OAR 411-070-0470: Nursing Assistant Training and Competency Evaluation Programs Request for Reimbursement

(1) The Omnibus Budget Reconciliation Act (OBRA) of 1987 and 1990 requires that any nursing assistant employed in a nursing facility completes a competency evaluation program. Medicaid reimburses a Medicaid certified nursing facility for the Medicaid share of the allowable cost directly related to meeting the nursing assistant training and competency evaluation requirement. (2) A facility must notify, in writing, the nursing assistants upon hire that the nursing assistant may receive reimbursement up to 12 months after completing a Nursing Assistant Training and Competency Evaluation Program (NATCEP) training program. Failure to notify or failure to reimburse an eligible nursing assistant, shall result in an assessment for imposition of sanctions. (3) The nursing facility must reimburse newly employed Certified Nursing Assistants who have personally paid for NATCEP costs. The facility is not required to reimburse the nursing assistant in cases where the expenses were paid by an employer or education training program or reimbursed by a previous employer. (4) REQUEST FOR REIMBURSEMENT. Medicaid certified nursing facilities must file a NATCEP request for reimbursement with the Department that meets the following standards: (a) As of January 1, 2013, all requests for reimbursement must be submitted electronically. A facility must submit a request for reimbursement within 12 months after completing a NATCEP training program or reimbursing a nursing assistant as described in section (3) of this rule. The request for reimbursement must identify all costs incurred and related revenues (not including NATCEP payments from the Department) received during the reporting period. (b) A request for reimbursement must: (A) Be submitted electronically on a system provided by the Department. (B) Include actual costs incurred and paid by the facility. The Department may not reimburse a facility prospectively. (C) Include all revenue (not including NATCEP payments from the Department) received by the facility for conducting the approved nursing assistant training. All revenue must be used to offset the costs incurred and paid in the reporting period. (D) The facility must maintain and have available for review the appropriate documentation, as described in section (8) of this rule, to support each specific area identified for payment by the Department. Failure to provide required documentation, when requested, shall result in an overpayment to the facility. The facility must repay any overpayment to the Department within 60 days of receipt of notification. (E) Include all appropriate NATCEP costs and revenues only. NATCEP costs, including costs disallowed, must not be reimbursed as part of the facility's bundled rate. However, NATCEP costs, revenues, and reimbursement must be included on the facility's annual Nursing Facility Financial Statement (NFFS). (F) Include only true and accurate information. If a facility knowingly, or with reason to know, files a request for reimbursement containing false information, such action must constitute cause for termination of the facility's provider agreement with the Department. Providers filing false requests for reimbursements may be referred for prosecution under applicable statutes. (5) CHARGING OF FEES PROHIBITED. The nursing facility must not charge a trainee any fee for participation in NATCEP or for any textbooks or other materials required for NATCEP if the trainee is employed by or has an offer of employment from a nursing facility on the date on which the NATCEP begins. (6) FEES PAID BY EMPLOYER. (a) All charges and materials required for NATCEP and fees for nursing assistant certification must be paid by the nursing facility if it offered employment at the facility on the date training began. (b) If a nursing assistant who is not employed by a Medicaid certified facility or does not have an offer of employment by a Medicaid nursing facility on the date on which the NATCEP began becomes employed by, or receives an offer for employment from a nursing facility within 12 months after completing a NATCEP, the employing facility must reimburse the nursing assistant within the first three months of employment. Reimbursement must include any NATCEP fees for tuition, enrollment and textbook costs, testing fees, or other required course materials up to the amount determined by the Department that was paid by the nursing assistant. Evidence the nursing assistant paid for training must include receipt of payment and the graduation certificate from the school. (c) Such reimbursement must be calculated on a pro rata basis. The reimbursement must be determined by dividing the cost paid by the nursing assistant by 12 and multiplying by the number of months during this 12-month period that the nursing assistant worked for the facility. The facility must claim the appropriate pro rata amount on each request for reimbursement it submits not to exceed the lesser of 12 months or the total number of months the nursing assistant was employed at that facility. The facility must maintain evidence provided by the nursing assistant of the training costs incurred at an approved training facility. (d) A facility shall reimburse a nursing assistant before submitting a request for reimbursement from the Department. (7) FACILITY REIMBURSEMENT BY THE DEPARTMENT. The Department shall reimburse the facility for the Medicaid portion of the costs described in this section unless limited by the application of section (4) of this rule. This portion is calculated by multiplying the eligible costs paid by the facility by the percentage of resident days that are attributable to Medicaid residents during the reporting period. The Department’s payment to the facility for the NATCEP cost is in addition to payments based upon the facility's bundled rate. (a) EMPLOYEE COMPENSATION. Reimbursement for trainer hours must not exceed one and a one-third times the number of hours required for certification. A facility may claim reimbursement for the portion of an employee's compensation attributable to nursing assistant training if: (A) The employee meets the qualifications of 42 CFR 483.152 and OAR chapter 851, division 061; (B) The employee directly conducts training or testing in an approved program; (C) The