Michigan State Plan - MDHHS

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Jan 28, 2014 - (All references in this plan to "the Medicaid agencyu mean the agency named in this paragraph.) ATTACHMEN
Michigan Department of Health and Human Services

Medicaid State Plan

The Michigan Medicaid State Plan is an agreement between the State of Michigan and the federal government which identifies the general health care services, reimbursement of those services and the beneficiary and provider eligibility policies in effect under Michigan’s Medicaid program. The Centers for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services is the federal agency with oversight responsibility of the Medicaid Program. All parts, including updates or changes to the Plan, must be approved by CMS in order to become effective. Federal regulations detailing the State Plan purpose and maintenance procedures may be found at 42 CFR 430 Subpart B. The State Plan posted here is available for information purposes only; it does not replace the official version and does not contain any pending amendment information or amendments approved since October 1, 2017. Amendments pending approval or approved since October 1, 2017 may be found at: www.michigan.gov/mdhhs >> Inside MDHHS >> Budget and Finance >> Medicaid Waiver & State Plan Amend. Notification

http://www.michigan.gov/mdhhs/0,1607,7-132-2946_5080-108153--,00.html Questions regarding the State Plan may be e-mailed to: [email protected]

The following table identifies the sections of the State Plan and a brief overview of each.

1

Single State Agency Organization

provides information regarding the State’s designation of the Michigan Medicaid Single State Agency, the authority under which it operates and a description of the organization.

2

Coverage & Eligibility

outlines Michigan Medicaid’s eligibility conditions such as income, resources, assets and the various groups (i.e. aged, blind, disabled and family independence program)

3

Amount, Duration and Scope of Services Provided

Attachment 3.1-A lists the services covered under the Michigan Medicaid program and the Supplements to Attachment 3.1-A provide a more detailed description of those services, including any limitations or requirements to/for that coverage

4

General Program Administration

Medicaid reimbursement methodologies takes up the bulk of Section 4; specifically Attachment 4.19. Attachment 4.19-A provides a full description of inpatient hospital reimbursement, Attachment 4.19-B explains reimbursement to all providers except inpatient hospital and long term care facilities. Attachment 4.19-D covers Medicaid payment for long term care facilities.

10/1/2017 - Transmittal 111

Page 1 of 2

Michigan Department of Health and Human Services

Medicaid State Plan 5

Personnel Administration

provides assurances the State is in compliance with Federal Regulations regarding personnel administration standards and training.

6

Financial Administration

provides assurances the State is in compliance with Federal Regulations regarding fiscal policies and accountability, cost allocation and financial participation.

7

General Provisions

covers additional federal requirements such as State Plan amendments, nondiscrimination and the Governor’s review.

10/1/2017 - Transmittal 111

Page 1 of 2

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM

HCFA-AT-80-38 (BPP) May 22, 1980

October 1, 2017 Version. This plan is provided

for informational use only and does not replace the original version.

Revision:

HCFA-PH-87-4 UARCH 1987

(BERC)

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT Medical Assistance Program State/Territory:

MICHIGAN TABLE OF CONTENTS

SECTION

PAGE NUMBERS

....... ............ SECTION 1 - SINGLE STATE AGENCY ORGANIZATION . . . ..... .. 1.1 Designation and Authority . . . . . . . . . . . . . . . . . . 1.2 Organization for Administration . . . . . . . . . . . . . . . 1.3 Statewide Operation . . . . . . . . . . . . . . . . . . . . . 1.4 State Medical Care Advisory Committee . . . . . .. . . . . . . State Plan Submittal Statement

-

TNNo.87-11 Supersedes TN No. N / A

October 1, 2017 Version. This plan is provided

Approval Date

08/76/87

1 2

2 7 8 9

Effective Date 07/01/87

for informational use only and does not replace the original version.

HCFA ID:

1002P/0010P

Revision:

HCFA-PU-87-4

XARCH 1987

(BERC)

PAGE NUHBERS

SECTION SECTION 2

-

COVERAGE AND ELIGIBILITY

. . . . . . . . . . . . . . . . 10

. . . . . . . . . . . . . . . . . . . 10 Conditions of Eligibility .,. . . . . . . . . . 12

2.1 Application, Determination of Eligibility and Furnishing Uedicaid 2.2 Coverage and

. . . . . . . . . .: . . . . . . . . . 16 Furnished Out of State . . . . . . . . . . . . . . . 18

2.6 Financial Eligibility

2.7 Uedicaid

-

TN NO. 87-11 Supersedes TNNo. N/A

October 1, 2017 Version. This plan is provided

Approval Date

08/26/87

Effective Date

for informational use only and does not replace the original version.

HCFA ID:

07/01/87 1002P/0010P

Revision:

HCFA-PH-87-4 MARCH 1987

.-

(BERC)

SECTION SECTION 3

-

SERVICES:

GENERAL PROVISIONS

....

PAGE NUKBBRS

. . . . . . . . . 19

. . . . . . . . . . . 19 Medicaid with Hedicare Part B . . . . . . . 29

3.1 Amount, Duration, and Scope of Services

3.2 Coordination OF

,

...

3.3 Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases

. . . . . . . . . . 30

. . . . . .. . . . . . . . . . . . . 31

3.4 Special Requirements Applicable to

Sterilization Procedures

. . . . . . . . . . . . . . 31a

3.5 Medicaid for Medicare Cost Sharing for Qualified Hedicare Beneficiaries

. . . . . . . . . . . . 31b

3.6 Ambulatory Prenatal Care for Pregnant Women

during Presumptive Eligibility Period

iii

A.

TN No. 87-11 Supersedes TN No. N / A

October 1, 2017 Version. This plan is provided

Approval Date

08/26/87

Effective Date

for informational use only and does not replace the original version.

HCFA ID:

07/01/87 1002P/0010P

Revision:

HCFA-PM-87-4 MARCH 1987

(BERC)

SECTION

PAGB m B R S

. . . . . . . . . . . . . 32 . . . . . . . . . . . . . . . . . . 32

SECTION 4 .GENERAL PROGRAM ADHINISTRATION 4.1 Methods of Administration

4.2 Hearings for Applicants and Recipients

...........

33

. . . . . . . . . . . . . . . . . . . . . . . . 34 Quality Control . . . . . . . . . . . . . . . . . . 35

4.3 Safeguarding Information on Applicants and Recipients 4.4 Medicaid

. . . . . . . . . . . . . . . . . . . . 36 Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Maintenanceof Records . . . . . . . . . . . . . . . . . . . 38 Availability of Agency Program Manuals . . . . . . . . . . . 39

4.5 Medicaid Agency Fraud Detection and Investigation Program 4.6 4.7 4.8

. . . . . . . . . . . . . . . . . . 40 . . . . . . . . . . . . . . . . . . 41

4.9 Reporting Provider Payments to the Internal Revenue Service 4.10 Free Choice of providers

. . . . . . . . . . . . . . . . . . . . . 42 Consultation to Medical Facilities . . . . . . . . . . . . . 44 Required Provider Agreement . . . . . . . . . . . . . . . . . 45 Utilization Control . . . . . . . . . . . . . . . . . . . . . 46

4.11 Relations with Standard-Setting and Survey Agencies 4.12 4.13 4.14

4.15 Inspections of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Diseases

. . . . . . . . . . . . . . 51

. . . . . . . . 52 . . . . . . . . . . . . . . . . . . . . 53

4.16 Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees 4.17 Liens and Recoveries

. . . . . . . . . . . . . . 54 . . . . . . . . . . . . . . . . . . . . 57

4.18 Cost Sharing andmSimilar Charges

4.19 Payment for Services

. TN NO .

87-11

Supersedes TN NO . N / A

October 1, 2017 Version. This plan is provided

Approval Date

08/76/87

for informational use only and does not replace the original version.

Effective Date 07/01/87 HCFA ID:

1002P/0010P

Revision:

HCFA-PH-90-2

(BPD)

OMB NO. 0938-0193

JANUARY 1990 PAGE NUHBERS

... . .

. . . . . . 67

4.20 Direct Payments to Certain Recipients for Physicians' or Dentists' Services

. . . . . . . . . . . . . . . . . . . . . . . 68 Liability . . . . . . . . . . . . . . . . . . . . 69

4.21 Prohibition Against Reassignment of Provider Claims 4.22 Third Party

. . . . . . . . . . . 72

4.24 Standards for Payments for Skilled Nursing and Intermediate Care Facility Services

. . . . . . . . .. . . . . . . . . . . . . .

4.25 Program for Licensing Administrators of Nursing Homes

4.27 Disclosure.of Survey Infonnation and Provider or Contractor Evaluation

73

. . . . . . . . . . . . 75

. . . . . . . . . . . . . . 76 . . . . . . . . . . . . . . . 77

4.28 Appeals Process for Skilled Uursing and Intermediate Care Facilities \

4.29 Conflict of Interest Provisions

4.30 Exclusion of Providers and Suspension of Practitioners Convicted and Other Individuals

. . . . . . . . 78

. . . . . . . . . . . . . . . . . . . . . . 79 Income and Eligibility Verification System . . . . . . . . . 79

4.31 Disclosure of Information by Providers and Fiscal hgents 4.32

. . . . . . . . . . . . . . . . . . 79a Verification for Entitlements . . . . . . . 79b

4.33 Medicaid Eligibility Cards for Homeless Individuals 4.34 Systematic Alien

4.35 Remedies for Skilled Nursing and Intermediate Care Facilities that Do Not Heet Requirements of Participation

. . . . . . . . . . . . . . . 79c

TI lo. Supersedes TI lo. 87-1 1

Approval Date

d3-69-%?

Effective Date HCFA ID:

October 1, 2017 Version. This plan is provided

for informational use only and does not replace the original version.

01-01-92 1002P/0010P

Revision : HCFA-PW-87-4 m C H 1987 .-

(BERC)

OMB NO. 0938-0193 PAGE NUHBRRS

SECTION SECTION 5

-

. . . . . . . . . . . . . . . . 80 of Personnel Administration . . . . . . . . . . . . 80 . . . . . . . . . . . . . . . . . . . . . . . . . . 81

PERSONNEL ADMINISTRATION

5.1 Standards

5.2 RESERVED

. . . . . . . . . . . . . . . . . . 82

5.3 Training Programs; Subprofessional and Volunteer Programs . . .

.

TN No. 87-11 Supersedes TN No. N I A

October 1, 2017 Version. This plan is provided

Approval Date

08/26/87

for informational use only and does not replace the original version.

Effective Date

HCFA ID:

07/01/87 1002P/0010P

Revision:

HCFA-PX-87-4

W C H 1987

(BERC) PAGE NUMBERS

SECTION

. . . . . . . . . . . . . . . . 83 6.1 Fiscal Policies and Accountability . . . . . . . . . . . . . 83 6.2 Cost Allocation . . . . . . . . . . . . . . . . . . . . . . . 84 6.3 State Financial Participation . . . . . . . . . . . . . . . . 85

SECTION 6

- FINANCIAL ADMINISTRATION

vii

n

TN NO. 87-11 Supersedes TN No. NIA

Approval Date

08/26/87

Effective Date 07/01/87 HCFA ID:

October 1, 2017 Version. This plan is provided

for informational use only and does not replace the original version.

1002P10010P

Revision:

HCFA-PM-91August 1991

4

. (BPD)

OMB No. 0938-

SECTION

... . ...' . Plan Amendments . . . . . . . . . . . . Nondiscrimination . . . . . . . . . . . Maintenance of AFDC Effort . . . . . . State Governor's Review. . ... . . . .

SECTION7-GENERALPROVISIONS

7.1 7.2 7.3

7.4

PAGE NUMBERS

. . . . . . . . .86 . . . . . . . . . . 86 . . . . . . . . . . 87 . . . . . . . . . . 88 . . . . . . . . :. 89

viii

TN No. q3-c') Supersedes TNNo. 87-11

Approval Date

9-//-'%

Effective Date HCFA ID:

October 1, 2017 Version. This plan is provided

for informational use only and does not replace the original version.

7982E

10-01-91

Revision:

HCFA-PM-914 (BPD)

-

LIST OF ATTACHMENTS Title of Attachments

* 1. l -A

Attorney General's Certification

* I. l -B Waivers under the Intergovernmental Cooperation Act 1-2-A Organization and Function of State Agency 1.2-B Organization and Function of Medical Assistance Unit 1.2-C Professional Medical and Supporting Staff 1.2-D Description of Staff Malung Eligibility Determination *2.2-A Groups Covered and Agencies Responsible for Eligibility Determinations

* Supplement 1 -

.

* Supplement 2 -

* Supplement 3 -

Reasonable Classifications of Individuals under the Age of 21,20, 19 and 18 Definitions of Blindness and Disability (Territories only) Method of Determining Cost Effectiveness of Caring for Certain Disabled Children at Home

*2.6-A Eligibility Conditions and Requirements (States only)

* Supplement 1 -

* Supplement 2 * Supplcme~?!3 * Supplement 4 -

Income Eligibility Levels - Categorically Needy, Medically Needy and Qualified Medicare Beneficiaries Resource Levels - Categorically Needy, Including Groups with Incomes Up to a Percentage of the Federal Poverty Level, Medically Needy, and other Optional Groups Rzasc-zb!e Limits on k-nounts for Necessary Medical or Remedial Care Not Covered under Medicaid Section 1902(f) lblethodologies for Treatment of Income that Differ from those of the SSI Program

*Forms Provided

TN No.: 03-13

Approval Date

Effective Date: 0811312003 /-??,kt i

Supersedes

TN NO.: 92-01 October 1, 2017 Version. This plan is provided

for informational use only and does not replace the original version.

Revision:

HCFA-PM-91-8

OMB No. :

'(MB)

Page 2

October 1991

No. -

Title of Attachment Supplement 5

-

Supplement 5a-

* *

Supplement 6

-

Supplement 7

-

Supplement 8

-

Supplement 8aSupplement 8b-

*

*

Supplement 9 Supplement 10Supplement 11-

*2.6-A

Section.1902 ( f ) Methodologies for Treatment of Resources that Differ from those of the SSI Program Methodologies for Treatment of Resources for Individuals With Incomes Up to a Percentage of the Federal Poverty Level Standards for Optional State Supplementary Payments Income Levels for 1902(f) States Categorically Needy Who Are Covered under Requirements More Restrictive than SSI Resource Standards for 1902(f) States Categorically Needy More Liberal Methods of Treating Income Under Section 1902(r)(2) of the Act More Liberal Methods of Treating Resources Under Section 1902(r)(2) of the Act Transfer of Resources Consideration of Medicaid Qualifying Trusts--Undue Hardship Cost-Effective Methods for COBRA Groups (States and Territories)

Eligibility Conditions and Requirements (Territories only)

*

Supplement 1

-

Supplement 2

-

Supplement 3

-

Supplement 4

-

Supplement 5 Suppl'ement 6

-

-

Income Eligibility Levels Categorically Needy, Medically Needy, and Qualified Medicare Beneficiaries Reasonable Limits on Amounts for Necessary Medical or Remedial Care Not Covered under Medicaid Resource Levels for Optional Groups with Incomes Up to a Percentage of the Federal Poverty Level and Medically Needy Consideration of Medicaid Qualifying Trusts--Undue Hardship More Liberal Methods of Treating Income under Section 1902(r)(2) of the Act More Liberal Methods of Treating Resources under Section 1902(r)(2) of the Act

*Forms Provided

41

No. 30 Supersedes Approval Date TN NO. 87-1 1

FN

07-06-92

Ef'fective Date HCFA ID:

October 1, 2017 Version. This plan is provided

for informational use only and does not replace the original version.

