Revised Code of Washington - RCW Title 74 Public Assistance - Chapter 74.46 Nursing Facility Medicaid Payment System

  • 74.46.010 Short title -- Purpose
    This chapter may be known and cited as the "nursing facility medicaid payment system." The purposes of this chapter are to specify the manner by ...
  • 74.46.020 Definitions
    Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter. (1) "Accrual method of accounting" means a method of accounting ...
  • 74.46.030 Principles of reporting requirements
    The principle inherent within RCW 74.46.040 through 74.46.090 is that the department shall receive complete, annual reporting of costs and financial condition of the contractor ...
  • 74.46.040 Due dates for cost reports
    (1) Not later than March 31st of each year, each contractor shall submit to the department an annual cost report for the period from January ...
  • 74.46.050 Improperly completed or late cost report -- Fines -- Adverse rate actions -- Rules
    (1) If the cost report is not properly completed or if it is not received by the due date, all or part of any payments ...
  • 74.46.060 Completing cost reports and maintaining records
    (1) Cost reports shall be prepared in a standard manner and form, as determined by the department. Costs reported shall be determined in accordance with ...
  • 74.46.080 Requirements for retention of records by the contractor
    (1) All records supporting the required cost reports, as well as trust funds established by RCW 74.46.700, shall be retained by the contractor for a ...
  • 74.46.090 Retention of cost reports and resident assessment information by the department
    The department will retain the required cost reports for a period of one year after final settlement or reconciliation, or the period required under chapter ...
  • 74.46.100 Purposes of department audits -- Examination -- Incomplete or incorrect reports -- Contractor's duties -- Access to facility -- Fines -- Adverse rate actions
    (1) The purposes of department audits under this chapter are to ascertain, through department audit of the financial and statistical records of the contractor's nursing ...
  • 74.46.155 Reconciliation of medicaid resident days to billed days and medicaid payments -- Payments due -- Accrued interest -- Withholding funds
    (1) The department shall reconcile medicaid resident days to billed days and medicaid payments for each medicaid nursing facility for the preceding calendar year, or ...
  • 74.46.165 Proposed settlement report -- Payment refunds -- Overpayments -- Determination of unused rate funds -- Total and component payment rates
    (1) Contractors shall be required to submit with each annual nursing facility cost report a proposed settlement report showing underspending or overspending in each component ...
  • 74.46.190 Principles of allowable costs
    (1) The substance of a transaction will prevail over its form. (2) All documented costs which are ordinary, necessary, related to care of medical care ...
  • 74.46.200 Offset of miscellaneous revenues
    (1) Allowable costs shall be reduced by the contractor whenever the item, service, or activity covered by such costs generates revenue or financial benefits other ...
  • 74.46.220 Payments to related organizations -- Limits -- Documentation
    (1) Costs applicable to services, facilities, and supplies furnished by a related organization to the contractor shall be allowable only to the extent they do ...
  • 74.46.230 Initial cost of operation
    (1) The necessary and ordinary one-time expenses directly incident to the preparation of a newly constructed or purchased building by a contractor for operation as ...
  • 74.46.240 Education and training
    (1) Necessary and ordinary expenses of on-the-job training and in-service training required for employee orientation and certification training directly related to the performance of duties ...
  • 74.46.250 Owner or relative -- Compensation
    (1) Total compensation of an owner or relative of an owner shall be limited to ordinary compensation for necessary services actually performed. (a) Compensation is ...
  • 74.46.270 Disclosure and approval or rejection of cost allocation
    (1) The contractor shall disclose to the department: (a) The nature and purpose of all costs which represent allocations of joint facility costs; and (b) ...
  • 74.46.280 Management fees, agreements -- Limitation on scope of services
    (1) Management fees will be allowed only if: (a) A written management agreement both creates a principal/agent relationship between the contractor and the manager, and ...
  • 74.46.290 Expense for construction interest
    (1) Interest expense and loan origination fees relating to construction of a facility incurred during the period of construction shall be capitalized and amortized over ...
  • 74.46.300 Operating leases of office equipment -- Rules
    Rental or lease costs under arm's-length operating leases of office equipment shall be allowable to the extent the cost is necessary and ordinary. The department ...
  • 74.46.310 Capitalization
    The following costs shall be capitalized: (1) Expenses for facilities or equipment with historical cost in excess of seven hundred fifty dollars per unit and ...
  • 74.46.320 Depreciation expense
    Depreciation expense on depreciable assets which are required in the regular course of providing patient care will be an allowable cost. It shall be computed ...
  • 74.46.330 Depreciable assets
    Tangible assets of the following types in which a contractor has an interest through ownership or leasing are subject to depreciation: (1) Building - the ...
  • 74.46.340 Land, improvements -- Depreciation
    Land is not depreciable. The cost of land includes but is not limited to, off-site sewer and water lines, public utility charges necessary to service ...
