Florida Medicaid. Nursing Facility Services Coverage and Limitations Handbook. Agency for Health Care Administration

Transcription

1 Florida Medicaid Nursing Facility Services Coverage and Limitations Handbook Agency for Health Care Administration

2 Nursing Facility Screening and Reimbursement Requirements Federal Requirements for CNA Reimbursement for Training and Testing Federal regulations require that certified nursing assistants (CNAs) be reimbursed for the training and testing required for certification. Nursing facilities must reimburse individuals for training and testing costs incurred by any nursing assistant who is hired or receives an offer of employment within 12 months of completing the state-approved nurse aide training and competency evaluation program. Reimbursement must be made in full and is not to be made in installments. Reimbursement may be withheld until the nursing assistant completes the facility s probationary period consistent with the facility s personnel policies and procedures. The nursing facility cannot refuse to reimburse this cost if the facility is enrolled as a Medicaid provider. Reimbursable costs include: (1) tuition, required textbooks, and other required course materials; and (2) the competency evaluation, including the written or oral examination and the skills demonstration. The cost of tuition is the amount charged by an approved training site. Reimbursable costs do not include personal items. Examples of personal items are uniforms, shoes, notepads, pencils, dictionaries and insurance. In order to be reimbursed for training, the CNA must present documentation of the reimbursable costs associated with the training. Acceptable documentation includes dated receipts from the training site, cancelled checks, or letter from the training site stipulating dates of attendance and successful completion of coursework with documentation of payment by the individual. CNAs are eligible for reimbursement only if the costs were personally incurred. If training was provided through a scholarship or a jobtraining program, the employee is not eligible for reimbursement. Medicaid Reimbursement for CNA Training and Testing Medicaid reimburses nursing facilities a percentage of the total costs of CNA training and testing based on the percentage of Medicaid occupancy for the month prior to billing. The nursing facility s costs for training and competency evaluation of nurse aides must be allocated among Medicaid, Medicare, and private pay residents. Medicaid will reimburse the nursing facility only for the properly allocated Medicaid portion of these costs. Costs are to be allocated based on the percentage of Medicaid occupancy determined by the daily census log for the month preceding the date of billing; i.e., if billing in January, the facility would use the December census log and divide Medicaid days by the total days. Nursing facilities cannot include costs incurred for nurse aide certification in their cost reports. Medicaid does not reimburse costs incurred for certification after three unsuccessful attempts at passing the examinations. To obtain Medicaid reimbursement, nursing facilities must submit the completed Nurse Aide Training and Competency Evaluation Program Invoice form to their area Medicaid office along with appropriate documentation that the course work was completed satisfactorily and resulted in certification. 1-8 October 2003

3 Nursing-Facility Screening and Reimbursement Requirements, continued Medicaid Reimbursement for CNA Training and Testing, continued Note: See Appendix A for a copy of the Nurse Aide Training and Competency Evaluation Program Invoice, AHCA Form , and instructions to obtain reimbursement for CNA training and testing costs. This form may also be obtained from the area Medicaid offices. See Appendix C in the Florida Medicaid Provider General Handbook for a listing of the area offices telephone numbers and addresses. Staff Screening Section , F.S., requires background screenings be conducted for certain nursing facility employees. The law requires screening of nursing facility employees or prospective employees who are expected to fulfill the following responsibilities: Those who provide personal care or services to residents; Have access to resident living areas; or Those who have access to resident funds or other personal property. Facilities must have in their possession evidence that screening has been completed before allowing an employee to begin working with patients. The Background Screening Unit of AHCA s Bureau of Health Facility Regulation coordinates background checks. For additional information, call (850) July

4 APPENDIX A CERTIFIED NURSING ASSISTANT REIMBURSEMENT INSTRUCTIONS October 2003 A-1

5 NURSE AIDE TRAINING AND COMPETENCY EVALUATION PROGRAM INVOICE FOR THE MONTH OF 1. Provider No. 2. Invoice No. 3. Facility Name 4. FEID No. 5. Mailing Address TUITION 6. Name of Examinee(s) Social Last First MI Security No. 7. Date Total amount Tuition 8. $ WRITTEN EXAMINATION 9. Name of Examinee(s) Social Last First MI Security No. 10. Date Total Amount Written Exam ($ x no. of persons) 11. $ SKILLS DEMONSTRATION 12. Name of Examinee(s) Social Last First MI Security No. 13. Date Total Amount Skills Demo ($ x no. of persons) 14. $ Total Amount (tuition + written exam. + skills demo) 15. $ Total Payment Requested ($ total amount x Medicaid Percentage) 16. $ 17. This is to certify that the above information is true, accurate and complete. Facility Representative s Signature/Title/Telephone No.: 18. Date Signed DO NOT WRITE BELOW THIS LINE 19. Date Invoice Received 20. Date of Approval 21. Total Amt. Approved for Payment $ 22. Org. Code 23. EO 24 Signature of Individual Approving Payment 25. Date Signed AHCA Form , August 2000

6 NURSE AIDE TRAINING AND COMPETENCY EVALUATION PROGRAM INVOICE This form is to be completed by Medicare and Medicaid participating nursing facilities that employ nurse aides. Federal Medicaid regulations require that certified nurse aides (CNAs) employed by nursing facilities be reimbursed for costs associated with training and testing within one year of certification. Medicaid reimburses the Medicaid share of costs based on the facility s percentage of Medicaid occupancy for the month preceding the date of billing. This form is to be submitted to the Area Medicaid Office for reimbursement of costs associated with nurse aide certification. A. INSTRUCTIONS FOR COMPLETION OF THE TOP PORTION OF THE INVOIC E 1. Provider No.: Enter the facility s Medicaid provider number 2. Invoice No.: Enter a unique number assigned by the facility to identify each invoice 3. Facility Name : Enter the complete name of the facility 4. FEID No.: Enter the facility s federal employer identification number 5. Address: Enter the complete mailing address of the facility 6. Tuition: Enter the name and social security number of each nurse aide 7. Date: Enter the date that each nurse aide took the course 8. Total Tuition: Enter the total amount of training costs (textbooks, fees, and other course materials) 9. Written Exam: Enter the name and social security number of each nurse aide 10. Date: Enter the date that each nurse aide completed the written examination 11. Total Amount Exam: Enter $35 per student (allowed by Medicaid) for cost of the written examination 12. Skill Demonstration: Enter the name and social security number of each nurse aide 13. Date: Enter the date that each nurse aide completed the skills demonstration 14. Total Amount Skills: Enter the amount requested for the skills demonstration 15. Total Amount: Enter the sum of the amounts for tuition, written exam, and skills demonstration 16. Total Payment: Multiply the total amount from line # 15 by the Medicaid percentage derived from Medicaid days divided by total days for the month preceding the date of billing 17. Rep s Signature: Enter the name, title and telephone number of the facility representative Responsible for completing the invoice 18. Date: Enter the date the invoice was signed by the facility representative B. INSTRUCTIONS FOR COMPLETION OF THE BOTTOM PORTION OF THE INVOIC E Area Medicaid Off ice staff is responsible for completing this portion of the invoice. C. REQUIRED DOCUMENTATION Please attach a copy of the cancelled check or paid receipt from a college or other teaching institution to ensure payment. Please Contact the Area Medicaid Office with any Questions AHCA Form , August 2000