7982E

10-01-91

HCFA-PM-90- 2 JpWhRY 1990

Revision:

OHB NO.: 0938-0193 Page 3 .

(BPD) Title of Attachment

Charges Imposed on Categorically Needy Medically Needy

-

Premium

Charges Imposed on Medically leedy Methods and Standards for Establishing Payment Rates Hospital Care Methods and Standards for Establishing Payment Rates of Care

-

Inpatient

-

Other Types

-

Skilled

Payments for Reserved Beds Methods and Standards for Establishing Payment Rates Nursing and Intermediate Care Facility Services Timely-Claims Payment

- Definition of Claim

Conditions for Direct Payment for Physicians' and Dentists* Services Requirements for Third Party Liability--Identifying Liable Resources Requirements for Third Party Liability--Payment of C l a h Income and Eligibility Verification System Procedures: Other State kencies

Requests to

Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals Criteria for the Application of Specified Remedies for Skilled mrsing and Intennediate Care Facilities Alternative Remedies to Specified Remedies for Skilled Uursing and Intemediate Care Facilities Methods of hddministration

- Civil Rights

(Title VI)

*Form Provided TU Uo.

@+6 Approval ,Date

03-6992

Effective Date HCFA ID:

October 1, 2017 Version. This plan is provided

for informational use only and does not replace the original version.

01-0 1-97 1020P/0014P

Revision: HCFA-PM-91-4 August 1991

OMB No. 0938-

(BPD)

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECUFtITY ACT MEDICAL ASSISTANCE PROGRAM State/Territory:

MICHIGAN

As a condition for receipt of Federal funds under title XIX of the Social Security Act, the

Citation 42 CFR 430.10

M I C H I G A N DEPARTMENT OF COMMUNITY HEALTH (Single State Agency) submits the following State Plan for the medical assistance program, and hereby agrees to administer the program in accordance with the provisions of this State plan, the requirements of titles XI and XIX of the Act, and all applicable Federal regulations and other official issuances of the Department.

TNNo.

96-09!?

Approval Date

9-23- 96

Effective Date

Supersedes TN NO.

92-01

October 1, 2017 Version. This plan is provided

HCFA

ID: 7982E

for informational use only and does not replace the original version.

04/01 /96

2

Revision:

HCFA-AT-80-38.(BPP) May 22, 1980

MICHIGAN

State SECTION 1 Citation 42 CFR 431.10 AT-79-29

a.

SINGLE STATE AGENCY ORGANIZATION 1.1

Desimation and Authoritv (a) The

MICHIGAN DEPARTMENT OF COMMUNITY HEALTH

is the single State agency designated to administer or supervise the administration of the Medicaid program under title XIX of the Social Security Act. (All references in this plan to "the Medicaid agencyu mean the agency named in this paragraph.) ATTACHMENT 1.1-A is a certification signed by the State Attorney General identifying the single State agency and citing the legal authority under which it administers or supervises administration of the program.

TN NO.

96-010

Approval Date

Yd-.?3-

Effective Date

Supersedes

October 1, 2017 Version. This plan is provided

for informational use only and does not replace the original version.

04/07 /9f,

Rev isicn:

ImA-AT-30-38 1 % ~

22, 1980

State

(BPP)

MICHIGAN

Citation Sec. 1302 (a) of the A c t

l.l(b)

The S t s t e agency t h a t aciministered or supervised the administration of the plan approved under t i t l e X of the A c t as of January 1, 1965, nzs k e n separakly designated to adrninistsr o r s p e r v i s e the adni n i s t r a t i c n of t h a t p a r t of this plan which r e l a t e s to b1i.d individuals

/7

.

Yes. The S t a t e agenc] 2esignatad is

SQ

This agency has a sepa:=te > l m cover ing f l a t t i c n of 5 e , State ~ l m uridnr tit:? :cd 2. is:= { A ) ,113)( 2 ):ivj ( 1 : ) 1--i n-b:ece =o 1433 CS t h e As= s-e 3Y9'~L. .. , :.. . :,, ...'

,>-.. ". -- - ,

.

011 l i n v.lmncos I n this column wn*n m ~h. Pmrider Raimhrrs-I

-

WORKSHEET

TYEAMOUNTISTOBLDEDUCTEDOI TOWYICHTYE

AMOUNT

(2)

.,

I I

PROM

ADJUSTMENTS TO EXPENSES

Form 4 p m - d

OUB No. 72.R1010

.?-

. . ' . I ;

+.

P m

1.

L I N E NO.

I

>:. ,? +.,:. z.++: ..s .;. ,:.. ;d.

/

I 2 NO

Yes -

A *rhich resulted I, chapter lo?

(If

Attachment 4.19-D

kHIL c -?4.0

Y

Page 12

,,,,..,

OM8 No. 7tRIO10

PERIOD:

FROM

HOSPITAL-

Are there ony costs included on Worksheet Provider Reimbursement Monual, Port

I

PROVIOER NO.:

STATEMENT OF COSTS OF SERVICES FROM RELATED ORGANIZATIONS A.

$ L/C L,

WORKSHEET A-8-1

To

horn transactions with related organizationr as deiined i n the

'Yes,"

complete Parts B o n d

--

C) -

B. Costs

incurred ond odiustrnent required os result of transactions with related

organizations: AMOUHT

LOCATION AND bMOUNT INCLUDED ON WRKSHEET A, COLUMN 5 LINE NO.

1

COST CENTER

I

EXPENSE ITEMS

AMOUNT

3

1

2

NET AOJUSTMENT ICOL. I YINUI COL. 51

ALkO,",*gE 5

6

-

~

-

a 9. T O T U S (Sun o l l i n s 1.9) (Trns1.r col 6. lines 1-9 (Trms1.r col. 6, tin. 10 to m s t h-8, col. 2. line 20)

lo'

C.

m

6. li-a

VLst A. -1.

Interrelationship of provider to related or90nization(s):

T Secretory 7 v i r t w o ovt orily gronte un er e o i o n C thtprovider 1 ; fqrrniah thefinfoh-tion req,4tedd onsPo,

4

~:!h!.b)!~!k!h.%

s

as mppnpried

o 1

s

Heolth Insumnce 10 the Aped end D i s o b l d Act, r e q u i n s

inforrmtion rill b used by the f o c i o l Secuity Adminisnotion ond i t s intermd-rims in determining that the costs opplicoble to servic.s facilities ond supplies funish-d by o.ponixotimn relotmd to the prorider by common ornetship or control, r e p e a m t reosmoble roride o l l or costs o.'determined under Section 1861 of the Hcolth Insumnce for the Aped ond Di-bkd Act. I f the prorider d a s -1 on7 or, of the requested informotim, the cost ..pa rill b. conaidmrmd incomplete ond not occemoble for purposes of crmiminp reim%urs.m.nt under title XVIIl.

Tk

SYMBOL

NAME

PERCENT OWNERSHIP OF PROVIDER

RELATE0 ORGANIZATIONISI NAME

Il\

--

(1)

PCRCCNT OF OWNERSHIP

TYPE OF mUSINESS

~~

Us. lh. h l l o r i n g symbols to indicek the int.rr.lmionship A.

8. C. D.

E. F. G.

of the proridmr to n l m d orgni=otions:

Individwl has 1inmci.l int.rnt [sto&koldm., ponn.r. mtc.1 i n bolh relmed ergonizaien end in pm.id.r. bvpormion, pe.tn.rship. or ether oreoni~mianhas finoneid intmr.st in pvorider. Pv0.id.r hos hnmciol intmnst in mrpormion. pann.rship. or Olhw ~ t g ~ i l . l i ~ . Divanor. ofiir... mdministnrov, or key prvson e l pmridw or rolmir. o i such persrr has finmd*l n i t.sr i n nlotod 0lpnizmi.n. lndiridvol i s dinoo., eflic.,. .dminirtntor, or Lay p.*- o i prorida and r . l ~ l d o ~ ~ m i x n i a . Dinoor, of1ic.r. mkinisrrao.. a. Ley parson o l relend orgmixotia or .o l t.i 01 w h p.vson hs. linmciol int.o.t in pm.id.r. Other (linonciol ev n-linoncial) specify.

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

-

/Clr,F~4,dwcb

PART 1

I

-

I QUESTIONNAIRE

P a w 13

FROM

MOSPITAL

~

7.1,-u

Form h m r d

I

PERIOD:

PROVIOLR no.: DEPRECIATION

~LLULIIIIIGIIL

WORKSHEET A-8-2

Depreciotion reported i n cost stotement:

S

A. Straight-Line

0.

C. Sum-af-the-Yeors' Digits

D. Optional Allowonce Declining Balonce E. Depreciation reported on Worksheet A, column 7 (Sum of A. B. C, ond D) Bolonce In Fund At End of Period S

2

Is Depreciation Funded? (If Yes:

3

Were There Any Disposals of Capitol Assets During Period?

4

Wos Accelerated Depreciotion Cloimed On Any Assets In The t 'd - vnA I f Yes: A We. Acc.lwmd D.pv.~imtien Claim.d On Assat. Acplirmd On 01 Ah*, *uqu.t 1, 1970) (5.. Pnwid.r 1.imburs.mnt Yonuel, P-r I. doptmt 1)

S Yes

No

)

8. Did Pnrid., C.om. To P o n i c i p m In The Y.dicoeo Pregro. At End 0 1 P.tmd To m i c h This Co.1 Repon Applies? fir Pmvid.. R.imburs.mnt Ypruol. P a n I, chapter I)

-

C. Was Thn. S~bstontiol00cr.o.. In Health Insurmc. P l o p o n i ~01 All.-obl. Coat. Fmm Monuml. Pmn I. chaprn I) Ptior Cost Reponinq Pmviods? (5.. Plovid.. R.mburs.n.nt

PART I1 COMPUTATION OF THE OPTIONAL ALLOWANCE FOR DEPRECIATION 1

1965 Operating Cost Reloted to Potient Core

2

Less:

Actual Deoreciotion

'

1 .

- included on line 1

.

.

.

... ..

.

..

d

..

5

Current Yeor's Allowoble Cost (SEE INSTRUCTIONS)

6

Less: Actuol Depreciotion

(cot

'

- included on line 5

8

Adiusted Current Year's Allowoble Cost (line 5 minus

9

Lower of lines 4 or 8 obove

(col

Gross Allowonce (line 9 x line 10)

12

Less: Estimoted depreciotion on ossets rented i n 1965 (Some fiscal period for which cost is reported on line 1)

13

Adiusted Allowonce (line 11 minus line 12)

S

01 10

'

I

Add:

S

S

Depreciotion on owned ossets ocquired oher 1965 (Comp6ted on o stroight-line basis)

Totol (Sum of lines 14,

1 1

IS,ond 16)

S

I

Less: 6% of odiusted current yeor's ollowoble cost (line 8 obove)

1s

Deduction in Allowance (Only when line 17 exceeds 18)

-

20

Net Allowonce (line 14 minus line 19)

-

1

Net Optional Allowance (line 20)

2

Add: Depreciot~onon ossets acquired oher 1965 (computed In occordonce with Medicare P r i n c i ~ l e sof Reimbursement) Totol Allowoble Depreciation on Owned Assets (Optionol Allowonce Cloimed-Sum of lines 1 and 2) (Option01 Allowonce Not Cloimed

-

SEE INSTRUCTIONS)

5 (1)

UILOINGSL

FIXTURES MOVABLE EOUIPYLNT

I

1

s S

-

Less: Depreciotion recorded on the provider's books (Fmm Worksheet A. column 5) (SEE INSTRUCTIONS Adiustment to Depreciotion on Owned Assets (line 3 minus line 4) (Transfer to Worksheet A-8, lines 61 and 62, or opproprlote) I f Port I 1 i s completed, providers should complete lines complete lines 3 through 5.

--

S

PART Ill COMPUTATION OF ADJUSTMENT TO DEPREClATlON ON OWNED ASSETS (1)

4

I

Estimated straight-line depreciution on oll depreciable type ossets rented in the current year

16

3

9

S

.

COMPUTATION OF THE LIMITATION OF THE OPTIONAL ALLOWANCE

15

+ 7)

.

11

Adiusted Allowonce (line 13)

1, lines 6

S S

Percmtoge Allowonce (SEE INSTRUCTIONS)

19

- f

column 2)

10

14

t

1, lines 2 + 3)

s line 7,

,

.

.--s

'

Lower of rentol chorge or estimated snoight-line depreciot~on on rented depreciable type ossets

7

. ..

a

Adjusted 1965 Operating Cost (line 1 minus ltne 3, column 2)

4

18

s

,,

Lower of rentul charge or estimated strolght-line depreciotion on rented de~reclobletvoe assets

3

17

2

1 through 5.

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

I f Port

S

S

s

s

II i s not completed, providers w i l l only

Jl'/& LC. ,"

-

,J ,g

Page 14

1

30 31 32

Blod Blood Storing, Pnc..sinq

Phrsicd h r q v

3s

0cru.mionol

u

OEPRECIATION MOVABLE EOUIPMENT

DEPRECIATION BUlLDlNGS b FIXTURES

EMPLOVLE nEALTn b WELFARE

Y)

6 Ahimisnmion

31 32 33

34 35

INPATIENT ROUTINE SERVICE COST CENTERS

A<s 6 PJi.trics 1Grm.I Routin. C r d

Im*nsin C*n h i t

a

G n n r r C-

39

H w o H d t h Amcr

3

b h l a n c * 5onins

,A',

I?:' .&w ,,;: ;!:,, .::y;a- z;#'4:~:.$s,. . ..;',',..,:,. .c:,,t.< a;:,?;,*: e +, . "??'*$:L,~(:w%; . . . , . . i ..: &ii .it..;:::.., .,$ .:;, ,F+sirtsi2j;;$ &~;[~s~~.pL~~;~~2.;-; ;*:*.?*~:::::,,~:~::~ :.k,,i;.*;'.>.,;;< r,.,,::.$ :

.

SUPPLEMENT B

Attachment 4.19-D Page 43 "Fixed Assets" may include several cl a s s i f j cati ons of plant and equipment used

i n the operati on of nursing homes : 1 and, bui 1 dings , leasehold improvements and equipment are l i s t e d on Schedule C. If needed, other categories may be

added by footnote to Schedule C.

Fixed asset classifications should be recorded a t cost. The accumulated reserve f o r depreciation f o r each category should be shown in the "reserve" column. The sum of the net book values i s extended t o the asset column. I t i s essential supporting data be maintained in the home's business office t o substanticte a1 1 .figures reported.

'

.

!%ccounts Payable" represents 1 iabi 1' t i e s on routine transactions normal t y kept on open account and limited t o amounts owing specific creditors f o r goods and/or servi ces purchased.

.

