEP.
"Primarily" means more than 50 percent. The facility must maintain satisfactory
documentation supporting the NATCEP need for and percentage of use of the
equipment. Disposition of equipment and software purchased in whole or in part
under the Title XIX Medicaid Program must meet the requirements of the
facility's provider agreement.
(e)
CERTIFICATION FEES. Nursing assistant certification and recertification fees
paid to the Oregon State Board of Nursing for facility employees are eligible.
(f) REIMBURSEMENT FOR NURSING
ASSISTANTS. Reimbursement provided to nursing assistants pursuant to section
(6) of this rule are eligible. The training must have occurred at an approved
training center, including nursing facilities in Oregon or other states. If a
facility chooses to reimburse the nursing assistant's full amount in one
request, the facility may not recoup payment from a nursing assistant if the
nursing assistant's employment ends, regardless of cause.
(g) CONTRACT TRAINERS. Payment for nursing
assistant training classes provided under contract by persons who meet the
qualifications of
42
CFR 483.152 are eligible for reimbursement.
For this purpose, either the facility or the contractor must be approved for
NATCEP. Allowable contract trainer payments shall be limited to the lesser of
actual cost or the salary calculation described in section (7)(a) of this rule.
(h) INELIGIBLE COSTS - TRAINEE
WAGES. Wages paid to nursing assistants in training are not eligible for NATCEP
reimbursement, but may be claimed as part of the daily reimbursement costs.
(i) REIMBURSEMENT FOR COMBINED
CLASSES. If two or more Medicaid certified facilities cooperate to conduct
nursing assistant training, the Department shall not reimburse any
participating facility for the combined training class until all participating
facilities have filed a request for reimbursement. For a combined class, the
Department shall apportion reimbursement to participating facilities pro rata
based on the number of students enrolled at the completion of the first 30
hours of classroom training or in any other equitable manner agreed to by the
participating facilities. However, when cooperating facilities file separate
NATCEP requests for reimbursements, nothing in this section authorizes the
Department to deny or limit reimbursement to a facility based on a failure to
file or a delay in filing by a cooperating facility.
(8) RECORDKEEPING, AUDIT, SANCTIONS,
REPORTING, AND APPEAL.
(a) The facility must
maintain supportive documentation for a period of not less than three years
following the date of submission of the NATCEP request for reimbursement. This
documentation must include records in sufficient detail to substantiate the
request for reimbursement. If there are unresolved audit questions at the end
of the three-year period, the records must be maintained until the questions
are resolved. The records must be maintained in a condition that can be
audited.
(b) Each facility must
submit a quarterly NATCEP report to the Department using the Department's
approved method and format. The report must provide an accurate monthly account
of nursing assistant new hires, which includes date of hire, date of completion
of an approved Nursing Assistant Level 1 training program, and the date of
reimbursement.
(A) The facility must submit
the report to the Department no later than the end of the month immediately
following the end of each calendar quarter. (Example: For the calendar quarter
ending March 31, the report must be received no later than April 30.)
(B) Upon the Department's request,
the facility must provide documentation to support the quarterly report
including payroll records.
(c) All requests for reimbursements are
subject to audit at the discretion of the Department. The facility shall be
notified in writing of the amount to be reimbursed and of any adjustments to
the request for reimbursement. Payment of any amounts due to the Department
must be made within 60 days of the date of notification to the facility.
(d) Sanctions and remedies may be
provided pursuant to OAR chapter 411, division 89. One or more remedies may be
imposed by the Department when a facility fails to comply with state
regulations. The remedy(s) issued by the Department may be based upon findings
of noncompliance with one or more requirements of participation.
(e) A facility is entitled to an informal
conference and contested case hearing pursuant to ORS
183.413 through
183.470, as described in OAR
411-070-0435, to protest the reimbursement amount or the adjustment. If no
written request for an informal conference or contested case hearing is made
within 30 days, the decision becomes final.
Notes
Publications: Publications referenced are available from the agency.
Stat. Auth.: ORS 414.070
Stats. Implemented: ORS 410.070
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