Rules and Regulations of the State of Georgia
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Rule 350-7-.01 Definitions

(1) "Medically indigent" means a person who meets the state-wide standards of indigency adopted by the Department which is a person with an income no greater than 200 percent of the federal poverty level guidelines as published by the United States Department Health and Human Services.
(2) "Nursing home" means a freestanding facility or distinct part or unit of a hospital required to be licensed or permitted as a nursing home under the provisions of O.C.G.A. Title 31, Chapter 8, Article 5, which is not owned or operated by the state or federal government.
(3) "Nursing Home that disproportionately serves the medically indigent" means a nursing home for which the patient days attributable to medically indigent residents account for more than 15 percent of the nursing home's total patient days during a 12-month period. For purposes of this computation, Medicare program patient days shall not be included in the nursing home's total patient days.
(4) "Patient day" means a day of care provided to an individual resident of a nursing home by the nursing home. A patient day includes the date of admission but does not include the date of discharge, unless the dates of admission and discharge occur on the same day.
(5) "Provider fee" means the fee imposed pursuant to these rules for the privilege of operating a nursing home.
(6) "Segregated account" means an account for the dedication and deposit of provider fees which is established within the Indigent Care Trust Fund.
(7) "State plan" means all documentation submitted by the Commissioner of the Department of Community Health to the United States Department of Health and Human Services, Center for Medicare and Medicaid Services, pursuant to Title XIX of the federal Social Security Act.
(8) "Trust fund" means the Indigent Care Trust Fund created pursuant to O.C.G.A. Title 31, Chapter 8, Article 6.
(9) "Waiver" means a waiver of the uniform tax requirement for permissible health care related taxes, as provided for in 42 C.F.R. § 433.68(e)(2)(i)(ii).

Rule 350-7-.02 Payments to the Segregated Account

(1) There is established within the Indigent Care Trust Fund a segregated account for revenues raised through imposition of the provider fee. All revenues raised through the nursing home provider fees shall be credited to the segregated account. All said revenues raised shall be dedicated and used for the sole purpose of obtaining federal financial participation for medical assistance payments to nursing homes that disproportionately serve the medically indigent. Payments to the segregated nursing home provider fee account shall be made by any nursing home required to do so pursuant to O.C.G.A. Section 31-8-164. Such payments to the segregated account shall be irrevocable and shall not include any limitation upon use of such contributions except as permitted in this article or by the Department. Payments shall only be used for the purposes contained in O.C.G.A. Section 31-8-165. Contributions and transfers to the Indigent Care Trust Fund pursuant to O.C.G.A. Section 31-8-153 and 31-8-153.1 shall not be deposited into the segregated account.
(2) Each nursing home shall be assessed a provider fee with respect to each patient day for the preceding quarter, excluding Medicare program patient days. The provider fee shall be assessed uniformly upon all nursing homes except with respect to the waiver to be applied for pursuant to O.C.G.A. Section 31-8-168. The aggregate provider fees imposed shall not exceed the maximum amount that may be assessed pursuant to the 6 percent indirect guarantee threshold set forth in 42 C.F.R. Section 433.68(f)(3)(i). Such provider fee payments may be deposited to the segregated account by means of electronic funds transfer, when pre-authorized by the Department.
(3) The provider fee shall be paid quarterly by each nursing home to the Department. A nursing home shall calculate and report the provider fee due upon a form prepared and distributed by the Department. The payments shall be submitted no later than the thirtieth day following the end of each calendar quarter. The initial provider fee report shall be filed and the initial provider fee payment shall be submitted no later than July 30, 2003. The initial provider fee payment for July 30, 2003 shall be calculated using the patient day information for the calendar quarter ending June 30, 2003.
(4) Each nursing home shall keep and preserve for a period of three years such books and records as may be necessary to determine the amount for which it is liable for a provider fee pursuant to these rules. The Department shall have the authority to inspect and copy the records of a nursing home for purposes of auditing the calculation of the provider fee. All information obtained by the Department for this purpose shall be confidential and shall not constitute a public record.
(5) In the event the Department determines that a nursing home has underpaid or overpaid the provider fee, the Department shall notify the nursing home of the balance of the provider fee or refund that is due. Such payment or refund shall be due within 30 days of the Department's notice to the nursing home.
(6) Any nursing home that fails to pay the provider fee pursuant to these rules within the time periods specified by these rules shall pay, in addition to the outstanding provider fee, a 6 percent penalty for each month or fraction thereof that the payment is overdue. If a provider fee has not been received by the Department by the last day of the month, the Department shall withhold an amount equal to the provider fee and penalty owed from any Medicaid payment due the nursing home in question. The provider fee levied by this article shall constitute a debt due the state and may be collected by civil action and the filing of tax liens in addition to such methods provided for by these rules. Any penalty that accrues as a result of late payments shall be credited to the segregated account.

Rule 350-7-.03 Use of Provider Fees

(1) The General Assembly is authorized to appropriate as state funds to the Department for use in any fiscal year all revenues dedicated and credited to the segregated account. These appropriations shall be made for the sole purpose of obtaining federal financial participation in the provision of support to nursing homes that disproportionately serve the medically indigent. Any appropriation from the segregated account for any purpose other than Medicaid payments to nursing homes shall be null and void.
(2) Revenues appropriated to the Department pursuant to these rules shall be used to match federal funds that are available for the purpose for which such trust funds have been appropriated.
(3) Appropriations from the segregated account to the Department shall not lapse to the general fund at the end of the fiscal year.
(4) The Department shall annually report to the General Assembly on the use of revenues credited to the segregated account and appropriated to the Department for the purposes outlined in these rules. Such report shall be submitted to the Lieutenant Governor, Speaker, legislative counsel and legislative budget officer no later than January 31 of each calendar year. Such reports shall be made available to the public as a public record.

Rule 350-7-.04 Open Records

All Department records related to the Indigent Care Trust Fund segregated account, except as provided for in Rule 350-7-.02(4) shall be open for public inspection in accordance with the Open Records Act, O.C.G.A. § 50-18-70et seq.

Rule 350-7-.05 Applicability of Medical Assistance Generally

Except where inconsistent with O.C.G.A., Title 31, Chapter 8, Article 6A, the provisions of O.C.G.A., Title 49, Chapter 4, Article 7 (Georgia Medical Assistance Act of 1977) shall apply to the Department in carrying out the purposes of the nursing home provider fee.