"Notes Payable" represents amounts due creditors, normal ly evidenced by written instruments and may be of short-term or long-term duration. "Accrued s a l a r i e s , wages payable" represents the salaries and wages earned by employees b u t not paid during the accounting period. To be recognized as an allowable expense, s a l a r i e s accrued a t the end of the accounting year must be paid w i t h i n ninety days of the year end. "Deferred Income" i s a l i a b i l i t y i f revenue i s received before i t has been earned. Services which wi 11 be rendered in a future accounting period f o r which monies have been collected i s an example of deferred income. "Lonq- term Li abi l i t i e s " include mortgages payable, 1ong-term notes payabl e and contracts payable. "Capital" includes the investnients made i n the home by the owners (proprietary, partnership o r corporation). If capital stock i s involved, the amount outstanding a t the balance sheet date wi 11 be shown. "Surplus" accounts r e s u l t from a variety of transactions. The most common surplus account i s "retained earnings" - the accumulation of undistributed earnings over the l i f e of the corporation. The surplus section of the balance sheet i s designed t o disclose the surplus balance a t the beginning of the year, the increases or decreases during the year and 'the end of the year balance. Schedule D

-

Analyses of Income and Expenses

Section 1 of Schedule D

-

Selected patient revenue and other income accounts

This schedule i d e n t i f i e s a1 1 patient revenue by category of service. In addition, income derived from non-patient a c t i v i t i e s i s also shown in appropriate revenue accounts.' All sources of income must be recorded i n t h i s schedule. Section 2 of Schedule D

-

Operatinq Expenses

Individual costs as recorded in the home's general ledger are normally grouped by departmental function i n the health care f a c i l i t y chart of accounts. This schedule i d e n t i f i e s most of the departmental' functions i n nursing homes. Total expenses October 1, 2017 Version. This plan informational useon only 1 and does 1 not the originalA. vers (1.i ne 27) i sis provided a1 so forrecorded i ne ,replace Schedule ion.

SUPPLEMENT B

Attachment 4.19-D Page 44

To i l l u s t r a t e the composition and type of expenses which are normally included in a few representative departments in the schedule -

-

L3ne 1

NURSING WAGES

The total salaries and wages paid in the nursing serv7ces department for ( 1 ) bedside nursing care a n d ( 2 ) for recreational activity salaries during the accounting period. Included in salaries and wages. for line 1 are: compensation for hours worked in providing care to the resident patient, sick pay, vacation pay, holiday pay and s h i f t differential pay. --

-

Line 2

NURSING WAGE FRINGES AND PAYROLL TAXES

That portion of t h e payroll fringe benefit package which i s allowable to the nursing and recreational salaries and wages recorded on line 1 should be recorded on line 2 , Schedule D, Section 2 . Nursing's fringe benefits include the nursing department's f a i r share of payroll taxes (FICA, federal and s t a t e unemployment), insurance (hospitalization, health and accident and 1 i f e ) , workmen's compensation, income replacement, etc.

-

Line 3

RAW FOOD COSTS

Includes only the costs of unprocessed food. are to be recorded on 1 i ne 5.

-

Line 5

Costs of preparation and serving

OTHER DIETARY EXPENSES

Salaries

-

Supplies

-

All purchases used in the department: products, vegetables, staples, etc.

Other

-

Maintenance cost of dietary equipment, replacement of dishes and s i 1 verware, and/or contracted dietary services , etc.

Line 6

'

Cooks, d i e t i tian, ki tchen and cafeteria help

- ADMINISTRATIVE AND

The sum of:

Salaries

-

Supplies

-

Other

-

i-ncludes meats, dairy

GENERAL

administration and clerical a1 1 office and administrative supplies including magazine subscri ptions , postage, dues, etc. Advertising, telephone and telegraph, insurance, repair and maintenance of office equipment, legal and audit expense, a1 1 employee fringe benefits, etc.

For purpose.s of determining allowable. operating costs, the maximum amount of compensation that may be paid full-time (40-hour work week) administrator(s) (vi z: combined salary for the administrator , assistant administrator, and/or administrative assistant) may not exceed: October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

.

.-

SUPPLEMENT B Attachment 4.19-D Page 45 Maxi mum A1 1owabl e Combi ned S a l a r y A1 1owance

No. of Beds i n Home 1 - 49 50 - 99 100 - 149 150 and over

Paragraph: 405.426 "Pr-inciples of Reimbursement f o r Provider Costs" d e f i n e s a reasonable a1 1owance o f compensation f o r s e r v i c e s of owners. To be reascnabl e , an ' e paid f o r -- owner's compensation must "be such an amount a s would o r d i n a r i l y D comparable s e r v i c e s by comparable i n s t i t u t i o n ~". S a l a r y ranges1 f o r a d m i n i s t r a t o r s and a s s i s t a n t a d m i n i s t r a t o r s developed by the Soci a1 Securi t y Admi ni s t r a t i on, Bureau of Heal t h Insurance a s r e a s o n a b l e 1971 (most r e c e n t d a t a a v a i l a b l e ) compensation f o r Michigan a r e a s f o l l o w s : Bed S i z e

Administrators

250 and over $1 2,000-27,000

M'edi an Administrators

Assistant Adrni n i s t r a t o r s

$20,350

$12,000-18,000

Medi an Assistant Administrators

$1 5,500

To i n t e r p r e t the above g u i d e l i n e s , one must use Medicare's p o i n t system f o r p l a c i n g owner/administrator compensation w i t h i n the appropri a t e range: experience formal e d u c a t i o n , and . o t h e r c o n s i d e r a t i o n s a r e assigned v a l u e s , the r e s u l t i ng t o t a l determines t h e r e l a t i v e p o s i t i o n an owner has w i t h i n the range and becomes his maximum allowable compensation. The do1 l a r values used i n the s c h e d u l e above r e p r e s e n t 1971 survey r e s u l t s . update the v a l u e s , t h e following percentages a r e used: For 1973

1.088 i s a p p l i e d t o above values

i 974

1.138 i s appl i e d t o above i a l ues

1975 a s e s t i m a t e d

1.188 i s a p p l i e d t o above values

I

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

To

SUPPLEMENT B

Attqchment 4.19-D Page 46 Line 9

- OPERATION AND MAINTENANCE OF PLANT

Supplies Other . Salaries

Line 11

.-:

Salaries

U t i l i t i e s (gas, o i l , e l e c t r i c , water), small tools, paint, etc. Purchased repair services , etc.

.PHARMACY

-

-

Supplies

Bui 1di ng engi neer and mai ntenanee personnel

Registered pharmaci s t ( s ) Drugs and medications

Line 15 or Lines 24-26

-

Nonally, general ledger account balances are grouped with other ledger account balances and appear on one of the apprqpriate lines printed in Schedule D, Section 2. However, unusual expense categories which are significant i n amount, may be -recorded separately in one of the 1ines identified by t h i s paragraph. Lines 17 and 18

- DEPRECIATION

The allowable depreciation expense i s restricted t o the straight-line method of calculation. Amounts claimed must be supported by appropriate records in the home's accounting department. For further instructions, see Schedule D , Section 3 below. Line 19

-

PURCHASED SERVICES

This 1 ine i s reserved f o r those special services or supplies a nursing home may purchase f o r individual c l i e n t s , pay with nursing home funds and recover i t s cost through collections from the cl ient or patient. Purchased service expenses which would be used on 1ine 21 include: X-ray, 1aboratory , physi cal therapy, occupational therapy, braces, individual wheel chairs and/or physi cian-prescri bed non-routine nursing care type expendi tures Section' 3 of Schedule D

-

.

Depreciation'

Include a l l depreciable assets u s i n g f o r asset cost the values reported f o r income tax purposes during the period covered by t h i s report. Use the s t r a i g h t - l i n e method f o r determining the amount of depreciation allowance claimed f o r the accounting year, and apply the reasonable 1i f e f o r each depreciable asset (normally asset 1i f e acceptable t o the Internal Revenue Service would be acceptable f o r the Medicaid/ Medl care program). The assessed. valuation which appears on your most recent real e s t a t e tax bi 11 should be shown i n the space requested. I t i s the intent of the schedule t o exclude land values from the real property assessed valuation.

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

..

SUPPLEMENT B

-13Section 4 , Schedule D

-

Attachment 4.19-D Page 47

Salaries a n d Wagis

This schedule i s for informational purposes only. The d a t a requested i s readily avai 1able from schedules contained in your federal report on employee earnings ( v i z : W-2's). The schedule's total represents the total salary and wages paid during the calendar year. Section 5, Schedule D

-

Fixed Asset Schedule

1h;'~ixed Asset Schedule i s designed t o summarize the cost d a t a contained in the . -- f a c i l i t y ' s "lapse schedule", "plant ledger" or similar record of fixed assets by category (building, equipment, etc. ) and by year of acquisition. The d a t a recorded in this schedule should conform with cost values used in column 3 "Cost or other basis" of Schedule D , Section 3. The remaining portion of D-5 i s devoted t o identifying the number of square feet within the facility t h a t is used for: Line Line Line Line 6

34 1 2

Schedule E

-

patient areas (bed areas, day rooms, etc. ) offices - administrative areas residence - living quarters assigned personnel service areas - self-explanatory Statement of Provider Transactions with Businesses Having Comon Ownership (Related Organizations)

Schedule E i s designed t o identify those costs for which reimbursement i s claimed t h a t contain expenditures for services, f a c i l i t i e s , and/or supplies furnished to the provider by organizations .related t o the provider by common ownership or control.

all providers. Part I of Schedule E must be completed by -

Parts I I and I1 I of Schedule E mu.st be completed whenever the answer t o Part I i s "yes". Schedule F

-

Statement of Admi ni strator's and/or Owner's Compensation

Schedule F i s designed t o show the compensation p a i d t o administrators as well as. compensation paid t o sole proprietors, partners and corporati on officers. The amount shown in the schedule i s also in the total expenses (line 27, Schedule D , Section 2 ) . Compensation i s defined as the total benefit received or receivable by the administrator or owner for the services he renders the institution. I t includes salary amounts paid for managerial, administrative, professional and other services; amounts paid by the institution for the personal benefit of the owner; and the cost of the assets and services which the owner receives from the institution.

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

SUPPLEMENT B ATTACHMENT 4.19-D Page 48

Each cost report submitted must contain a certification to the accuracy of the report and be signed by an officer or administrator of the nursing home or supervised residential care facility.

..

ion of Certified Public Accountant ( O ~ t i o u The certification of the cost report by a certified public accountant is optional and may be made either in the abbreviated statement printed on the lower half of page 8, or in a separately prepared statement. However, the signed opinion must certify to the reliability of data contained in the "Statistical and Operating Cost Reportt1, Schedule C and D, Sections 1, 2 and 3. MAILING ADDRESS FOR THE C0MPLETF.D REPORT Mr. Richard E. Maharan Institutional Review Division Bureau of Medical Assistance Michigan Department of Social Services 300 S. Capitol Avenue Lansing, Michiggn 48926 All questions and inquiries should be addressed to: Mr. Richard E. Maharan at the above address or by telephone: area code (517) 374-9530. *

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

SUPPLEMENT B Attachment 4.19-D Page 49

MICHIGAN NURSING CARE FACILITY MICHIGAN SUPERVISED RESIDENTIAL CARE FACILITY STATISTICAL AND OPERATING COST REPORT SCHEDULE

A P r w i d e r Number F w Year Endad

Raporl of ( C k c k Onel City

.

Entlre Facility ~istrn;t Pati

Licensed As

u

Hospital . Nursing Home Home for Aged

Extended Care (Title XVIII) Skilled Nursing Home Basic Nursing Home Residence for the Aged

Voluntary Non-Profit Governmentrl Proprietary

-

0 1. TOTAL EXPENSElS ( L i a 27 Schedule D. Sec. 2)

ADJUSTMENTS T 0 EXPENSES 2. Income from telephone s e w i c e (pry stations excluded) 3. Employee and guest meals 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

I

!

b

r

Sale of medical abstracts. etc. Sale of scrap. waste, etc. Rental Income Cash. trade. quantity and other discounts on purchases Rebates, refunds, recovery on insured l o s s of expenses Allowance for admmistratlve services rendered specialists Interest income on commingled Unnstricted Funds Gradts. g ~ f t s .and Income designated by donor for speclfic expenses Fund ~ a l s k gExpenses Ancillary s e w t c e expense (Schedule B) Other

26.

TOTAL ADJUSTMENTS (Lines 2 through 25)

27.

Net Cost Routine Nursing Care Service (Line 1 l e s s Line 26)

28.

Number of r e s ~ d e n tor patient days of care

29.

Average daily cost for Routrne Nursing Services NOTE:

055.1976 111-771

This report is subject to audit.

1.

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers i ion. I:. !

'

Individual Partnersh~p Corporation Other

SUPPLEMENT B Attachment 4.19-D Page 50

SCHEDULE

8

SCHEDULE OF OTHER THAN RESIDENTIAL OR ROUTINE NURSING SERVICE EXPENSES Amount Non.Rou~nne N u r s ~ n gCora

t o l l Per Baobr

Anctllory Services ( P r o f c s s ~ o n a l lmanned) ~

1. Pharmacy .2.

.

.

Hadlology

-

3. Laboratory

-

4. Therapies

-

5. Other

-

d ~ r e ccosts ~ overhead a l l o c a l ~ o n d ~ r e c tCosts overhead allocalton dlrecl costs overhead allocalton direcl costs overhead a l l o c a t ~ o n S

s

Purcha'smd Services that or* included i n expenses (lin* 1, Scheduk A):

7. X-Ray Services 8. Laboratoty Services 9. Physical Therapy Treatments 10. Occupational Therapy Ttestments

I I. Speech

Therupy Treatments

12. Braces and/or Prosthettc Devices 13. Physician and Dental: Scrv~ceso l physicians Serv~ceso l dentists 14. Other:

,

15. Total Ancillary Service Expenses (Schedule A L ~ n e14)

5

S f A f IS7 !CAL O A T A

Complete Cols. 1. I . and J for factlolr checked aborr

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

-

SUPPLEMENT B

Attachment 4.19- D

Page 51

Providmr No.

SCHEDULE

D, Srction

4

SALARIES AND WAGES

OIIicersp Salaries

Total S a \ a r ~ e sand

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

SUPPLEMENT B A t t a c h m e n t 4.19-D P a g e 52 SCHEDULE D

Provldcr Number

ANALYSES OFJNCOME AND EXPENSES

SCHEDULE

SCHEDULE D. SECTION 1 SKI.ECTED P A T I E N T REVENUE(except routine nurmng services) ANI) OTHER INCOME ACCOUNTS Inp;allenl itevenue:

s

I.

1 -. .I.O x v ~ e n

OPERATING EXPENSES 1. N u r s ~ n gWages 2. Nurstne Wage Fnnges and . Payroll Taxes 3. Raw Food Costs

4. 5. 6. 5.

5. Pharmacy 6 . X-Ray

7. Ldboralory

R.

Yrdlcal Supplies 10. Therapy I\. 11.

9. Operat~onand Maintenance

o f Plant 10. Medical Supplies

12. Pallent Laundry Income 1.1.

11. 12. 13. 14.

Ou~pallentRevenue 14. IS. lh. 17. 18. 19.

X-Ray I.aboratory Emrrgcncy Therapy

Pharmacy X-Ray Dept. Laboratory Dept. Therapy Dept.

15. 16. Outpatient Dept.

-

17. IS. 19. 20.

Other Income: 20. Hrvrnuc from meals sold cmployees. Ruesls. elc. 21. Hrvenue from sale d r u ~ s .supplies. laundry l o others than p r l a n t s . 22. Hcvrnuc from rcnlal of non-patient laciltttes "23. I'uri-haw dtscuunls (Trade. Q u a n ~ ~ t yT.tme. Rebate) 24. ('tmlr~bul~np dun;*llons. bequcsls. etc. 25. Ini.llmc from I n v e s ~ m e n ~ r 2h. Olhrr

-

Depreciation Buildings Depreciation Equtp.. etc. Purchased Services Rent 21. Interest 22. Property Taxes 23. Asroclation Dues

-

I

27. T o t a l Expenses

27.

