Section 1200-13-02-.12 - ENHANCED RESPIRATORY CARE SERVICES ADD-ON PAYMENT(1) ERC Reimbursement in a dual certified and licensed SNF/NF shall be made only by TennCare MCOs in compliance with this Chapter and rates established by TennCare.(2) Each level of ERC Reimbursement shall be an add-on payment to the NF's established per diem rate. The amount of the NF's add-on payment for each of the specified levels of reimbursement shall be based on the facility's performance on quality outcome and technology measures pursuant to a methodology established by TennCare and set forth in an ERC Operations Manual which shall be provided to NFs and posted on the TennCare website. Quality outcome and technology measures, performance benchmarks, and the methodology to apply such measures and performance benchmarks to each of the specified levels of ERC Reimbursement shall be adjusted no more frequently than annually in order to continuously improve the quality of care and quality of life outcomes experienced by individuals receiving ERC in a NF.(3) ERC Reimbursement shall be provided only for services authorized and delivered in a facility operating in compliance with conditions of reimbursement for ERC specified in this chapter, and in a bed specifically licensed for such purpose, as applicable. A NF shall not be eligible for ERC Reimbursement if it does not meet the conditions for reimbursement, or for any ERC services provided in excess of the facility's licensed capacity to provide such services, regardless of payer source. Because Sub-Acute Tracheal Suctioning Reimbursement provides for intensive respiratory intervention during the period immediately following a person's liberation from the ventilator, Sub-Acute Tracheal Suctioning Reimbursement shall be provided only in a bed specifically licensed for ventilator care.Tenn. Comp. R. & Regs. 1200-13-02-.12
Original rules filed May 1, 2018; effective 7/30/2018.Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, and 71-5-1413.