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016.06.8-1-11. Penalties for Failure to Comply with the Medicaid Long Term Care Program.

AR ADC 016.06.8-1-11Arkansas Administrative Code

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 06. Division of Medical Services
Rule 8. Medical Assistance Program Manual of Cost Reimbursement Rules for Long Term Care Facilities
Chapter 1. Principles and Procedures
Ark. Admin. Code 016.06.8-1-11
016.06.8-1-11. Penalties for Failure to Comply with the Medicaid Long Term Care Program.
Currentness
A. By agreeing to participate in the Long Term Care program, providers must abide by these regulations. Participation in the program may be terminated should the provider:
1. Fail to keep and maintain auditable records.
2. Fail to disclose or make available to the Department, or its authorized agent, records concerning the operation of the facility, including home office records, if applicable.
3. Breach the terms of the Medicaid Provider Agreement or failure to comply with the terms of the provider's certifications set out on the Medicaid claim form.
4. Charge or attempt to charge Medicaid recipients for Medicaid covered services over and above that paid by the Department.
5. Rebate or accept a fee or portion of a fee or charge for a Medicaid resident referral.
6. Present, or cause to be presented, false information.
7. Submit, or cause to be submitted, false information for the purpose of obtaining greater compensation to which the provider is legally entitled.
In addition to the above listing of causes for termination, State or Federal laws or rules may create requirements, the violation of which may cause adverse action.
B. Arkansas Code 20-10-205 classifies violations relating to the administration of Long Term Care Facilities. Administrative and reporting requirements are classified as Class C and Class D Violations. A description of each follows:
Class C Violations: Providers who fail to comply with administrative and reporting requirements that do not directly threaten the health, safety, or welfare of a resident have committed a Class C Violation. Violations of this nature would include but are not limited to:
1. Failure to provide resident assessment instruments in accordance with the prescribed submission policy. The resident assessment instrument must be complete to be considered submitted.
2. Failure to maintain accurate census records in accordance with this Manual.
3. Failure to maintain accurate resident trust fund records in accordance with this Manual.
4. Submission on the facility's Cost Report as allowable, costs determined by the DHS audit staff to have been claimed under circumstances identical in all material respects to costs that have been disallowed by final desk review or audit. A desk review or audit is final if no timely appeal has been filed, or, if a timely appeal has been filed, there is a final appeal decision disallowing the cost. An appeal decision is final if no additional appeal is provided for by law, or if the time to file an additional appeal has expired. Any facility submitting as allowable costs, costs previously disallowed by a desk review or audit decision that is not final must identify each such cost and reference the pending appeal.
Class C Violations are subject to a civil money penalty to be set by the DHS Director or his designee, in an amount not to exceed five hundred dollars ($500.00) for a single violation. A single erroneous administrative or reporting practice will be considered a single violation regardless of the number of resident records affected by the practice.
Class D Violation: Failure to timely submit the Cost Report for Long Term Care Facilities. Cost Reports must be postmarked on or before the due date or the extended due date in order to avoid a penalty. The failure to timely submit a cost report shall be considered a separate Class D Violation during any month or part thereof of non-compliance.
Class D Violations are subject to a civil money penalty to be set by the Director, DHS, or his designee, in an amount not to exceed two hundred fifty dollars ($250.00) for each violation.
In addition to any civil money penalty which may be imposed, the Director of the OLTC is authorized after the first month of a Class D Violation to withhold any further reimbursement to the Long Term Care Facility until the Cost Report is received by the Office of Long Term Care.
Any violation repeated within six months subjects the facility to double civil money penalties up to a maximum of one thousand dollars ($1,000.00) per violation.
Assessment of civil money penalties does not limit the right of the OLTC to take such other action as may be authorized by law or regulation.
Providers violating this section may be referred to the Attorney General's office.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.8-1-11, AR ADC 016.06.8-1-11
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