SCHEDULE D. SECTION

;dlcll

3

D E P R E C l A TION (Lines 17 and 18. above)

Drsrnptnon 01 Ptopcny Oualdmlr

Dalr

. . . . . . . . .

Ocprecution allowed or allowable in pnor year

COSI or other basin

Acquired

S

S

Tolals to Itnra 17 Ik 10. Schrdutc D. Srotion 2. e b o n ~..**.cd

D, SECTION 2

SubTotal Other Nursing Expenses Other Dietary Expenses Admintstrative and General Hous-keeptng 9. Laundry and L ~ n e n

4 . 131-d and Plasma

-

'

valwtlon

055-1176 I l l - 7 7 )

- Real Pmpcny

txclusirr 01 land

S-

Prnonal Pmprfly

S

-

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Method conput~ng Dcprrcrm~~on SP.IS~I

LIW

L i l e or rate

Deprrc~m~~on clm8mcd lor ~ h t syear

t

1

SUPPLEMENT B Attachment 4.19-D Page 53

SCHEDULE

C

BALANCE SHEET ACCOUNTS ON

Provider Number (dale)

ASSETS 1. Cash on hand and in banks 2. Accounls and notes receivable (less allowance S 3. Inventories prtced at 4. lnvrslments 5. Prepatd Expenses 6. Fixed Assets: a. b. c. d.

Land Buildings Leasehold loprovemats Equipment

Cosl

.

Reserve

-

7. TOTAL ASSETS

8. Accounts Payable 9. Notes Payable 10. Accrued salaries. wages. fees payable 11. Deferred Income Long Term Liabilities: 12. Mortgage Payable 13. Notes Payable 14. Other

15. TOTAL LIABILITIES CAPITAL 16. Owners Equity (Proprietary or Partnership) 17. Capital Stock (Corporation) outstandint

18. Surplus

19. 20. 21.

- current beginning of year year's oprating profit (loss)

other surplus account transactions (net) 'balance. end of year

22: TOTAL LIABILITIES AND CAPITAL

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

)

Book Value

. 19 ---

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State:

MICHIGAN

Attachment 4.19-E Page 1

POLICY AND METHODS FOR TIMELY CLAIMS PAYMENT

8/23/79

I

The Michigan Department o f S o c i a l S e r v i c e s d e f i n e s a "claimll a s a " b i l l f o r s e r v i c e s " i n accordance w i t h 4 2 CFR 4 4 7 . 4 5 ( b ) .

Rev. 8/23/79

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Attachment 4.22-A Page 1

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State of MICHIGAN

Requirements for Third Party Liability-Identifying Liable Resources (I) Data Exchange Frequency (42 CFR 433.l38(f)) The Michigan Department of Human Services accesses the Michigan Employment Security Commission files weekly and makes the files available to IV -D and Friends of the Court. The Michigan Department of Human Services IV-A program determines Title XJX eligibility and secures information on Medicaid recipients that are employed and their employer on a continuous basis. The Michigan Department of Community Health has an agreement with the Worker's Disability Compensation Bureau to provide the Third Party Liability Division with information at least monthly, to pursue third party resources. The Department also reviews information on a monthly basis from the Departments of Transportation and State Police for all injury related and fatal accidents. Monthly the Michigan Department of Community Health identifies paid claims with diagnosis and trauma codes as designated by the Code of Federal Regulations and published updates. (2) Follow-up Requirements (42 CFR 433.1 38(g)) When appropriate, the Michigan Department of Community Health follows up on acquired information within 30 days to determine the legal liability of other resources. County caseworkers, as a matter of routine, pursue potential employer leads for both outside income and other insurance. Other third party resources discovered by the caseworkers as a result of the follow up are reported to third party and incorporated into the third party and eligibility case files. This information is accessed to assure appropriate claims payment. Within 60 days information is obtained to determine the legal liability of other resources. Health insurance information received from the caseworkers is entered on the TPL Master File for use in both the cost-avoidance and recovery processes. Valid Worker's Compensation information is maintained in a recovery case file.

TN NO.: 07-05

Approval Date: S£P

1 1 2007

Effective Date: 01/03/2007

Supersedes TN No.: 90-13 October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Attachment 4.22-A

Page 2

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State of MICHIGAN

Requirements for Third Party UabiJity - Identifying Liable Resources (3) State Motor Vehicle Accident Report (42 CFR 433.138(g)(3)) Monthly all reported accidents are matched to the Medicaid Management Information System to determine Medicaid eligibility status. If the individual is Medicaid eligible, the case is reviewed for potential recovery action. (4) Trauma Code Editing Follow-up (42 CFR 433. I 38(g)(4)) Monthly all claims with diagnosis and trauma edit codes as designated by the Code of Federal Regulations, are matched to the Medicaid Management Information system to determine Medicaid eligibility status. If the individual is Medicaid eligible, the case is reviewed for potential recovery action.

TN NO.: 07-05

Approval Date$EP

1 1 2007

Effective Date: 01/03/2007

Supersedes TN No.: 90-13 October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Attachment 4.22-B Page 1 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State of Michigan Requirements for Third Party Liability – Payment of Claims

1) Method Used to Determine Provider Compliance The State requires the provider to utilize all other resources to their fullest extent before presenting the claim to Medicaid for payment. 2) Guidelines Used to Determine Cost Effectiveness and Time/Dollar Thresholds for Billing Paternity Confinement Expenses - The State of Michigan IV-D program refers paternity cases to the local prosecuting attorney who petitions the court to order the absent parent to provide support for the minor child and repay Medicaid confinement expenses. The prosecutor and/or court requests from the Third Party Liability Division a statement of confinement expenses for inclusion in the court order. Confinement expense statements are provided by the Third Party Liability Division for every paternity case whether or not repayment is ordered and the terms of repayment is at the discretion of the court. Enforcement and collection is vested with an extension of each judicial circuit court in Michigan. Health Insurance - Recoveries from Health Insurers are initiated within 30 days of adding Health Insurance information to the TPL Master File. Billing for reimbursement is retrospective. Medicare- All current Medicare eligible recipients are monitored by the Invoice Processing system to assure payment of the lesser of the coinsurance and deductible amounts or the Medicaid screen amount minus any Medicare payment. Retroactive Medicare eligibility is pursued for covered provider types regardless of dollar amount since the process is automated. The part A and part B claims are claim adjusted to the Medicaid providers. Casualty - The Michigan Department of Health and Human Services pursues recovery of Casualty claims when claims exceed $300 for automobile cases or $1000 for general liability or medical malpractice cases. Requests from insurance companies and attorneys are processed regardless of the value of the paid claims. Claims for no-fault auto are accumulated for as much as 12 months. If the claims do not exceed the threshold as noted in the first sentence of this subsection, the case is closed. General Liability claims are accumulated to extend 6 months from the date of event or date of notification, whichever is longer. If the claims do not exceed the threshold, the case is closed. Once the case has been identified as exceeding the cost effective threshold, recovery is pursued.

TN NO.: 16-0013 Supersedes TN No.: 07-05

JAN 9, 2017 Approval Date: _____________

Effective Date: 10/01/2016

Revision:

HCFA-PM-91-8

(MB)

ATTACHMENT 4.22-C Page 1 OMB No. :

October 199 1

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State/Territory:

MICHIGAN - -

Condition or Requirement

Citation 1906 of the Act

State Method on Cost Effectiveness of Employer-Based Group Health Plans

-T N N ~ .

91-3; Supersedes

TN No.

Approval Date

07-06-92

Effective Date

N/A HCFA ID:

* u.S.

Govcrnmcnt Printing Office : 1991

-

312-149140352

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

7985E

10-0 1-9 1

1

-

*

Revision:

HCFA-PM-92-4

Attachment 4.30 Page 1

( HsQB

AUGUST 1992

Citation

Sanctions f o r Psychiatric Hospitals

1902(y)(l), 1902(y)(Z)(A), and S e c t i o n 1902(~)(3) of :he Ac= (P .L. 131-508, Section 4 7 5 5 ( a ) ( 2 ) )

(a)

The S t a t e a s s u r e s t h a t t h e r e q u i r e m e n t s o f s e c t i o n 1 9 0 2 ( y ) ( l ) , s e c t i o n 1 3 0 2 ( y ) ( 2 ) ( ~ )acd , s e c t i o n 1 9 0 2 ( ~ ) ( 3of ) t h e Act a r e met con=e=:i:g s a n c t i o n s f o r p s y c h i a t r i c h o s o i t a l s t h a t do E ~ meet :he requirements of p a r t i c i p a t i o n when :ke h o s p i t a l ' s d e f i c i e n c i e s immediately j e o p a r d i z e t h e h e a l t h and s a f e t y of i t s p a t i e n t s o r do not immediately j e o p a r d i z e t h e h e a l t h and s a f e t y o f its patients. The S t a t e t e r m i n a t e s t h e h o s p i t a l ' s p a r t i c i p a t i o n under t h e S t a t e p l a n when t h e S t a t e determines t h a t t h e h o s p i t a l does n o t m e e t t h e requirements f o r a p s y c h i a t r i c h o s p i t a l and f u r t h e r f i n d s t h a t t h e h o s p i t a l ' s d e f i c i e n c i e s immediately j e o p a r d i z e t h e h e a l t h and s a f e t y of i t s p a t i e n t s .

1 9 0 2 ( ~()1 )( A ) of t h e A c t

(b)

1 9 0 2 ( y )( 1 )( B ) of t h e A c t

( c ) When t h e S t a t e determines t h a t t h e h o s p i t a l does

1902(y) ( 2 ) ( A ) of t h e A c t

TN No. 93-24

=

not m e e t t h e requirqments f o r a p s y c h i a t r i c h o s p i t a l and f u r t h e r f i n d e t h a t t h e h o s p i t a l ' s d e f i c i e n c i e s do not immediately j e o p a r d i z e t h e h e a l t h and s a f e t y of i t s p a t i e n t s , t h e S t a t e may:

(d)

1.

terminate t h e hospital's participation under t h e S t a t e plan; o r

2.

p r o v i d e t h a t no payment w i l l b e made under t h e S t a t e p l a n w i t h r e s p e c t any i n d i v i d u a l admitted t o s u c h h o a p i t a l a f t e r t h e e f f e c t i v e d a t e st t h e finding; o r

3.

terminate t h e hospital's participation under t h e S t a t e p l a n and p r o v i d e t h a t no payment w i l l b e made under t h e S t a t e p l a n w i t h r e a p e c t t o any i n d i v i d u a l admitted t o such h o a p i t a l a f t e r t h e e f f e c t i v e d a t e of t h e finding.

=:

When t h e p s y c h i a t r i c h o a p i t a l d e s c r i b e d i n ( c ) above h a s n o t complied w i t h t h e r e q u i r e m e n t s f o r a p a y c h i a t r i c h o e p i t a l w i t h i n 3 months a f t e r t h e d a t e t h e h o e p i t a l is found t o b e o u t of compliance w i t h such requirements, t h e S t a t e s h a l l p r o v i d e t h a t no payment w i l l b e made under t h e S t a t e p l a n w i t h r e s p e c t t o any i n d i v i d u a l a d m i t t e d t o such h o a p i t a l a f t e r t h e end of s u c h 3-month period.

Approval Date

/O d d - 4 3

E f f e c t i v e Date

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

7-/-43

Attachment 4.30 Pzge 2

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT Sbte of MICHIGAN Procaram Administration Citation

Sanctions for MCOs and PCCMs

1932(e) 42 CFR 428.726

(a) The State will monitor for violations that involve the actions and failure to act specified in 42 CFR Part 438 Subpart I and to implement the provisions in 42 CFR 438 Subpart I, in manner specified below: (b) The State uses the definition below of the threshold that would be met before an MCO is considered to have repeatedly committed violations of section 1903(m) and thus subject to imposition of temporary management. (c) The State's contracts with MCOs provide that payments provided for under the contract will be denied for new enrollees when, and for so Iong as, payment for those enrollees is denied by CMS under 42 CFR 438.730(e).

- Not applicable; the State does not conbact with MCOs, or the State does not choose to impose intermediate sanctions on PCCMs.

TN NO.: 03/13

Approval Date: L / $ $ , L ~ ~

Effect~veDate: 0811312003

Supersedes TN No.: N1A - new page

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Revision: HCFA-PM-86-9 May 1986

(BERC)

Attachment 4.32-A Page 1 OMB NO.: 0938-0193

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State:

MICHIGAN

INCOME AND ELIGIBILITY VERIFICATION SYSTEM PROCEDURES REQUESTS TO OTHER STATE AGENCIES

No. 87-4 Supersedes TN No. N/A '1.N

1.

We request quarterly wage information from the Michigan Employment Security Commission, which is not yet t h e designated SWICA.

2.

We request, from the Secretary of State, using an on-line inquiry system, descriptions of any licensed vehicles owned o r being purchased by recipients.

3.

Since t h e Michigan Department of Social Services is a single S t a t e agency with a single d a t a base, information f r o m all o t h e r s t a t e administered programs is routinely available while making determinations of Medicaid eligibility.

Approval D a t e Q4/16/87

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Effective D a t e 06/01/86 HCFA ID:

0123P/0002P

Revision:

HCFA-PM-87-4 (BERC) MARCH 1987

Attachment 4.33-A Page 1 OMB NO.: 0938-0193

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT StateITerritory:

MICHIGAN

METHOD FOR ISSUANCE OF MEDICAID ELIGIBILITY CARDS TO HOMELESS INDIVIDUALS

The homeless individual may designate where helshe wants the Medicaid eligibility card sent, including the local Department of Social Services office.

'11u No. 87-IJ Supersedes TN No. &A !

Approval Date 08/26/87

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Effective Date 01/01/87 HCFA ID:

1080P/0020P

STATE OF MICHIGAN

Attachment 4.34-A

p. l(a)

JOHN ENGLER, Governor

DEPARTMENT OF PUBLIC HEALTH 3423 N. LOGAN I MARTIN L. KING JR. BLVD. P.O. BOX 30195, LANSING, MICHIGAN 48909 VERNICE DAVIS ANTHONY, MPH, Dlrector

November 25, 1991

TO:

Administrators/Managers of Hospitals, Nursing Homes, Hospice Programs, Home Health Agencies and Health Maintenance Organizations

FROM:

Walter S. Wheeler 111, Bureau of Health Systems

SUBJECT:

New Federal Requirements

The Federal Omnibus Budget Reconciliation Act of 1990 (OBRA) contains a section we now refer to as the "Patient SelfDetermination Actw (PSDA) which imposes new responsibilities on certain providers of Medicare and/or Medicaid services. Effective December 1, 1991, hospitals, nursing homes, certain HMO agencies, home health agencies and hospice programs are required to develop policies.and programs on advance directives and those programs must: Provide written information to patients/residents at admission regarding their rights under State law to make decisions regarding medical care and on the programs' policies governing implementation of those rights.

.

Document in the patient/resident medical record whether or not he/she has executed an advance directive. Ensure compliance with the requirements of Michigan law respecting advance directives at the institution. 8

Provide, individually or with others, education for staff and the community on issues concerning advance directives.

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

,

A t t a c h m e n t 4.34-A

Page l(b)

Page hjo November 25, 1991



Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive.