employee's compensation, including benefits, is commensurate with other licensed nurse compensation paid by the facility; (D) The employee's total compensated hours do not exceed 40 in any week during which NATCEP reimbursement is claimed; (E) No portion of the claimed reimbursement is for providing direct care services while assisting in the training of nursing assistants if providing direct care services is within the normal duties of the employee; and (F) The facility provides the Department with satisfactory documentation to support the methodology for allocating costs between facility operation and NATCEP. (b) TRAINING SPACE AND UTILITIES. Costs associated with space and utilities are eligible only if the space and utilities are devoted 100 percent to the NATCEP. The facility must provide documentation satisfactory to the Department to support the need for, and use of, the space and utilities. (c) TEXTBOOKS AND COURSE MATERIALS. A portion of the cost of textbooks and materials is eligible if textbooks and materials are used primarily for NATCEP. The portion reimbursable is equal to the percentage of use attributable to NATCEP. "Primarily" means more than 50 percent. The facility must provide satisfactory documentation supporting the NATCEP need for and percentage of use of textbooks and materials. (d) EQUIPMENT. A portion of the cost of equipment is eligible if used primarily for NATCEP. However, equipment purchased for $500 or more per item, must be prior approved by the Department to qualify for reimbursement. The portion reimbursable is equal to the percentage of use attributable to NATCEP. "Primarily" means more than 50 percent. The facility must maintain satisfactory documentation supporting the NATCEP need for and percentage of use of the equipment. Disposition of equipment and software purchased in whole or in part under the Title XIX Medicaid Program must meet the requirements of the facility's provider agreement. (e) CERTIFICATION FEES. Nursing assistant certification and recertification fees paid to the Oregon State Board of Nursing for facility employees are eligible. (f) REIMBURSEMENT FOR NURSING ASSISTANTS. Reimbursement provided to nursing assistants pursuant to section (6) of this rule are eligible. The training must have occurred at an approved training center, including nursing facilities in Oregon or other states. If a facility chooses to reimburse the nursing assistant’s full amount in one request, the facility may not recoup payment from a nursing assistant if the nursing assistant’s employment ends, regardless of cause. (g) CONTRACT TRAINERS. Payment for nursing assistant training classes provided under contract by persons who meet the qualifications of 42 CFR 483.152 are eligible for reimbursement. For this purpose, either the facility or the contractor must be approved for NATCEP. Allowable contract trainer payments shall be limited to the lesser of actual cost or the salary calculation described in section (7)(a) of this rule. (h) INELIGIBLE COSTS — TRAINEE WAGES. Wages paid to nursing assistants in training are not eligible for NATCEP reimbursement, but may be claimed as part of the daily reimbursement costs. (i) REIMBURSEMENT FOR COMBINED CLASSES. If two or more Medicaid certified facilities cooperate to conduct nursing assistant training, the Department shall not reimburse any participating facility for the combined training class until all participating facilities have filed a request for reimbursement. For a combined class, the Department shall apportion reimbursement to participating facilities pro rata based on the number of students enrolled at the completion of the first 30 hours of classroom training or in any other equitable manner agreed to by the participating facilities. However, when cooperating facilities file separate NATCEP requests for reimbursements, nothing in this section authorizes the Department to deny or limit reimbursement to a facility based on a failure to file or a delay in filing by a cooperating facility. (8) RECORDKEEPING, AUDIT, SANCTIONS, REPORTING, AND APPEAL. (a) The facility must maintain supportive documentation for a period of not less than three years following the date of submission of the NATCEP request for reimbursement. This documentation must include records in sufficient detail to substantiate the request for reimbursement. If there are unresolved audit questions at the end of the three-year period, the records must be maintained until the questions are resolved. The records must be maintained in a condition that can be audited. (b) Each facility must submit a quarterly NATCEP report to the Department using the Department’s approved method and format. The report must provide an accurate monthly account of nursing assistant new hires, which includes date of hire, date of completion of an approved Nursing Assistant Level 1 training program, and the date of reimbursement. (A) The facility must submit the report to the Department no later than the end of the month immediately following the end of each calendar quarter. (Example: For the calendar quarter ending March 31, the report must be received no later than April 30.) (B) Upon the Department’s request, the facility must provide documentation to support the quarterly report including payroll records. (c) All requests for reimbursements are subject to audit at the discretion of the Department. The facility shall be notified in writing of the amount to be reimbursed and of any adjustments to the request for reimbursement. Payment of any amounts due to the Department must be made within 60 days of the date of notification to the facility. (d) Sanctions and remedies may be provided pursuant to OAR chapter 411, division 89. One or more remedies may be imposed by the Department when a facility fails to comply with state regulations. The remedy(s) issued by the Department may be based upon findings of noncompliance with one or more requirements of participation. (e) A facility is entitled to an informal conference and contested case hearing pursuant to ORS 183.413 through 183.470, as described in OAR 411-070-0435, to protest the reimbursement amount or the adjustment. If no written request for an informal conference or contested case hearing is made within 30 days, the decision becomes final. [Publications: Publications referenced are available from the agency.]