ADHC’s:

a.       Any new facility that has been in operation for at least a year.

b.      The facilities that have been operating the longest without an audit.

Individuals who need the type of medical care usually available in facilities but who can be treated successfully and cost-effectively in other settings may be allowed to receive the necessary care at home or in the community.  The Medicaid Program provides this coverage for a limited number of persons who are otherwise eligible for and would require facility placement.  Current Home and Community-Based (Waiver) Services include:

Medically Needy provides Medicaid eligibility to qualified individuals and families who may have too much income to qualify for regular Medicaid programs.  Individuals and families who meet all Medicaid program requirements, except that their income is above those program limits, can spend-down or reduce their income to Medicaid eligibility levels using incurred medical expenses.

Countable resources cannot be worth more than $2,000 for an individual or $3,000 for a couple who needs long-term care.  Under Spousal Impoverishment rules, a couple can have up to $104,400 in countable resources, as long as there is a spouse at home who does not get long-term care.  Resources owned separately, by either spouse, and all resources owned jointly by the couple are used to determine countable couple assets.  Resources owned jointly by the couple, and those in excess of the $2,000 allowed for the long-term care spouse must be transferred to the at-home spouse before the first review of eligibility.  The Spousal Impoverishment resource limit increases each year BUT the limit that applies is the one that was in effect at the time of the most recent admission.

Resources include money plus certain items that are owned by the person who needs long-term care, the legal spouse, or those that are jointly owned.  Resources include cash, financial assets, stocks, savings bonds, land, life insurance, vehicles, and anything else which could be changed to cash.

Financial assets include checking, savings, and credit union accounts; stocks, bonds, certificates of deposit, money market accounts, promissory notes, and safety deposit boxes.  We look at account ownership to determine who has access to the money.  We use the balance as of the first moment of the first day of a month as the value of the asset and to determine asset eligibility for the entire month.  Income that is deposited on or for the first day of the month is not counted as part of the account value for that month.  Funds to cover outstanding checks that have not cleared the bank by close of business on the last day of a month are considered "available" and are used to determine resource eligibility.

Some things usually do not count toward the resource limit, no matter how much they are worth.  Examples of such things are a home and the land it is on, one car, life insurance policies with a combined face value of $1,500 or less, burial plots or spaces, and irrecoverable burial arrangements.

A burial fund is an asset set aside to pay for burial expenses.  In some cases, up to $1,500 of this money will not count as a resource.  Some or all of the money in a burial fund may count toward the resource limit if the person owns life insurance policies or has other burial arrangements.

We must look at any transfer of resources which occurred within the 36 months (60 months for trust situations) before or at any time after application.  Transfers for less than fair market value are presumed to have been done to qualify for Medicaid, unless the applicant provides convincing evidence that the transfer was done exclusively for another purpose.  If we determine that resources were transferred to qualify for Medicaid, the person who needs long-term care will not be eligible for facility payment for a specified period.  We use the uncompensated value of the transferred item to determine how long the person will be ineligible.

Q.     Many Hurricane victims in nursing homes were evacuated to other nursing homes without their medical history.  The national Minimum Data Set (MDS) is the only source of medical record information for many of these residents.

         What can nursing homes that have accepted residents do to obtain information available on the residents' MDS record to assure appropriate care of those residents?  In some cases, the States affected by the hurricane are unable to provide this information on an "as requested" basis.

A.     CMS has compiled a list of all nursing homes that were evacuated, and has compiled a file of critical clinical information from the MDS records of the residents in those nursing homes in an Excel spreadsheet.  Any nursing home that has received evacuees may request access to this file(s).

Q. Are receiving nursing homes required to complete an MDS Admission Assessment for residents received from evacuated nursing homes?

A. For "short-term stays under emergency conditions", Centers for Medicare & Medicaid Services (CMS) would not require that receiving facilities conduct initial MDS or OASIS assessments.  In most of these cases, the stay would be temporary, not usually exceeding 2-3 days.  Within 15 days, however, the majority of the facilities impacted by the storm would know whether or not their residents would be returning shortly.  As soon as the "receiving" LTC facility knew these residents would not be returning to the "sending" facility, arrangements need to be made to conduct the initial MDS assessment.  In no case, would a "short-term stay under emergency conditions" exist for more than 30 days.  By the 30th day the "receiving" facility would be required to have completed a new MDS assessment.

Licensing and regulations can be found at:

To order:

       According to the Louisiana MDS Rule, a Delinquent MDS resident assessment is defined as "an MDS assessment that is more than 121 days old, as measured by the R2b date field on the MDS".

       Remember that this definition is applied to the Case Mix system and does not replace the federal obligation to complete a standard (comprehensive or quarterly) assessment every 92 days.

Yes your fiscal year for Medicaid cost reporting purposes may be different from your fiscal year for Medicare cost reporting purposes. However in doing this you will be completing two separate cost reports using the CMS Form 2540-96.