In addition to this memorandum, this mailing contains a reprinting of the federal statutory change along with a short article on practical considerations regarding implementation that should be shared with your legal advisor and those responsible for implementation of this new requirement. To assist you in explaining patients' rights under Michigan law, the Michigan Department of Public Health convened a panel of experts who were responsible for drafting and finalizing the enclosed guide entitled "MICHIGAN NOTICE TO PATIENTS.Iv While you are required to provide the information contained in this guide to your patients at the time of admission, you are not required to use the document provided by the State. You may photocopy the material (with or without your own logo) or you may elect to include the contents of the guide in other material you are preparing to fulfill this new regulatory requirement. Long-term care providers (nursing homes) will notice that the "MICHIGAN NOTICE TO PATIENTSvvdiffers from the memorandum we issued in February 1991, which implied that a guardian was needed if a resident was no longer "able" to make his/her treatment decisions and that resident had not previously appointed a surrogate decision maker consistent with Michigan law.. Our panel of experts considered this matter carefully and,concluded that it is not always necessary to seek guardianship appointments when residents are "unablem to exercise their treatment decision options. We believe this material will be of considerable assistance as your program changes to meet new federal requirements. We understand that-severalprovider organizations-are working with their members to assist in implementation. Questions specific to a type of provider should be referred to that organization. In addition, the legal community has expressed significant interest in this subject and is available for consultation. Many State Senators and ~epresentativeshave available in their office material describing the process for the appointment of a surrogate decision maker consistent with Michigan law. Enclosure

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

I

Attachment 4.34-A

Page l(c)

MICHIGAN NOTICE TO PATIENTS

REQUIRED BY THE PATIENT SELF DETERMINATION ACT ("PSDA")

Distributed by the Mlchlgan Department of Public Health Bureau of Health Systems Not 1991 October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

A t t a c h m e n t 4.34-A

Page l ( d )

YOUR RIGHTS TO MAKE MEDICAL TREATMENT DECISIONS We are giving you this material to tell you about your right to make your own decisions about your medical treatment. As a competent adult, you have the right to accept or refuse any medical treatment. "Competent" means you have the ability to understand your medical condition and the medical treatments for it, to weigh the possible benefits and risks of each such treatment and then to decide whether you want to accept treatment or not.

WHO DECIDES WHAT TREATMENT I WILL GET? As long as you are competent, you are the only person who can decide what medical treatment you want to accept or reject. You will be given information and advice about the pros and cons of different kinds of treatment and you can ask questions about your options. But only you can say "yes" or "no" to any treatment offered. You can say "no" even if the treatment you refuse might keep you alive longer and even if others want you to have it.

WHAT IF I'M IN NO CONDITION TO DECIDE? Ifyou become unable to make your own decisions about medical care, decisions will have to be made for you. If you haven't given prior instructions, no one will know what you would l d refuse treatment if you were want. There may be difficult questions: for instance, w o ~ ~you unconscious and not likely to wake up? Would you refuse treatment ifyou were going to die soon no matter what? Would you want to receive any treatment your care givers recommend? When your wishes are not known, your family'or the courts may have to decide what to do.

WHAT CAN I DO NOW TO SEE THAT MY WISHES ARE HONORED IN THE FUTURE? While you are competent, you can name someone to make medical treatment decisions for you should you ever be unable to make them for yourself. To be certain that the person you name has the legal right to make those decisions, you must fillout a form called either a durable power of attorney for health care or a Patient Advocate Designation. The person named in the form to make or carry out your decisions about treatment is called a Patient Advocate. You have the right to give your Patient Advocate, your care givers and your family and friends written or spoken instructions about what medical treatment you want and don't want to receive.

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

A t t a d ~ 4.34-A ~ ~ ~ t

Page l(e)

WHO CAN BE MY PATIENT ADVOCATE? You can choose anyone to be your Patient Advocate as long as the person is at least 18 years old. You can pick a family member or a friend or any other person you trust, but you should make sure that person is willing to serve by signing an acceptance form. It's a good idea to name a backup choice, too, just in case the first person is unwilling or unable to act when the time comes.

WHERE CAN I GET A PATIENT ADVOCATE DESIGNATION FORM? Many Michigan hospitals, health maintenance organizations, nursing homes, homes for the aged, hospices and home health care agencies make forms available to people tree of charge. Many senior citizens' groups and church and civic groups do, too. You can also get a free form from various members of the Michigan legislature. Many lawyers also prepare Patient Advocate Designations for their clients. The forms aren't all alike. You should pick the one which suits your situation the best.

.+OW DO 1 SIGNA PATIENTADVOCATE DESIGNATION FORM SO THAT IT'S VALID? I

All you have to do is fill in the name of the advocate and sign the form in front of two witnesses. But that's not as simple as it sounds, because under this law some people cannot be your witnesses. Your spouse, parents, grandchildren, children, and brothers or sisters, for example, cannot witness your signature. Neither can anyone else who could be your heir or who is named to receive something in your will, or who is an employee of a company that insures your life or health. Finally, the law disqualifies the person you name as your Patient Advocate, your doctors and all employees of the facility or agency providing health care to you from being a witness to your signature. It is easier to make a Patient Advocate Designation before you become a patient or resident of a health care facility or agency. Friends or co-workers are often good people to ask to be witnesses, since they see you often and can, if necessary, swear that you acted voluntarily and were of sound mind when you made out the form.

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Attachment 4.34-A Page l(f)

DO I HAVE TO GIVE MY PATIENT ADVOCATE INSTRUCTIONS? No. A Patient Advocate Designation can be used just to name your Patient Advocate, the person you want to make decisions for you. But written instructions are generally helpful to everybody involved. And, if you want your Patient Advocate to be able to refuse treatment and let you die, you have to say so specifically in the Patient Advocate Designation document itself. Any other instructions you have you can either write down or just tell your Patient Advocate. Either way, the Patient Advocate's job is to follow your instructions.

CAN I JUST GIVE INSTRUCTIONS AND NOT NAME A PATIENT ADVOCATE? Yes, you can simply tell somebody, for example, your care giver or your family and close friends, what your wishes are. Better yet, you can write what is called a "Living Will," which is a written statement of your choices about medical treatment. Even though there is not yet a state Living Will law, courts and health care providers still find Living Wills valuable. Those taking care of you will pay more attention to what you have written about your treatment choices, whether in a Patient Advocate Designation or a Living Will, because they can be more confident they know what you would have wanted. Most doctors, hospitals and other health care providers will also pay attention to what you've said to others, especially your family, about medical treatment. But again, it's better for everyone involved if you write your wishes down.

DO 1 HAVE TO MAKE A DECISION NOW ABOUT MY FUTURE MEDICAL TREATMENT? No. You don't have to fill out a Patient Advocate Designation or a Living Will and you don't have to tell anybody your wishes about medical treatment. You will still get the medical treatment you choose now, while you are competent. Ifyou become unable to make decisions, but you've made sure that your family and friends know what you would want, they will be able to follow your wishes. Without instructions from you, your family or friends and care givers may still be able to agree how to proceed. Ifthey don't, however, a court may have to name a guardian to make decisions for you.

IF I MAKE DECISIONS NOW, CAN I CHANGE MY MIND LATER? Yes. You can give new instructions in writing or orally. You can also change your mind about naming a Patient Advocate at all and cancel a Patient Advocate Designation at any time.

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

A t t a c h m e n t 4.34-A

Page l(g)

lou should review your Patient Advocate Designation or Living WilI at least once a year to make sure it still accurately states how you want to be treated andlor names the person you want to make decisions for you.

WHAT ELSE SHOULD I THINK ABOUT? Treatment decisions are difficult. We encourage you to think about them in advance and discuss them with your family, friends, advisors and care givers. You can and should ask your facility or agency about their treatment policies and procedures to be sure you understand them and how they work.

If you want more information about a Patient Advocate Designation or Living Wills, or sample forms, pIease ask your care givers for assistance. Many facilities and agencies have staff available who can answer your qustions. Additional materials may be available from your state representative or senator.

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

A t t a c h m e n t 4.34-A

Page l ( h )

OMNIBUS BUDGET RECONCILIATION ACT OF 1990 P.L. 101-508 TEXT OF THE PATENT SELFDETERMINATION ACT SEC. 4206. MEDICARE PROVIDER AGREEMENTS ASSURING THE IMPLEMENTATION OF A PATIENT'S RIGHT TO PARTICIPATE IN AND DIRECT HEALTH CARE DECISIONS AFFECTING THE PATIENT.

In General is amended

(a)

-Section 18fh(a)(1)(42 U.S.C. 1395cc(a)(l))

-

(1) in subsection (a)(])

-

(A) by s~iking"and" at the end of subparagraph (0). (B) by saiking the period at thc end of subparagraph (P) and insating ",and". and

(0 by inserting afta subparagraph (P) h e following new subparagraph:

'@) to document in the individual's medical record whether or not the individual has executed an advance directive;

'(C) not to condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance diiectivc;

"0) to cnsun compliance with requirements of Sute law (whether statutory or as recognized by the courts of the State) respecting advance dimlives at faciliries of h e provider or organization; and "0to provide (iidividually or with others) for education for staff and the community on issues concerning advance directives. Subparagraph (C) shall not be construed as requiring the provision of care which conflicts with an advance directive. '(2) The written i n f m t i o n described in paragraph

(l)(A) shall be pvidcd to an adult individual

'(a

'(A) in the case of a hospital. at the time of the individual's admission as an inpatient,

in the case of hospitals, skilled nursing facilities. home health agencies, and hospice programs. to camply with tht requirement of subseaion (f) (relating to maintaining written policies and procedures respecting advance directives)."; and

'(B) in the case of a skilled nursing facility. at the timc of Ihc individual's admission as a resident, '(C) in the case of a home health agency. in advance of the individual coming under the care of the

(2) by insening after subsection (e) the following new

subsection:

ag=Y *

"(f)(l) For purposes of subsection (a)(l)O and sections 1819 (c)(2)0. 1833(r). 1876(c)(l). and 1891(a)(6). the requirement of this subseetion is that a provider of services or prepaid or eligible organization (as the case may be) maintain written policies and procedm with respect to all adult individuals receiving media can by or through the provider or organization

"(D) in the case of a hospice program, at the time of

initial receipt of hospice we by the individual ffom the program, and 'Q in thc case of an eligible organization (as defined in section 1876(B)) or an organization providcd payrncnts under section 1833(a)(l)(A). at the lime of enrollment of the individual with thc organization. .

-

"(A) to provide written information to each such individual concerning "(i) an individual's rights undcr Slate law (whether

statutory or as recognized by the couns of the State) to make decisions concerning such medical care. including the right to aECCpt or refuse medical or surgical lrcatmcnt and the right to formulate advance directives (as defined in paragraph (3)). and "(ii) the written policies of the providcr or arganization respecting the implementation of such rights;

-

In this subsection. the term 'advance directive' mcans a written insmaion. such as a living will or durablc powa of attorney for heallh care, recognized under Slatc law (whether statutory or as recognized by the c a w of the State) and relating to the provision of such care when he individual is incqxitated.". '(3)

-

(b) Application to Rcpaid Organizations. (1) Eligible Organizations. Scction 1876(c) of such Act (42 USC. 1395 mm(c)) is amended by addimg at the end the following new parapph:

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

-

A t t a c h m e n t 4.34-A

Page l(i)

"(8) A contract under Lhis section shall provide that the . eligible organization shall meet the requirement of section 1866(f) (relating to maintaining writtcn policies and procedures-*ting advance direcGvcs).". -

-

(2) Other Prcpaid Organizations. Section 1833 of such Act (42 U.S.C. 13951) is amended by adding at the end the following new subsection: "(r) The Secretary may not provide for palmcnt under subsection (a) (1) (A) with respect to an organimion unless the organization provides assurances satisfactory to the Secretary that the organization meets the requirement of section 1866(f) (relating to maintaining written policies and procedures respecling advance directives).".

-

(c) Effect on State Law. Nothing in subsdons (a) and @) shall be consaued to prohibit the application of a State law which allows for an objection on the basis of conscience for any health carc provider or any agent of such provider which. as a matter of conscience. cannot implement an advance directive. (d) Conforming Amendments.

-

(1) Section 1819 (c)(l) of such Act (42U.S.C. 1395i3(c)(l)) is amended by adding at the end the following new subparagraph:

"(E) Information Respecting Advance Directives. -

A skilled nursing facility must comply with thc

requirement of scction 1866(f) (relating to maintaining written policies and procedures respecting advance directives).". (2) Scction 1891(a) of such Act (42 U.S.C. 1395bbb(a)) is amended by adding at the end the following:

'(6) The agency complies with the requirement of section 1866(f) (relating to maintaining written policies and procedures respecting advance directives).". (e) Effective Dates.

-

(1) The amendments made by subsections (a) and (d) shall apply with rr~pectto services furnished on or after the first day of Ihe first month beginning mok than 1 year after Ihe date of the enactment of this Act. (2) The amendmentsmade by subsection (b) shall apply to contracts under section 1876of he Social Security Act and payments under section 1833 (a)(l)(A) of such Act as a fmt day of the tint month beginning more than 1 year afm the date of the macunent of this Act.

SEC. 4751. REQUIREMENTS FOR ADVANCED DIRECTIVES UNDER STATE PLANS FOR MEDICAL ASSISTANCE.

-

(a) In General. Section 1902 (42 US.C. 1396a(a)). as amended by sections 4401(a)(2). 4601(d). 4701(a). 4711. and 4722 ofthistitle. is amended (1) in subsection (a)

-

-

(A) by striking "and" at the end of paragraph (55). (B) by striking the period at the end of paragraph (56) and insening ";and", and

(C) by inscning after paragraph (56) the following new paragraphs: "(57) provide that each hospital, nursing facility, provider of homc health care or personal care srrvices, hospice program. or hcalth maintenance organization (as defined in section 1903(m)(l)(A))receiving funds under the plan shall comply with the requircments of subsection (w); "(58) provide lhat the State. acting through a State agency, association. or olher private nonprofit entity, develop a written description of the law of the State (whethm statutory or as recognized by Ihe courts of the State) concerning advance directives that would bc disuibutcd by providms or organizations under the requircments of subsection (w)."; and (2) by adding at Ihe end the following new subsection: "(w)(l) For purposes of subsection (a)(57) and sections 1903(m)(l)(a)and 1919(c)(ZXE). the q u i r m c n t of this subsection is that a provider or organization (as the w e m y be) maintain written policies and procedwes with rcspcct to all adult individuals receiving medical care by or through the provider or organization

-

"(A) to provide wriuen information to each such individual conarning

-

"(i) an individual's rights under State law (whcthcr statutory or as recognized by the courts of the State) to make decisions conccming such medical care. including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives (as defied in paragraph (311, and "(ii) the provider's or organization's written policies respecting the implanentatjon of sucb rights; '(B) to document in the individual's medical recard whether or not the individual has executed an advance directive;

'(0 not to conditim the provision of care or otherwise discriminate against an individual based on whether or not the mdividual has executed an advance directive? October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Atta-t

Page l ( j)

(D) to ensure compliance with nquircmmu of State law (whetha sWutm Or as mgnizd of Ur Sute) respecting advance directives; and

"(E)to provide (individually or with others) for education for staff and the community on issues concerning advance directives. Subparagraph (C) shall not be construed as requiring the provision of can which conflicts with an advance directive. "(2) The written information described in paragraph (l)(A) shall be provided to an adult individual

-

"(A) in the case of a hospital. a the time of the individual's admission as an inpatient. "(B) in the ease of a nursing facility. at the Lime of the individual's admission as a resident.