  • 74.46.350 Methods of depreciation
    (1) Buildings, land improvements, and fixed equipment shall be depreciated using the straight-line method of depreciation. For new or replacement building construction or for major ...
  • 74.46.360 Cost basis of land and depreciation base of depreciable assets
    (1) For all partial or whole rate periods after December 31, 1984, the cost basis of land and depreciation base of depreciable assets shall be ...
  • 74.46.370 Lives of assets
    (1) Except for new buildings, major remodels, and major repair projects, as defined in subsection (2) of this section, the contractor shall use lives which ...
  • 74.46.380 Depreciable assets
    (1) Where depreciable assets are disposed of through sale, trade-in, scrapping, exchange, theft, wrecking, or fire or other casualty, depreciation shall no longer be taken ...
  • 74.46.390 Gains and losses upon replacement of depreciable assets
    If the retired asset is replaced, the gain or loss shall be applied against or added to the cost of the replacement asset, provided that ...
  • 74.46.410 Unallowable costs
    (1) Costs will be unallowable if they are not documented, necessary, ordinary, and related to the provision of care services to authorized patients. (2) Unallowable ...
  • 74.46.421 Purpose of part E -- Nursing facility medicaid payment rates
    (1) The purpose of part E of this chapter is to determine nursing facility medicaid payment rates that, in the aggregate for all participating nursing ...
  • 74.46.431 Nursing facility medicaid payment rate allocations -- Components -- Minimum wage -- Rules
    (1) Effective July 1, 1999, nursing facility medicaid payment rate allocations shall be facility-specific and shall have seven components: Direct care, therapy care, support services, ...
  • 74.46.433 Variable return component rate allocation
    (1) The department shall establish for each medicaid nursing facility a variable return component rate allocation. In determining the variable return allowance: (a) Except as ...
  • 74.46.435 Property component rate allocation
    (1) Effective July 1, 2001, the property component rate allocation for each facility shall be determined by dividing the sum of the reported allowable prior ...
  • 74.46.437 Financing allowance component rate allocation
    (1) Beginning July 1, 1999, the department shall establish for each medicaid nursing facility a financing allowance component rate allocation. The financing allowance component rate ...
  • 74.46.439 Facilities leased in arm's-length agreements -- Recomputation of financing allowance -- Reimbursement for annualized lease payments -- Rate adjustment
    (1) In the case of a facility that was leased by the contractor as of January 1, 1980, in an arm's-length agreement, which continues to ...
  • 74.46.441 Public disclosure of rate-setting information
    The department shall disclose to any member of the public all rate-setting information consistent with requirements of state and federal laws.[1998 c 322 § 20.] ...
  • 74.46.445 Contractors -- Rate adjustments
    If a contractor experiences an increase in state or county property taxes as a result of new building construction, replacement building construction, or substantial building ...
  • 74.46.475 Submitted cost report -- Analysis and adjustment by department
    (1) The department shall analyze the submitted cost report or a portion thereof of each contractor for each report period to determine if the information ...
  • 74.46.485 Case mix classification methodology
    (1) The department shall employ the resource utilization group III case mix classification methodology. The department shall use the forty-four group index maximizing model for ...
  • 74.46.496 Case mix weights -- Determination--Revisions
    (1) Each case mix classification group shall be assigned a case mix weight. The case mix weight for each resident of a nursing facility for ...
  • 74.46.501 Average case mix indexes determined quarterly -- Facility average case mix index -- Medicaid average case mix index
    (1) From individual case mix weights for the applicable quarter, the department shall determine two average case mix indexes for each medicaid nursing facility, one ...
  • 74.46.506 Direct care component rate allocations -- Determination -- Quarterly updates -- Fines
    (1) The direct care component rate allocation corresponds to the provision of nursing care for one resident of a nursing facility for one day, including ...
  • 74.46.508 Direct care component rate allocation -- Increases -- Rules
    (1) The department is authorized to increase the direct care component rate allocation calculated under RCW 74.46.506(5) for residents who have unmet exceptional care needs ...
  • 74.46.511 Therapy care component rate allocation -- Determination
    (1) The therapy care component rate allocation corresponds to the provision of medicaid one-on-one therapy provided by a qualified therapist as defined in this chapter, ...
  • 74.46.515 Support services component rate allocation -- Determination
    (1) The support services component rate allocation corresponds to the provision of food, food preparation, dietary, housekeeping, and laundry services for one resident for one ...
  • 74.46.521 Operations component rate allocation -- Determination
    (1) The operations component rate allocation corresponds to the general operation of a nursing facility for one resident for one day, including but not limited ...
  • 74.46.531 Department may adjust component rates -- Contractor may request -- Errors or omissions
    (1) The department may adjust component rates for errors or omissions made in establishing component rates and determine amounts either overpaid to the contractor or ...
  • 74.46.533 Combined and estimated rebased rates -- Determination -- Hold harmless provision
    (1) For the purposes of comparison, the department shall determine the following during the rate-setting periods for fiscal years 2008 and 2009: (a) Each facility's ...
