Section 1200-13-02-.15 - PENALTIES, ADJUSTMENTS, AND WITHHOLDING(1) NF providers may be subject to penalties, cost report adjustments, and payment withholdings for: (a) Disclaimed Cost Reports.(b) Cost Report Delinquent Filing.(c) Cost Report Non-Filer.(d) Final (Terminating) Cost Report.(2) Disclaimed Cost Reports. A provider who has a disclaimed cost report will have its Medicare and Medicaid supplemental cost reports adjusted for use in the provider's specific reimbursement rate. These cost report adjustments may include, but are not limited to the following: (a) Adjusting costs without sufficient documentation to zero.(b) Adjusting total resident days to one hundred percent (100%) occupancy, and reconciling Medicaid's portion of those days to paid claims records.(c) The direct care spending floor adjustment, as defined in Rule .06, will be calculated utilizing the adjusted cost report.(3) Cost Report Delinquent Filing. (a) A cost report will be considered delinquent if an acceptable cost reporting package has not been filed within the timelines specified in Rule .05. The NF provider will be subject to a penalty of ten dollars ($10) per day for each day the NF is not in compliance.(b) Should the NF provider file a cost report that is received timely and initially accepted by the Comptroller, but upon further review by the Comptroller is determined to not be an acceptable cost report, the following will occur: 1. The Comptroller will provide written notice to the NF provider that an acceptable cost report has not been filed.2. The NF provider will have thirty (30) days from receipt of the written notice to correct any issues noted and file an acceptable cost report.3. If the NF provider does not file a corrected acceptable cost report within thirty (30) days of notice, it will be subjected to the penalty outlined in this paragraph from the date of the received written notice.(4) Cost Report Non-Filer. (a) A NF provider will be considered a cost report non-filer if its cost report is delinquent as of February 1 prior to the July 1 rate rebase in which it would have been used regardless if rebase actually occurs. A NF provider that is considered a cost report non-filer will have its reimbursement rates adjusted to be set equal to the lowest rate of any other active NF provider. The rate adjustments will commence with the July 1 rate setting following the NF provider obtaining a cost report non-filer status, and remain in effect for a minimum of one (1) year. The non-filer reimbursement rate will be determined using NF provider reimbursement rates prior to phase-in considerations. Reimbursement rate phase-in provisions established in Rule .06 are not applicable to the non-filer reimbursement rates.(b) TennCare maintains the right to grant a waiver from the application of a portion or all of the rate and direct care spending floor adjustments should certain extenuating circumstances exist with the NF provider. TennCare must be contacted by the NF provider prior to the initial cost report filing deadline, for a waiver to be considered by TennCare.(5) Final (Terminating) Cost Report. A NF provider is required to submit a final cost report as defined in Rule .05, and will be subject to a withholding of up to ten percent (10%) of the previous owner's final Medicaid recipient payments until an acceptable terminating cost report is received by the Comptroller. After receipt of the acceptable cost report, whether timely or non-timely, the withholding amount will be released to the facility (less any incurred penalties for non-timely filing).Tenn. Comp. R. & Regs. 1200-13-02-.15
Original rules filed May 1, 2018; effective 7/30/2018.Authority: T.C.A. §§ 4-5-202, 71-5-105, 71-5-109, 71-5-130, and 71-5-1413.