"(C) in the case of a provider of home health care or personal care services. in advance of the individual coming unda the care of the prwida, "(D) in the case of a hospice program. at the time of initial receipt of hospice care by the individual from the p r o m and

"Oin the case of a health maintenance organization, at the time of avollment of the individual with the organization. "(3) Nothing in this section shall be cansmed to prohibit the application of a State law which allows for an objection on the basis of conscience for any health care provider or any agent of such provider which as a matter of conscience cannot implement an advance directive.". "(4) In this subsection, the term 'advance directive*means a

written insauction, such as a living will or durable power of attomey for health can.recognized unda State law (whether statutory or as mgnizcd by the c o w of the State) and relating to the provision of such care when the individual is incapacitated. (b) Conforming Amendments.

-

(c) Effective Date. -The amendmenu made by Lhis section wih respecl to f-shed on or the fmt day of the first month beginning more than 1 year after the date of the emactmen1of this Act. (d) Public Education Campaign.

-

(1) section 1903(rn)(l)(A)(42 U5.C. 1396(b)(m)(l)(A))

(1) In General. The Smtary. no later than 6 months altcr the date of enactment of this section. shall develop and implement a national campaign to infonn the public of the option to execute advance directives md of a patient's righu to participate and direct health care decisions. (2) Development and Distribution of Information. -The

Sccrctary shall develop or approve nationwide informational materials that would be distributed by providers under the requirements of this section. to inform the public and the medical and legal profession of each penon's right to make decisions concerning medical care, including the right to accept or refuse mcdical or sugical ueatment. and the existenceof advance directives.

-

(3) Roviding Assistance to States. The Secretray shall assist appropriate State agencies. associations, or otha private entities in developing the State-specific documents tha would be disdbuted by providers under the rquircrnents of this section. Thc S m t a r y shall funha assist appropriate State agencies, associations. or otha ensuring that providers arc provided a private entities i i ~ copy of the documents that are to be dislributed unda the requirements of the section. (4) Duties of Secretary. -The

Secrelary shdl mail information to Social Security recipients. add a page to the medicare handbook with rcspcct to the provisions of this section.

LAYWERS ASSOCIATION

(A) by inserting 'meets the nquircment of section 1902 (w)" after "which" the fvtt place it appears, and

(B) by inserting "meets the requirement of section 1902(a) and' after "which" the second place k appears. (2) Section 1919(c)(2) of such Act (42US.C. 1396r(c)(2)) is amended by adding at the end the following new subparagraph:

-A

nursing facility must camply wilh the requirement of

section 1 W w ) (relating to maintaining written policies and procedures respecting advana directives)

.:

-

PROVIDED COURTESY OFTHE NATIONAL HEALTH

is amended -

Infarmation respecting advancc dircctivcs.

4.34-A

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Attachment 4.34-A

Page l(k)

PRACTICAL CONSIDERATIONS FOR HEALTHCARE PROVIDERS REGARDING THE IMPLEMENTATION OF THE PATIENT SELFDETERMINATION ACT OF 1990 By Thoma M. Fahey. Esquire. and Anne M. M q h y . Esquire. ojcofield ungaretti Harris & Slavin, Chicago, Illinois.

Healthcare instutions subject to the patient selfdetcrmination provisions of OBRA 1990 (the "Act") will need to address a number of issues regarding implementation of the Act. Some of thcsc questions involve interpreting the language of the Act itself and. when issued, regulations to be promulgated by the Health Care Financing Adminislration (HCFA), (the "Regulations"). Others involve deciding whether it is advisable to take measures technically not mandated under thc Act. but which may logically flow from these requiements. Set forth below are a number of issues commonly raised by healthcare institutions making preliminary plans for compliance with the Act htitutions may derive some comfon from the recognition that they are not alone in having these questions; however. there are not pat answers to most concerns. Lack of definitive guidance is caused by a number of factors, including the relatively broad nature of the Act, the cumnt lack of regulatory guidance and anticipated brevity of the interpetive Regulations. the continuing evolution of Slate law in many jurisdictions regarding advance directives and the right to terminate life suppon, and the need to evaluate the Act's requiremcnu in thc context of each institution's uniquc characteristics.

O The Act requins distribution of

watteninjormation to

certain patients. Many institutions are unclear as to the

scope of their responsibilities in implementing this provision.

(a) Written information must have fuo components: (i) a summary of individual rights under State law to makc

decisions regarding medical carc (including thc right to refuse or accept medical treatment arld execute an advance directive); and (ii) the written plicies of the entity regarding implementation of those rights. (i) 'The summary of State law ultimately should be furnished to providers by a State agency or assockion, thereby presumably maximizing consistency among institutions. In some jurisdictions, rapid evolution in the law will make it very difficult to compile an accurate, understandable

summary. (ii) Each institution will be rcquircd to maintain a

written policy regarding application by it of Stote

law covering the right to accept or tcrmmatc

medical treatment and execute advance directives. Healthcare institutions without such a policy in place will have to draft one. In drafting such a document, some institutions may avail themselves of State-specific form policies distributed by agencies or associations. Thought must be given to which persons or committees arc bcst suited to thc task of drafting or approving this policy. This may be especially difficult for nonhospital entities such as nursing facilities and home health agcncies, which may not have expertise to address fully Lhcsc concerns. If State law in this arca is confused, formulation of a written policy rcflccting the law will be made more difficult. (b) Written information is to be distributed to a11 a d f s . 'The Act makes no provision for distributing writtn information to an adult patient that is admitted or ~ incompetent. Unlcss initially comes under c a while addressed in the Regulations. institutions will have to decide whether or how to distribute written infonnation in these situations.

(c) Written information, generally stated. must be distributed to the patient ot the lime ojodmission to a hospital or nursing facility. or initially upon coming undcr the care of a home health agency, hospice or HMO. "Admission" is not defined in the Act, although it might be clarified in the Regulations. If consistent with the Regulation, institutions might consider mailing written infonnation with preadmission materials. (d) The Act is silent as to exactly how. or by whom, the witten i n f o ~ t i o nis to be distributed to patienu.

lnstilutions may wish to consult with othcr providers alrcady voluntarily making this type of infonnation available to get a sense of the range of options available (i.e.. use of social workers. chaplains, designatcd professional or nonprofessional staff memkrs).

(c) 7hc Act docs not instruct an institution how to handle inslanccs in which distribution of writcn information prompts a patient request to uecute an dvance directive. In othcr words, institutions are neither required to. nor prohibited from. providing assistance to patienu wishing to pnparc such a document. Again. preliminary indications are that the Regulations also will not provide a mandate on this issue. As a result, institutions probably will have to decidc for themselves whether to decline any involvcment in this process. make fonns available or

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

A t t a c h m e n t 4.34-A

Page 1(1) provide more extensive counseling regarding advance directives. If an institution decides to provide some guidance to patients, care must be taken to avoid the appearance of undue influence by institution personnel (this may be especially w e in nursing facilities) -for example, by prohibiting employees from witnessing advance directives if this is not already prohibited under State law.

(2) Institutions must document the patient's medical record to indicate whether an advance directive exists. m e Act does not rquire that a copy of the advance directive be

obtained and made a pan of the medical record. although State law regarding advance directives may otherwise impose this obligation upon Lhe attending physician. hospitals. or other providers. Institutions nevertheless might decide that the advance directive should bc made a part of the medical record, with provisions for confiiing its continued validity upon any re-admission or renewal of services. (3) TBe Act mandates that institutions provide education lo the stqfand t k cowununiry regarding advance directives issues. It is imporlan~UI note that these programs can be

provided by a number of different instiartions acting collectively.

Provided Courtesy of the National Health Lawyers Association

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Revision:

HCFA-PM-95-4 JUNE 1995

(HSQS)

Attachment 4.35-A Paye /

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY A C T State/Territory:

M i chiuan

ELIGIBILITY CONDITIONS AND REQUIREMENTS Enforcement of Corrrpliance for Nursing Facilities The State uses other factors described below to determine the seriousness of deficiencies in addition to those described at §488.404(b) (1):

TN No. 95-13 Supersedes TN No. q.l/-a/

Approval Date:

//-a '7 5

Effective Date: 9-30-95

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Revision:

HCFA-PM-95-4 JUNE 1995

(HSQB

Attachment 4.35-B /

Page

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State/Territory:

Michigan

ELIGIBILITY CONDITIONS AND REQUIREMENTS Enforcement of Compliance for Nursing Facilities Termination of Provider Aureement: Describe the criteria (as required at §1919(h)(2) (A)) for applying the remedy.

X Specified Remedy (Will use the criteria and notice requirements specified in the regulation.)

TN NO. 95-/5

supersedes TN NO.

G4&2/

Approval Date : )'-jl-95

Effective Date: 9 -

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Revision:

HCFA-PM-95-4 JUNE 1995

(HSQB)

Attachment 4.35-C i

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURIT?? ACT ~tate/Territory:

Michigan

ELIGIBILITY CONDITIONS AND REQUIRENESTS Enforcement of Compliance for Nursing Facilities Temporarv Manasement: applying the remedy.

Describe the criteria (as required at §1919(h)(2)(A)) for

X Specified Remedy -

- Alternative Remedy

(Will use the criteria and notice requirements specified in the regulation.)

(Describe the criteria and demonstrate that the alternative remedy is as effective in deterring non-compliance. Notice requirements are as specified in the regulations.)

TN No. 9515 Supersede NO. 6 4 / ~ /

Approval Date : 11-2-95

Effective Date:

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

*-

Revision: HCFA-PM-95-4 XiWE 1995

(HSQB)

Attachment 4.35-D

fpge1

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State/Territory:

Mi chi gan

ELIGIBILITY CONDITIONS AND REQUIREMENTS Enforcement of Compliance for Nursing Facilities

Denial of Payment for New Admissions: Describe the criteria (as required at §I919(h)(2)(A)) for applying the remedy.

-X

- Alternative Remedy

Specified Remedy

(Will use the criteria and notice requirements specified in the regulation.)

TN No.

93--/5

Supersedes TN No. 9 4 ~ 2 /

(Describe the criteria and demonstrate that the alternative remedy is as effective in deterring non-compliance. Notice requirements are as specified in the regulations.)

Approval Date : i/-d-qS

Effective Date :

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

9-30-95

Attachment 4.35-E Page 1

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State of MICHIGAN

Eligibility Conditions and Requirements Enforcement of Compliance for Nursing Facilities Civil Money Penalty:

- Specified Remedy

-X Alternative Remedy

-

Civil Monev Penaltv Alternate Remedy A civil money penalty (CMP) may be assessed for any Level 2 or higher deficiency, but is primarily assessed for F-SQC or Harm deficiencies, and Level 2 deficiencies following removal of an lmmediate Jeopardy. The State Survey Agency (SSA) may consider using a Per Instance Civil Money Penalty of $1,000 to $10,000 when the beginning date of the deficiency cannot be determined, or when a Civil Money Penalty is combined with other enforcement actions, e.g. a discretionary denial of payment for new admissions, a directed plan of correction, or a directed in-service training. The total civil money penatties assessed cannot exceed $3,000 per day or $10,000 per instance. For Immediate Jeopardy citations, a minimum of $3,000 per day or per instance up to a maximum of $10,000 per day or per instance is assessed.

No Opportunitv to Correct Providers will not be given an opportunity to correct deficiencies before remedies are imposed when they have deficiencies of actual harm (or higher) on the current survey event, as well as on the previous standard survey or any intervening survey. The previous harm (or higher) level deficiency must have been in a completed survey cycle with compliance verified. The MDCH will impose either a Civil Money Penatty or Denial of Payment for New Admissions, or both. The MDCH may impose other optional federal remedies, described by remedy category at the end of this section. Enforcement remedies imposed under state licensure authority are also specified.

Opportunity to Correct An opportunity to correct deficiencies before remedies are imposed is not assured. The SSA has no obligation to give a provider an opportunity to correct deficiencies prior to imposing remedies and must only meet the minimum notice requirements that are applicable to the imposition of remedies. At the SSA's discretion, it may provide facilities an opportuntty to correct deficiencies before remedies are imposed when they do not meet the criteria for 'No Opportunity to Correct." When an opportunity to correct deficiencies before remedies are imposed is offered, the SSA will request an acceptable plan of correction; provide initial notice of possible enforcement action; conduct a revisit (if applicable); and, provide formal notice of other remedies if noncompliance continues at revisit. While formal notice of denial of payment for new admissions is generally provided in the first revisit letter, the SSA may provide it to the faciltty in the inlial deficiency notice.

TN NO.: 04-19

Approval Date:

Effective Date: 11/1/2004

Supersedes TN NO.: 99-07 October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Attachment 4.35-E Page 2

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

State of MICHIGAN Chapter 'The MDCH must impose a Denial of Payment for New Admissions (DPNA) no later than three months after the last day of the survey that identified the noncompliance if substantial compliance is not achieved. The MDCH may impose either a per day or per instance Civil Money Penalty for past noncompliance for days of noncompliance after the finding is made, or a combination thereof. Amounts will be determined by the MDCH based on facility history, repeating deficiencies, high number of deficiencies, culpability of the provider, failure to achieve or maintain substantial compliance and for increasing noncompliance. Prior notice is not required before the imposition of CMPs. A penalty equivalent to a one-day penalty will apply in all circumstances even if the violation(s) is immediately corrected. The daily penalty will end on the day prior to the determination of substantial compliance, or on the day prior to the determination that a civil money penalty is no longer warranted. The SSA determines compliance. CMP amounts may be increased to reflect changes in levels of noncompliance at revisit or for repeat deficiencies. The SSA has developed a CMP schedule for Immediate Jeopardy and Harm or Potential Harm occurrences to promote a consistent application of penalties. The CMP schedule conforms to 42 CFR 488.408 and is intended to cover the majorii of cases of CMP imposition. Situations may occur that justify exceptions. Accrual of CMPs ceases when one of the following situations occurs: the facility is determined by the SSA to have achieved substantial compliance closure of a facility as evidenced by the filing of a notice of discontinuance of operation with the Michigan Department of Community Health under section 21785 of Act 368 of the Public Acts of 1978, as amended, being 333.21785 of the Michigan Compiled Laws. termination of a provider agreement Installment schedules are not allowed for payment of CMPs. Civil money penalties are not allowable Medicaid costs. Use of CMP Funds

Money collected by the State Medicaid Agency (SMA) as a result of civil money penalties is held in a special fund to be applied to the protection of the health or property of residents of any nursing facility that MDCH finds deficient. Money recovered by the SMA from funds due a facility (because of lack of payment of civil money penalties by the facility) is also deposited in this fund.

TN NO.: 04-19

Approval Date:

2?

-

7?.7C

. -,

Effective Date: 11/1/2004

Supersedes TN No.: 09-77 October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Attachment 4.35-E Page 3

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State of MICHIGAN

Eligibility Conditions and Requirements Failure to Re-admit a Qualified Medicaid Resident A daily Civil Money Penatty (CMP) of $400 will be imposed when an enrolled Medicaid facility refuses to re-admit a qualified Medicaid resident (as defined by CMS) following hospitalization. An opportunity to correct will not be provided. This daily CMP will start on the date validated by MDCH that nursing home readmission should have occurred. The daily $400 CMP continues until the resident is offered the next qualifying available Medicaid bed at the refusing facility, or the resident is placed in another suitable facility. The refusing facility will be notified by the SSA when an allegation of failure to readmit a qualified Medicaid resident is being investigated.

Alternate Remedv is as Effective in Deterrinq Non-compliance. lmwsition of CMPs conforms to the reaulation. 'The alternative comDonent of MDCH 's application of the remedy is that repayment schedules are not allowed. If the entire penalty amount is not voluntarily submitted within 30 days of notice that the CMP is due and payable or within 15 days of issuance of appeal results, the CMP amount is recovered in total by gross adjustment against the facility's next available Medicaid warrant or during final cost settlement in a change of ownership. 'Therefore, interest does not accrue. This alternative to the federal regulation of requiring collection of daily interest has been found to be administratively simple. Fine collection is not unduly delayed. Disallowing penalty payment schedules reduces paperwork for MDCH and providers and saves time in negotiating penalty payment schedules. Federal Enforcement Remedies Each federal remedy below is described in rules as stated in 42 CFR 488 et.seq., and further discussed in the CMS State Operations manual for Medicaid and/or Medicare certified facilities. Federal remedies available to MDCH or CMS include, but are not limited to: Category One: State Monitoring Directed Plan of Correction Directed In-service Training Category Two: Denial of Payment for new Admissions Denial of Payment for All Individuals, Imposed by CMS Civil Money Penalties $50 to $3,000 Administrative/Clinical Advisor (Additional Remedy) Category Three: Temporary Management

TN NO.: 04-19

Approval Date:

F-G 2.

,

!

-,17,h

Supersedes TN NO.: 99-07 October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Effective Date: 11/1/2004

Attachment 4.35-E Page 4

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State of MICHIGAN

Eligibility Conditions and Requirements Termination of Medical Assistance Provider Enrollment and Trading Partner Agreement Civil Money Penalties $3,050 to $10,000 Transfer of residents Closure of Facility with Transfer of Residents Alternative or specified state remedies approved by CMS The SSA has the option of imposing any state or federal remedy based on the facility's failure to maintain compliance, deficiencies cited within the same regulatory grouping that repeat within the last 24 months (or two standard sunrey cycles), and the degree of culpability of the facility. In addition to federal remedies, the SMA may accept one or more of the following enforcement actions taken by the SSA under state licensure authority. Michigan Enforcement Rules for Long Term Care Facilities at R 330.1 1001-330.1 1017: Emergency Order Limiting, Suspending or Revoking a License Notice of Intent to Revoke Licensure Correction Notice to Ban Admissions or Readmissions Transfer Selected Patients; Reduce Licensed Capacity; or Comply with Specific Requirements Appointment of a Temporary ManagerIAdvisor State Patient Rights Penalties, if applicable

TN NO.: 04-19 Supersedes TN NO.: 99-07

Approval Date:

kt3

-

---:
GJ

Effective Date: 1110112004

Supersedes TN NO.: 99-07 October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Revieion: HCFA-PM-91- 10

(BpD

ATTACHMENT 4.38 Page 1

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT state/Territory:

MICHIGAN

DISCLOSURE OF ADDITIONAL REGISTRY INFORMATION

The Michigan registery discloses through initial telephone contact 1) that the aide is certified and 2 ) abuse information. Written follow-up verification is sent ~ c contains: h

Name, Date of Birth, Gender Address City Where employed and addresses Date of training lhcation of training Date of written test Imation of written test Date of clinical test lhcation of clinical test Clinical evaluator code Certification date Certification code Certification numr

Approval Date 04/&

- 92

Effective Date 01-01-92 HCFA ID:

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

HCFA-PM-91-10

Revieion:

( BPD

ATTACHMENT Page 1

4.3-

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT state/Territory:

MICHIGAN

COLLECTION OF ADDITIONAL REGISTRY INFORMATION

In addition to data specified in 42 CFR 483.15b(c), the Michigan register stores clinical evaluator codes which identify the individual that performed the clinicdl evaluation.

TN No.

Approval Date

N/A

&af-P+

xttective oat. HCFA ID:

Q U.S.

Gowarwnt Printin# Offica : 1991 -311-14¶/40413

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

01-01-92

Revision: HCFA-PM-92-3 APRIL 1992

(HsQB)

Attachment 4.40-A Page 1 OMB No.:

STATE PLAN UNDER TITLE XM OF THE SOCIAL SECURITY A f f StatelTemtory: ELIGIBILITY CONDITIONS AND REQUIREMENTS Survey and Certification Program

The State bas in effect the following m e y Pod certification periodic education program for the staff Pod resideate (d their repffsentatives) of nursing fpcilitiesio order to present curreat regulations, procedures, and policies.

Through a cooperative effort between the Michigan DepPrtmmt of Public Health (as the State Survey A g s y [SSA]) md h d t h care a t i s ~ ~ i nat di ~o ~r ~dber p~~fessioaol or a t e agencies, regional Pod periodic education program8 ue conducted. 'Ihese p m p m s focus on disseminating knowledge pertinent to relevant stnte .nd federal regulatory requiremats through tbe following mechanisms: ( 1 ) F o d and informal p r e s e n t a t i d ~ o n by s Staff Developmeat Unit personnel regarding regulatory changes, interpretrrtions, ageacy policy/procedure, and how to ~ccessinform~tion/other nsources furnished to clients and providers of care.

(2)Technicd assis&nce and educational and training progmms furnished by SSA LirMfiingICertificotionstaff.

(3)Notification to residents of their right to attend andlor participate in the meylcertification exit confereace.

M No.

9Y3/d

Supersedes TN No. N/A

Approval Date

4

93

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Effective Date 1- 1-9 3 HCFA ID:

Revision: HCFA-PM-92-3 APRIL 1992

At-t

4.40-B Page 1 OMB No.:

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT StatelTerritoxy: Michinaq

ELIGIBILITY CONDITIONS AND REQLJIREMENTS

P m s s for the Investigation of Allegations of Resident Neglect and Abuse and Misappropriation of Resident Property

The State ha8 in effect the following process for the receipt and timely review and investigation of allegations of neglect and rrbuso and misappropriation of resideat property by a nurse aide or a resident in a nursing focility by another individual used by the focility in providing services to such a resident. Michigan Public Hedth Code: 333.21771 Abusbg, ' -

"

yl, aneghhgp.tieat;q m r b i invcstiptio~;ret.li.tiaapdiibd

(1) A licensee, nursing home administrator, or employee of a nursing home shall not physically, nxmtally, or e d o n n l l y , abuse, mistreat, or harmfully neglect a patient. (2) A nurshg home employeewho becomes aware of an act prohibited by this section immediately shall report the matter to the nursing home administrator or nursing director. A nursing home administrator or nursing director who becomes swam of an act prohibited by this aection immediately shall report the matter by telephone to tbe DepPrtmeat of Public H d t h , which in turn &all notify the Doprrrtment of Social Services. (3) Aay person may report a violation of this section to the DepPrtmeot. (4) A physician or other liceased heolth care personnel of a hospital or other health care facility to which a patient is transferred who becomes a w m of an act prohibited by this saction shall report the act to the DepPrtmurt.

(5) Upon receipt of a report made under this section, the Departmat shall make an investigation. The DepPrtmeot may require the person muking the report to submit a writtea report or to supply pdditionnl infonrrption, or both. (6) A lica~seeor nursing home administrator shall not evict, borPss, dismiss, or retaliate against a patient, a patieht's represmtative, or an employee who makes a report under this section. 333.21799(8),-V

' ''&listing vid.tian ed public b p d h ; rcgoR ofMas;peprlly; request

complint; i n v c s t i e dieclorna; &9

p m k h a vid.tsd; copics of

fixbaring;noticbofbaring.

(1) A person who believes that this part, a rule promulgated under this part, or a federal certification regulation applying to a nursing home may hovc been violated may request an investigation of a nursing home. The request shall be submitted to the Department State Survey Agency-Michigan Deportment of Public Health as a written complaint or the Department shall

TN No.

$?g~fi

SupedN,A TN No.

Approval Date

4I-@

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

-

Effective Date 1 1-9 3 HCFA ID:

Revision: HCFA-PM-92-3 APRIL 1992

(HsQB)

Aupchmtnt 4.40-B Page 2 OMB No.:

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT Stote/remtory: ELIGIBILITY CONDlTiONS AND REQUIREMENTS

Pmcas for the Investigation of Allegations of Resident Neglect and Abuse and Misnppropriation of Resident Property the person in reducing an oral request to a writtea complaint within seven (7) &ye after the oral request is made. assist

(2) The substance of the complaint shall be provided to the liceasee no earlier than at the comnmcemeat of the on-site inspection of the nursing home which takes place pursuant to the complaint.

(3) Tbe complaint; a copy of the complaint; or a m r d published, released, or othenvisedisclosed to the nursing home shall not disclose the name of the c o m p b t or a [resident] named in the complaint unless the complainnot or [resident] consents in writing to the disclosure or the investigatim nsults in an dminisMive hearing or a judicial pmceedbg, or unless disclosure is considered essential to the investigation by the Depprtment. If the disclosure is considered essential to the investigation, the complahmt shall be given the opportunity to withdraw the complaint before disclosure. (4) Upon m i p t of a complaint, the Deptmeat shnll determine, based on the allegations p n s e n d , whethex this part, a rule promulgated under the part, or a federal certification regulatioa for nursing bomts has been, is, or is in danger of Wing violated. The Department shall investigate the complaint according to the urgeacy detemhed by the Deprrrtment. The initiation of a complaint investigation shall commeace within 15 &ye after mxipt of the written complaint by the Department.

(5) If, at any tim, the Dejmtnmt determines that this part, a rule promulgated under this part, or a federal certification regulation for nursing homes has been violated, the Deprutmeot shall List the violation md provisions violated on the state and federal licensure and cmtification forms for nursing homes. The violations shall be considered, as evideaced by a writtea explanation, by the Department whea it makes a licensun and certification decision or recommendation. (6) In all cases, the Depwtnmt shall inform the complainant of its findings unless, otherwise indicated by the complainant. Within 30 days after the receipt of complaiit, the Departmeat shall provide the complainant a copy, if any, of the writtea determination, the correction notice, the warning notice, and the state licensure or federal certification form, or both, on which the violation is listed, or a stahrs report indicating when these docummts may be expected. The final report shall include a copy of the original complaint. The complainant m y request additional copies of the doc-& listed in this subsection and shall reimburse the Degartment for the copies in rccord with established policies and p d u r e s .

w NO. 43-/O supersedes

TN No. N/A

Approval Date

qd/- 93

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

EffectiveDate 1-1-93 HCFA ID:

AttPchmot 4.40-B Page 3 OMB No.: STATE PLAN UNDER TlTLE ITLE OF THE SOCIAL SECURITY ACT S M h t o r y : Michinan

ELIGIBILITY CONDITIONS AND REQUIREMENTS

Process for the Investigation of Allegations of Raideat Neglect and Abuse and Misappropriation of Resideat Property (7) A writka determination, c o d o n notica, or waning notice wncemhg a complaint shall be available for public inspection, but the namo of the complainant or M e a t shall not be disclosed without the complainaat's or patieat's c0mea.t.

(8) A violation discovered as a result of the complaint investigation procedure ahdl be reported to penums administoring eectioae 217% to 21799~.The violation shall be a i w s d a pePPlty M described in this act. (9) A complainaut who is dissatisfied with the determination or investigation by the Depubmmt may quest. a hearing. A nquest for a hearing &all be submitted in writing to the Director

witbin 30 days after the mailing of the Deportmeat's findings as described in subsection (6). Notice of the time dplace of the hearbg shall be sent to the complainant and the nusing home. And any other provisions witbin the Michigan Public Health Code, if applicnble.

TN No.

sv==de= TN No.

q3-/0 N/A

Approval Date

4-/-?9

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Effective Date 1- 1-93 HCFA ID:

Revision: HCFA-PM-92-3 APRIL 1!X2

Attachmatt 4.40C Page 1 OMB No.:

mATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACI' Stnterrerritory: Michina

ELIGIBILITY CONDITIONS AND REQUIREMENTS Procedures for Scheduling and Conduct of Standiud Surveys

The State baa in effect IIIC following p d u r e s for tbe scheduling d d u c t of s&ndtud surveys to asam that it has taka all reasoonble steps to avoid giving d c c . Michigan Public Health W. 333.20155 Vitr b haltb hditias md rsmdg; inveetiptium ar pia no&kq .*~ m i P b m r r n n r @ t . t i m y i p i t B ; ~ p a i o d i E r s p a t e ; y . . 8 a r b ~8;

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~ & ; b m ; d ~ d & ~ o f b r ( i m -* d ~ ~ svidmoeof~b~.gcrrcy.

(1) Except as provided for clinical lnbo~toriesin Section 20511, the Deprtnmt Michigan Departmat of Public Health M tbe State Survey A m y ] ahdl make annual ad dher visits to henlth facilities and agencies covered by this article, other than a liceasee under Part 215, for the purposes of sumey, evaluation, ad consultotion. Except for facilities described in Section 2Olw(l)(f) and (h) [i.e., home for the aged a d nursing home], the Departmat ahdl determine whether the visits shall be announced or u n m m d , except that a complaint investigation shnll not be ad there shall be at leaut one (1) uzwnouced visit other tbnn a complaint investigocion annually to the facilities described in Section 20106(l)(c) d (d) [i.e., county medical cue fociIity d fraestsnding surgical wtpntiat facility]. The Depsrtmmt shall make biennial visits to hospitals for survey ad for evaluation for the purpose of liceawe. However, this requiremeat shall not be constmed to prohibit the Deportment from conducting investigations or inspections p u r s u ~to t Section 20156 or from conducting m e y s of hospitals for the purpose of complaint investigation or federal certification, nor to preclude the State Fire Mprshnl from d u c t i n g annual m e y s of hospitals. (2) Investigations or inspections. Mher than inspections of fum~5.lrecords of facilities described in Section 20lOd(l)(f) and (h) [i.e., home for the aged and nursing home], shall be conducted without prior noticc to the kility. An empIoyee of a state agency charged with inspecting the M i t y or an employee of a 1 4 health departmeat who directly or indirectly gives prior notice regding an inqkction, other than an irtspection of the fiDPncial records, to the facility or to an employee thereof, is guilty of a misdemeanor. Consultation visits, not for the p u p s c of annual or follow-up inspedon or survey, may be anaounced. (3) The Department shall maintain a record indicating whether visits are a n n d or

unannounced. Information gathered at all visits, announced or unannounced, shall be t a k a into

.ccount in licensure decisions.

TN NO. supersedes TN No. . N/A

Approval Date

4'-q3

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Attschmnt 4.#D Page 1 OMB No.:

Revision: HCFA-PM-92-3 APRIL 1992

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT SMemtory: ELIGIBILITY CONDITIONS AND REQUIREMENTS P r o m to Mepnue Pod Reduce Incons-Y The State has in effect the following programs to measure and reduce inconsistency in the application of survey d t s among surveyors.

Activities typically conductad on a routine or special basis include (1)Surveyor .tteodPnca at HCFAapoo8ored training on variws issues related to LTC survey process and interpntotions of requiremts. (2)Monthly inaervice tRiniag on general or specific issues identified as achrallpotezrtial inconsistency areas. (3)Upper-level maaagement and quality asswane reviews of all surveys involving specified &ficieociea prior to issuance of survey reports. (4)Periodic reviews of deficiency data for treads which m y indicate significant deviations from national, regional, and state citation rates. (5)Special studies of survey processes Pod hficieacy decision-making (e.g., during FY92 the State Survey Agency paxticipated, as one of 10 6elected states, in a shldy of OBRA survey process conducted by ABT Associates under a HCFA contract). (6)Adyses. in conjunction with HCFA, of Federal Monitoring Surveys conducted by HCFA surveyors &sequeat to State surveys of providers on n sampled basis. ( 7 ) h f o d reconsideration of deficiencies in cases where providers have cause to questionvalidity and encouragemeat for providers to ptuticipate in survey process and exit confemce. (8)Routine commdaications/rneetingswith provider md amsum=rorganizetiom to discusspossible misinterpdons.