“The following should be submitted for each facility: Two (2) paper copies and three (3) electronic copies on either diskette or CD are required in each case for the Medicare cost report (CMS Form 2540-96) including the Compliance Questionnaire (CMS Form 339), the Louisiana Medicaid Supplemental Cost Report, and the Medicare home office cost report (CMS Form 287-92) if applicable.”  Rate and Audit Review also needs paper copies of all the attachments submitted with the cost report packet.

Yes you must file the Medicare cost report for Medicaid purposes.  Louisiana’s Medicaid program has adopted the Medicare skilled nursing cost report, CMS Form 2540-96 and the Medicare Home Office Cost Statement, CMS Form 287-92 for Medicaid cost reporting purposes. See LAC 50:VII.1303.  Nursing facilities participating in the Louisiana Medicaid program must complete the skilled nursing facility cost report adopted by the Medicare program (CMS Form 2540-96) in order to satisfy cost reporting requirements. For nursing facilities under the ownership of a hospital, the cost reporting document is the Health Care Financing Administration (HCFA) 2552.

The home office is not required to have the same year-end as the facility.  The home office should file its cost report based on the home office’s year-end.  When the home office accounting period differs from the cost reporting period of the related facilities, the allowable home office costs of the provider for the period covered by the home office cost statement should be included in the provider’s cost report.  An amount of allowable home office costs for the provider for the portion of its reporting year not covered by the home office statement will be tentatively projected at a rate not in excess of the previous year’s home office costs as set forth in the applicable home office cost statement.

Example:  The home office has an accounting year ending August 31, 2002.  For that year, home office costs of $120,000 were allocated to Provider A and $84,000 to Provider B.  Provider A’s reporting year ends on December 31; Provider B’s reporting year ends on March 31.

Of the $120,000 costs allocated to Provider A, $40,000 applies to its reporting year ended 12/31/01, covering the period from 9/1/01 to 12/31/01; and $80,000 applies to its reporting year ending 12/31/02, covering the period from 1/1/02 to 8/31/02.  Therefore, in its cost report for the year ending 12/31/02, Provider A may include home office costs of $40,000 projected for the period 9/1/02 to 12/31/02, which is not covered by the home office cost statement ($10,000 per month x 4 months).

Of the $84,000 allocated to Provider B, $49,000 applies to its reporting year ending 3/31/02, covering the period from 9/1/01 to 3/31/02; and $35,000 applies to its reporting year ending 3/31/03, covering the period from 4/1/02 to 8/31/02.  Therefore, in its cost report for the year ending 3/31/03, Provider B may include home office costs of $49,000 projected for the period 9/1/02 to 3/31/03, which is not covered by the home office cost statement ($7,000 per month x 7 months).

Then, the following year, when actual costs are determined, the projected amounts will be adjusted to agree with the actual amounts, and appropriate adjustments made.

Source:  Provider Reimbursement Manual Part I, Section 2150.3

Facilities are required to file the Medicare cost report based on their fiscal year end. The cost reporting period begin date shall be the later of the first day of the facility’s fiscal period or the facility’s Medicaid certification date. The cost reporting end date shall be the last day of the facility’s fiscal period.

The facility must file the Medicare cost report for the entire year to meet Louisiana’s Medicaid cost reporting requirements. The cost reporting period begin date shall be the later of the first day of the facility’s fiscal period or the facility’s Medicaid certification date. The cost reporting end date shall be the last day of the facility’s fiscal period.

NURSING HOMES:

a.       The facility was a Skilled Nursing – Infectious Disease (SN-ID) and/or a Skilled Nursing – Technology Dependent Care (SN/TDC) provider the previous year.

b.      The facility did not submit a cost report for the previous year.

c.       The facility had a disclaimer on the previous year’s audit.

d.      The facility had problems with provider fees..

e.       The facility had not been audited in the previous two years.

No, you should complete the Medicare cost report as required by the Medicare Provider Reimbursement Manual. All Medicaid required adjustments should be made only on the LA Supplemental Cost Report schedules.

When a long-term care recipient dies, Estate Recovery provisions require that we take steps to recover the cost of certain Medicaid payments from his or her estate.  These costs include the total amount of payments for facility services, hospital care, and prescription drugs the person received at age 55 or older.

Changes must be reported to us within 10 days if the person who gets Medicaid or his/her legal spouse:

• has a change in income or resources, including inheritances;
• has a change in health insurance coverage or premiums; or
• has a change in residence or mailing address.

Countable income consists of:

• unearned income, which includes money received from SSA, pensions, retirement, Veteran's benefits, interest income, cash from friends and relatives, and
• earned income, which is money received from working.

The purpose of the personal care services is to enable an individual whose needs would otherwise require placement in an acute or long term care facility to remain safely in that individual’s own home.

To qualify for coverage, an individual must:

To qualify for coverage, an individual must: