Licensure Regulations Manual

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Department of Health and,Senior Services,Division 30 Division of Regulation and Licensure. Chapter 81 Certification,Title Page, 19 CSR 30 81 010 General Certification Requirements 81 010 1 4. 19 CSR 30 81 015 Resident Assessment Instrument Rescinded September 30 2012 81 015 1. 19 CSR 30 81 020 Prelong Term Care Screening Rescinded February 28 2006 81 020 1. 19 CSR 30 81 030 Evaluation and Assessment Measures for Title XIX Recipients and. Applicants in Long Term Care Facilities 81 030 1 4. Chapter 81 Certification 19 CSR 30 81, Title 19 DEPARTMENT OF I Nursing facility NF shall mean an SNF or ICF. HEALTH AND SENIOR SERVICES licensed under Chapter 198 RSMo which has signed an. Division 30 Division of Regulation and Licensure agreement with the Department of Social Services to. Chapter 81 Certification participate in the Medicaid program and which is certified. by the department As used within the contents of this rule. 19 CSR 30 81 010 General Certification Requirements licensed SNFs SNF ICF and ICFs participating in the. Medicaid program are subject to state and federal laws and. PURPOSE This rule sets forth application procedures and regulations for participation as an NF. general certification requirements for nursing facilities J Section for Long Term Care SLTC shall mean that. certified under the Title XIX Medicaid program and section of the department responsible for licensing and. skilled nursing facilities under Title XVIII Medicare and regulating long term care facilities licensed under Chapter. procedures to be followed by nursing facilities when 198 RSMo. requesting a nurse staffing waiver K Skilled nursing facility SNF shall mean an SNF. licensed under Chapter 198 RSMo which has a signed. PUBLISHER S NOTE The secretary of state has agreement with the CMS to participate in the Medicare. determined that the publication of the entire text of the program and which has been recommended for certification. material which is incorporated by reference as a portion of by the department. this rule would be unduly cumbersome or expensive This L Title XVIII shall mean the Medicare program as. material as incorporated by reference in this rule shall be provided for in the federal Social Security Act. maintained by the agency at its headquarters and shall be M Title XIX shall mean the Medicaid program as. made available to the public for inspection and copying at provided for in the federal Social Security Act. no more than the actual cost of reproduction This note. applies only to the reference material The entire text of the 2 An operator of an SNF or ICF licensed by the. rule is printed here department electing to be certified as a provider of skilled. nursing services under the Title XVIII Medicare or NF. 1 Definitions services under the Title XIX Medicaid program of the. A Certification shall mean the determination by the Social Security Act or an operator of a facility electing to. Missouri Department of Health and Senior Services or the be certified as an ICF MR facility under Title XIX shall. Centers for Medicare and Medicaid Services that a submit application materials to the department as required. licensed skilled nursing or intermediate care facility by federal law and shall comply with standards set forth in. SNF ICF licensed under Chapter 198 RSMo or an ICF the Code of Federal Regulations CFR of the United. for person with mental retardation ICF MR is in States Department of Health and Human Services in 42. substantial compliance with all federal requirements and is CFR chapter IV part 483 subpart B for nursing homes and. approved to participate in the Medicaid or Medicare 42 CFR chapter IV part 483 subpart I for ICF MR. programs facilities as appropriate, B CMS shall mean the Centers for Medicare and A For Medicaid the application shall include. Medicaid Services of the U S Department of Health and 1 Long Term Care Facility Application for Medicare. Human Services and Medicaid Form CMS 671 12 02 incorporated by. C Cost reporting year shall mean the facility s twelve reference in this rule and available through the Centers for. 12 month fiscal reporting period covering the same Medicare and Medicaid website. twelve 12 month period that the facility uses for its http www cms hhs gov forms or by mail at Centers for. federal income tax reporting Medicare and Medicaid Services 7500 Security Boulevard. D Distinct part shall mean a portion of an institution or Baltimore MD 21244 1850. institutional complex that is certified to provide SNF or NF 2 Form DA 113 Bed Classification for Licensure and. services A distinct part must be physically distinguishable Certification by Category 8 05 incorporated by reference. from the larger institution and must consist of all beds in this rule and available through the department s website. within the designated area The distinct part may be a www dhss mo gov or by mail at Department of Health and. separate building floor wing ward hallway or several Senior Services Warehouse Attention General Services. rooms at one end of a hall or one side of a corridor Warehouse PO Box 570 Jefferson City MO 65102 0570. E Department shall mean the Missouri Department of telephone 573 526 3861. Health and Senior Services B For Medicare the application shall include. F ICF MR shall mean intermediate care facility for 1 Long Term Care Facility Application for Medicare. persons with mental retardation and Medicaid, G Medicaid shall mean Title XIX of the federal Social 2 Expression of Intermediary Preference Form 8 05.
Security Act incorporated by reference in this rule and available through. H Medicare shall mean Title XVIII of the federal the department s website www dhss mo gov or by mail at. Social Security Act Department of Health and Senior Services Warehouse. Attention General Services Warehouse PO Box 570,Jefferson City MO 65102 0570 telephone 573 526. 3 Form DA 113 Bed Classification for Licensure and. Certification by Category,Effective Date 4 30 06 81 010 1. Chapter 81 Certification 19 CSR 30 81, 4 Three 3 copies of Health Insurance Benefit 4 Any facility certified for participation as an NF in the. Agreement Form CMS 1561 07 01 incorporated by Title XIX Medicaid program electing to participate in the. reference in this rule and available through the Centers for Title XVIII Medicare program shall submit an application. Medicare and Medicaid website signed and dated by the operator or his or her authorized. http www cms hhs gov forms or by mail at Centers for representative to the department s SLTC central office. Medicare and Medicaid Services 7500 Security Boulevard licensure unit The department will recommend Medicare. Baltimore MD 21244 1850 certification to the CMS effective the date the application. 5 Three 3 copies of Assurance of Compliance Form material is received by the department or a subsequent date. HHS 690 5 97 incorporated by reference in this rule and if requested by the provider provided the facility was in. available through the Centers for Medicare and Medicaid compliance with all federal and state regulations for SNFs. website http www cms hhs gov forms or by mail at the at the last survey conducted by the department and. U S Department of Health and Human Services 200 provided the facility s application is complete and has been. Independence Avenue SW Washington DC 20201 approved by the Medicare fiscal intermediary. telephone 202 619 0257 Toll Free 1 877 696 6775, 6 The forms incorporated by reference in subsections 5 Any facility certified for participation in the Medicare. 2 A and B do not include any later amendments or program wishing to participate in the Medicaid program. additions shall submit a signed and dated application to the. C SNFs or NFs which are newly certified or which are department central office The department will certify the. undergoing a change of ownership shall submit an initial facility for Medicaid participation effective the date the. certification fee in the amount up to one thousand dollars application is received by the department or a subsequent. 1 000 as stipulated by the department in writing to the date requested by the provider provided the facility was in. operator following receipt of the properly completed compliance with all federal regulations at the last survey. application material referenced in section 2 The amount conducted by the department and the application is. for the initial certification fee shall be the prorated portion complete. of one thousand dollars 1 000 with prorating based on. the month of receipt of the application in relation to the 6 For newly certified facilities the facility will be. beginning of the next federal fiscal year This initial certified for either Medicare or Medicaid participation. certification fee shall be nonrefundable and a facility shall effective the date the facility receives a license at the proper. not be certified until the fee has been paid level or the date the facility achieves substantial. D All SNFs or NFs certified to participate in the compliance with the federal participation requirements. Medicaid or Medicare program s shall submit to the whichever is the later date The application shall be. department an annual certification fee of one thousand completed For certification in the Title XVIII Medicare. dollars 1 000 prior to October 1 of each year If the fee is program the Medicare fiscal intermediary must approve. not received by that date each year a late fee of fifty the application and the CMS must concur with the. dollars 50 per month shall be payable to the department department s recommendation. If payment of any fees due is not received by the, department by the time the facility license expires or by 7 The department shall conduct federal surveys in SNFs.
December 31 of that year whichever is earlier the NFs and ICF MR facilities utilizing regulations and. department shall notify the Division of Medical Services procedures contained in. and the CMS recommending termination of the Medicaid A The State Operations Manual SOM HCFA. or Medicare agreement as denial of license will occur as Publication 7. provided in 19 CSR 30 82 010 and section 198 022 RSMo B The Survey and Certification Regional letters. received by the department from the CMS, 3 Application material shall be signed and dated and C For SNFs and NFs federal regulation 42 CFR. submitted to the department s SLTC licensure unit at least chapter IV part 483 subpart B and. fourteen 14 working days prior to the date the facility is D For ICF MR facilities federal regulation 42 CFR. ready to be surveyed for compliance with federal chapter IV part 483 subpart I. regulations Initial Certification Survey The operator or. authorized representative shall notify the appropriate 8 A facility in its application shall designate the number. department regional office by letter or by phone as to the of beds to be certified and their location in the facility A. date the facility will be ready to be surveyed There shall be facility can be wholly or partially certified If partially. at least two 2 residents in the facility before a survey can certified the beds shall be in a distinct part of the facility. be conducted The facility shall already be licensed or with and all beds shall be contiguous. licensure in process shall be in compliance with all state. Effective Date 4 30 06 81 010 2,Chapter 81 Certification 19 CSR 30 81. 9 If a facility certified to participate in the Title XIX 12 If a facility certified to participate in the Medicaid. Medicaid or Title XVIII Medicare program elects to Title XIX program has been decertified as a result of. change the size of its distinct part it must submit a written noncompliance with the federal requirements the facility. request to the Licensure Certification Unit or the ICF MR can be readmitted to the Medicaid program by submitting. Unit of the department as applicable The request shall an application for initial participation in the Medicaid. specify the room numbers involved the number of beds in program After having received the application the. each room and the facility cost reporting year end date The department shall conduct a survey at the earliest possible. request must include a floor diagram of the facility and a date to determine if the facility is in substantial compliance. signed DA 113 form Bed Classification for Licensure and with all federal participation requirements The effective. Certification by Category A facility is allowed two 2 date of participation will be the date the facility is found to. changes in the size of its distinct part during the facility substantially comply with all federal requirements. cost reporting year This may be two 2 increases or one. 1 increase and one 1 decrease It may not be two 2 13 If a change in the administrator or the director of. decreases The first change can be done only at the nursing of a facility occurs the facility shall provide. beginning of the facility cost reporting year and the second written notice to the department s SLTC central office. change can be done effective at the beginning of a facility licensure unit within ten 10 calendar days of the change. cost reporting quarter within that facility cost reporting The notice shall show the effective date of the change the. year All requests must be submitted to the identity of the new director of nursing or administrator and. Licensure Certification Unit or the ICF MR Unit of the a copy of his or her license or the license number Change<. J Section for Long Term Care SLTC shall mean that section of the department responsible for licensing and regulating long term care facilities licensed under Chapter 198 RSMo K Skilled nursing facility SNF shall mean an SNF licensed under Chapter 198 RSMo which has a signed

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