  • 74.46.600 Billing period
    A contractor shall bill the department for care provided to medical care recipients from the first through the last day of each calendar month.[1980 c ...
  • 74.46.610 Billing procedure -- Rules
    (1) A contractor shall bill the department each month by completing and returning a facility billing statement as provided by the department. The statement shall ...
  • 74.46.620 Payment
    (1) The department will pay a contractor for service rendered under the facility contract and billed in accordance with RCW 74.46.610. (2) The amount paid ...
  • 74.46.625 Supplemental payments
    To the extent the federal government approves such payments under the state's plan for medical assistance, and only to the extent that funds are specifically ...
  • 74.46.630 Charges to patients
    (1) The department will notify a contractor of the amount each medical care recipient is required to pay for care provided under the contract and ...
  • 74.46.640 Suspension of payments
    (1) Payments to a contractor may be withheld by the department in each of the following circumstances: (a) A required report is not properly completed ...
  • 74.46.650 Termination of payments
    All payments to a contractor will end no later than sixty days after any of the following occurs: (1) A contract is terminated, assigned, or ...
  • 74.46.660 Conditions of participation
    In order to participate in the nursing facility medicaid payment system established by this chapter, the person or legal entity responsible for operation of a ...
  • 74.46.680 Change of ownership -- Assignment of department's contract
    (1) On the effective date of a change of ownership the department's contract with the old owner shall be automatically assigned to the new owner, ...
  • 74.46.690 Change of ownership -- Final reports -- Settlement
    (1) When there is a change of ownership for any reason, final reports shall be submitted as required by RCW 74.46.040. (2) Upon a notification ...
  • 74.46.700 Resident personal funds -- Records -- Rules
    Each nursing home shall establish and maintain, as a service to the resident, a bookkeeping system incorporated into the business records for all resident moneys ...
  • 74.46.711 Resident personal funds -- Conveyance upon death of resident
    Upon the death of a resident with a personal fund deposited with the facility, the facility must convey within thirty days the resident's funds, and ...
  • 74.46.770 Contractor appeals -- Challenges of laws, rules, or contract provisions -- Challenge based on federal law
    (1) If a contractor wishes to contest the way in which a rule relating to the medicaid payment system was applied to the contractor by ...
  • 74.46.780 Appeals or exception procedure
    The department shall establish in rule, consistent with federal requirements for nursing facilities participating in the medicaid program, an appeals or exception procedure that allows ...
  • 74.46.790 Denial, suspension, or revocation of license or provisional license -- Penalties
    The department is authorized to deny, suspend, or revoke a license or provisional license or, in lieu thereof or in addition thereto, assess monetary penalties ...
  • 74.46.800 Rule-making authority
    (1) The department shall have authority to adopt, amend, and rescind such administrative rules and definitions as it deems necessary to carry out the policies ...
  • 74.46.803 Certificate of capital authorization -- Rules -- Emergency situations
    (1) The department shall establish rules for issuing a certificate of capital authorization. The rules shall address the following subjects, among others: (a) The period ...
  • 74.46.807 Capital authorization -- Determination
    The total capital authorization available for any state fiscal year shall be specified in the biennial appropriations act and shall be calculated on an annual ...
  • 74.46.820 Public disclosure
    (1) Cost reports and their final audit reports filed by the contractor shall be subject to public disclosure pursuant to the requirements of chapter 42.56 ...
  • 74.46.835 AIDS pilot nursing facility--Payment for direct care
    (1) Payment for direct care at the pilot nursing facility in King county designed to meet the service needs of residents living with AIDS, as ...
  • 74.46.840 Conflict with federal requirements
    If any part of this chapter or RCW 18.51.145 or 74.09.120 is found by an agency of the federal government to be in conflict with ...
  • 74.46.900 Severability -- 1980 c 177
    If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application ...
  • 74.46.901 Effective dates -- 1983 1st ex.s. c 67; 1980 c 177
    (1) Sections 2, 7, 83, 85, 86, and 91 of chapter 177, Laws of 1980 are necessary for the immediate preservation of the public peace, ...
  • 74.46.902 Section captions -- 1980 c 177
    Section captions as used in this act do not constitute any part of the law.[1980 c 177 § 89.] ...
  • 74.46.905 Severability -- 1983 1st ex.s. c 67
    If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application ...
  • 74.46.906 Effective date -- 1998 c 322 ยงยง 1-37, 40-49, and 52-54
    Sections 1 through 37, 40 through 49, and 52 through 54 of this act take effect July 1, 1998.[1998 c 322 § 55.] ...
  • 74.46.907 Severability -- 1998 c 322
    If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application ...
  • 74.46.909 Retrospective application -- Clarification of chapter 8, Laws of 2001 1st sp. sess. -- 2008 c 263
    The legislature clarifies the enactment of *chapter 8, Laws of 2001 1st sp. sess. and intends this act be curative, remedial, and retrospectively applicable to ...

Last modified: April 7, 2009