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urrs of inconsisbcy &or

(9)Rotation of tepm lesders and other sweyors assigned to participate in individual surveys by each liceosing unit. Rotation of providers assigned to each licensing unit. (10)Paxticipation of quality assurance staff (senior sweyors) in surveys, either in m active surveyor role or as observers.

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October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

~ffectiveDate 1-1 -93 HCFA ID:

Revision: HCFA-PM-92-3 APRIL 1992

(HsQB)

AttPchmeot 4.40.D Page 2 OMB No.:

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT StataA'erritory: &chi gag EUGIBILITY CONDITIONS AND REQUIREMENTS Program to Measure and Reduce Inconsisteacy (1l)Ongoing stivities related to consisteat interpretations of regulations, through receipt Pnd distribution of HCFA material and by ideatifidon of itsues needing interpretation and/or cluificltion by HCFA. (12)Puticipntion in HCFA Surveyor Minimum Qualifications Test (SMQT). (13)Puticipntion in *odic provider tniniag programs sddressing the LTC requiremeat Pnd i n t e r p d m , with inteat of oddnssing paFPdwd inconsiskacies which nre due to provider misirrrerpretotions of requiremalts. ( 1 4 ) k c d emphasis on proper docwlyptation of deficieacies in survey reports, including we of HCFA 'Principles of Documentotion' guidelines published in 1992.

83//8

TN No. supersedes TN No. N/A

App~ovalDate

L/-/-93

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

EffectiveDate 1-1-93 HCFA ID:

Revision: HCFA-PM-92-3 APRIL 1992

(HsQB)

Attschmeat 4.40-E w e1 OMB No.:

STATE PLAN UNDER TITLE XM OF THE SOCIAL SECURITY ACI' State/Territory: ELIGIBILITY CONDITIONS AND REQUIREMENTS

Process for Investigations of Comphhb d Monitoring 'Ibe State has in effect the following process h r investigating complaints of violations of requirements by nursing facilities d monitors onsite on a regular, M needed basis, a nursing facility's compliance with

the requirements of subsection (b), (c), d (d) for the following reasons:

(i)the focility bas bem found not to be in compliance with such requirements and is in the process of correcting deficieocies to &eve such compliance; .ad hre (ii)the focility WM pmviously fwnd not to be in c o m p l h with such req-ts corrected deficimcies to achieve such compliance, .ad verification of conhued compliance is i n d i w , or

@)the Seto hns reason to question the compliance of the 'facility with such requirements. Michigan Public Health Code: 333.21799(a) V W a o ; ~vid.tad;copicsof& far~noticaofbarirpg.

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~ @ p l M i c ~ n p a r t d ~ p m r l Q ; ~

(1) A person who believes that this part, a nrle promulgated under this part, or a federal certification regulation applying to a nursing home m y have bem violated m y request an investigation of a nursing home. 'Ihe request shall be submitted to the DepPrtmeat State Survey Agency-Michigan Departmeat of Public Health M a Attea complaint or the D q m t m a t ahdl the person in d u c i n g an oral request to a writtea complaint within seven (7) days after the drequestismpde.

(2) 'Ihe substance of the complaint shall be provided to the licensee no d e r than .t the commemement of the on-site hqection of the nursing home which takes plsce pursuant to the complaint. (3) 'Ihe complaint; a copy of the complaint; or a record published, released, or otherwise disclosed to the nursing home shall not disclose the nem of the complainant or a [resideat] named in the complaint unless the complainant or [resideat] conseats in writing to the disclosure or the investigation results in an administrative hearing or a judicial proceeding, or unless disclosure is consided essential to the investigation by the Deprutment. If the disclosure is considered essential to the investigation, the compIainant shall be given the opportunity to withdraw the complaint before disclosure.

(4) Upon receipt of a complaint, the Deparhmt shall determine, bnsed on the allegations pffseated, whether this part, a rule promulgated under the part, or a federal certification regulation for nursing homes hns been, is, or is in danger of being violated. The D e p r h m t sball investigate the complaint according to the urgency determined by the Department. The initiation

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TN No. supersedes TN No. N/A

Appnwal Date

%/-~3

October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Effective Date 1-1-93 HCFA ID:

Revision: HCFA-PMm-3 APRIL 1992

(HsQB)

Avrehment 4.40-E hge2 OMB No.:

STATE PLAN UNDER TlTLE XIX OF THE SOCIAL SECURlTY ACI' SUeRerritmy: M i c b i m

ELIGIBILITY CONDITIONS AND REQUIREMENTS Process for the Investigation of Complaints and Monitoring of r complaint investigation shall coby the DepPrtment.

within 15 &ye rfter receipt of the writtea complaint

(5) If, at my time, the Deputmat determines that this put, r rule promulgated under this put, or r federal certifidon regulation for nursing homes has been violated, the Deportmeat dull list the viointion and provisions violated on the atare md fsdernf limd certification fonns for nursing hometi. The violati008sbrll be cod-, re by r writtm explsnotion, by the -mat when it makes r licensure and cartification Becision or recommaddon.

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(6) In dl cases, the Dcptmeat shall infonn the complainant of its findings unless, oh&

indicated by the complainaat. Within 30 &ye after the d p t of complaint, the Dcprtmmt shall provide the complainant r copy, if my, of the writ- determination, the correction notice, the warning notice, and the dote licensun or federal certification fom, or both, on which the violation is listed, or r stPhls report indicrting whm these d o a n m ~ tmay s be expted. The find report shall include r copy of the original complaint. 'Ihe complainant may request additional copies of the docru~lmtslisted in this ahsection and shall reimburse the Department for the copies in accord with established policies and procedures. (7) A written de&mbtion, correction notice, or warning notice amceraing r complaint shall be available for public inspection, but the nam of the complainant or patiat shall not be disclosed without the complainant'e or patieat'e contmt.

(8) A violation discovered re r d t of the complaint investigation procedure shall be reported to pemm administering sections 21799~to 21799e. The violation shall be asetsed r pedty re described in this 8ct. (9) A complainant who is dissatisfied with the determinntion or investigation by the Departmerrt mny quest r hearing. A request for r hearing shall be submitted in writing to the Di-r within 30 &ys after the mailing of the Depmwmt'e findings re described in subsection (6). Notice of the time and place of the hearing shall be smt to the complainnot and the nursing home. And my other provisions within the Michigm Public Health Code, if applicable.

Appmvd Date 4-/-4!3 s w ~ / ~ TN No. October 1, 2017 Version. This plan is provided for informational use only and does not replace the original vers ion.

Effective Date HCFA ID:

Attachment 4.42-A Page 1

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

State of MICHIGAN Employee Education about False Claims Recoveries The Michigan Department of Community Health (MDCH), Medical Services Administration (MSA) conducts an annual review of all enrolled Medicaid providers, Medical Care Organizations (MCOs), Pre-paid Inpatient Hospital Plans (PIHPs), Program of All-Inclusive Care for the Elder1y (PACE) contractors and any other entity that provides Medicaid health care items or services under Michigan's State Plan and waivers to determine those entities meeting the criteria covered by section 1902(a)(68) of the Social Security Act (SSA). Each provider, MCOs, PIHPs, PACE contractors and any other entity that provides Medicaid health care items or services under Michigan's State Plan and waivers meeting the criteria is sent an informational packet outlining the requirements of Section 6032 of the Deficit Reduction Act (DRA) of 2005 and their obligations and responsibilities under that mandate. This is done each year for all identified providers, MCOs, PIHPs, PACE contractors and any other entity that provides Medicaid health care items or services under Michigan's State Plan and waivers whether or not they received instructions in previous years. For calendar year 2007, initial letters outlining the entities' responsibilities and notices of the requirement to provide attestation and a 'Certification of Compliance' were sent to all identified entities during the second calendar year quarter. The initia/letters were sent AprilS, 2007, followed by the notice and 'Certification of Compliance' on June 27,2007. Beginning with calendar year 08 and on an annual basis thereafter, each identified entity receives a letter outlining their obligations and a 'Certification of Compliance' to be signed by an individual within the entity with attestation authority. The certification stipulates that the entity is in full compliance with the requirements of section 6032 of the Deficit Reduction Act of 2005. The notices and 'Certification of Compliance' are sent prior to the end of the first calendar year quarter of each year. For calendar year 07 and 08 and beyond, the entities have 60 days to return their attestations. Follow up to the attestation is conducted as part of the routine, ongoing monitoring and oversight of any entity conducted by the MDCH.

TN NO.: 07-06

Approval Date:

AUG 1 7 2007 _

Effective Date: 01/01/2007

Supersedes TN No.: N/A new page October 1, 2017 Version. This plan is provided

for informational use only and does not replace the original version.

Attachment 4.43 Page 1

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

State of MICHIGAN Cooperation with Medicaid Integrity Program Efforts

Citation

4.43

1902(a}(69} of the Act, P.L. 109-171 (section 6034)

TN NO.: 08-05

Cooperation with Medicaid Integrity Program Efforts The Medicaid agency assures it complies with such requirements determined by the Secretary to be necessary for carrying out the Medicaid Integrity Program established under section 1936 of the Act.

Approval

Dat~~_U_L_1_7_2_00_8

Effective Date: 04/01/2008

Supersedes TN No.: N/A new page October 1, 2017 Version. This plan is provided

for informational use only and does not replace the original version.

Attachment 4.44 Page 1

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State of MICHIGAN Cooperation with Medicaid Integrity Program Efforts Citation

4.44

1902(a)(80) of the Social Security Act, P.L. 111-148 (section 6505)

TN NO.: 11-01

Medicaid Prohibition on Payments to Institutions or Entities Located Outside of the United States The State shall not provide any payments for items or services provided under the State plan or under a waiver to any financial institution or entity located outside of the United States.

JUN 23 2011 Approval Date: __________________

Effective Date: 06/01/2011

Supersedes TN No.: N/A new page October 1, 2017 Version. This plan is provided

for informational use only and does not replace the original version.

Attachment 4.45 Page 1 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State of MICHIGAN Cooperation with Medicaid Integrity Program Efforts Citation 1902(a)(77) 1902(a)(39) 1902(kk); P.L. 111-148 and P.L. 111-152

4.45

Provider Screening and Enrollment The State Medicaid agency gives the following assurances:

42 CFR 455 Subpart E

PROVIDER SCREENING ☒ Assures that the State Medicaid agency complies with the process for screening providers under section 1902(a)(39), 1902(a)(77) and 1902(kk) of the Act.

42 CFR 455.410

ENROLLMENT AND SCREENING OF PROVIDERS ☒ Assures enrolled providers will be screened in accordance with 42 CFR 455.400 et seq. ☒ Assures that the State Medicaid agency requires all ordering or referring physicians or other professionals to be enrolled under the State plan or under a waiver of the Plan as a participating provider.

42 CFR 455.412

VERIFICATION OF PROVIDERS LICENSES ☒ Assures that the State Medicaid agency has a method for verifying providers licensed by the State and that such providers licenses have not expired or have no current limitations.

42 CFR 445.414

REVALIDATION OF ENROLLMENT ☒ Assures that providers will be revalidated regardless of provider type at least every 5 years.

42 CFR 455.416

TERMINATION OR DENIAL OR ENROLLMENT ☒ Assures that the State Medicaid agency will comply with section 1902(a)(39) of the Act and with requirements outlined in 42 CFR 455.416 for all terminations or denials of provider enrollment.

42 CFR 455.420

REACTIVATION OF PROVIDER ENROLLMENT ☒ Assures that any reactivation of a provider will include re-screening and payment of application fees as required by 42 CFR 455.460.

42 CFR 455.422

APPEAL RIGHTS ☒ Assures that all terminated providers and providers denied enrollment as a result of the requirements of 42 CFR 455.416 will have appeal rights available under procedures established by State law or regulation.

TN NO.: 12-03

JUN 22 2012 Approval Date: ___________________

Effective Date: 01/01/2012

Supersedes TN No.: N/A new page October 1, 2017 Version. This plan is provided

for informational use only and does not replace the original version.

Attachment 4.45 Page 2 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State of MICHIGAN Cooperation with Medicaid Integrity Program Efforts Citation 42 CFR 455.432

SITE VISITS ☒ Assures that pre-enrollment and post-enrollment site visits of providers who are in "moderate" or "high" risk categories will occur.

42 CFR 455.434

CRIMINAL BACKGROUND CHECKS ☒ Assures that providers, as a condition of enrollment, will be required to consent to criminal background checks including fingerprints, if required to do so under State law, or by the level of screening based on risk of fraud, waste or abuse of that category of provider.

42 CFR 455.436

FEDERAL DATABASE CHECKS ☒ Assures that the State Medicaid agency will perform Federal database checks on all providers or any person with an ownership or controlling interest or who is an agent or managing employee of the provider.

42 CFR 455.440

NATIONAL PROVIDER IDENTIFIER ☒ Assures that the State Medicaid agency requires the National Provider Identifier of any ordering or referring physician or other professional to be specified on any claim for payment that is based on an order or referral of the physician or other professional.

42 CFR 455.450

SCREENING LEVELS FOR MEDICAID PROVIDERS ☒ Assures that the State Medicaid agency complies with 1902(a)(77) and 1902(kk) of the Act and with the requirements outlined in 42 CFR 455.450 for screening levels based upon the categorical risk level determined for a provider.

42 CFR 455.460

APPLICATION FEE ☒ Assures that the State Medicaid agency complies with the requirements for collection of the application fee set forth in section 1866(j)(2)(C) of the Act and 42 CFR 455.460.

42 CFR 455.470

TEMPORARY MORATORIUM ON ENROLLMENT OF NEW PROVIDERS OR SUPPLIERS ☒ Assures that the State Medicaid agency complies with any temporary moratorium on the enrollment of new providers or provider types imposed by the Secretary under section 1866(j)(7) and 1902(kk)(4) of the Act, subject to any determination by the State and written notice to the Secretary that such a temporary moratorium would not adversely impact beneficiaries' access to medical assistance.

TN NO.: 12-03

JUN 22 2012 Approval Date: ___________________

Effective Date: 01/01/2012

Supersedes TN No.: N/A new page October 1, 2017 Version. This plan is provided

for informational use only and does not replace the original version.

Michigan's State Plan

SECTION 7: General Provisions

TN No.: N/A new page

October 1, 2017 Version. This plan isprovided

for informational use only and does not replace the original version.

A t t a c h m e n t 7.2-A STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

State:

MICHIGAN

NONDISCRIMINATION

This certifies that t h e Statement of Compliance (Form CB-FS 5022) and the S t a t e agency's implementing methods of administration submitted on March 2, 1965 and June 15, 1965 as a part of the S t a t e CWS and PA Plans a r e hereby extended t o t h e S t a t e Title XIX, Medical Assistance Program. The S t a t e Plan f o r Medical Assistance will b e administered in such a way that no person in the United S t a t e s will, on t h e ground of race, color, s e x o r national origin, be excluded from participation in, b e denied any aid, care, services, o r o t h e r benefits of, o r be otherwise subjected t o discrimination in the program under t h e S t a t e Plan. In addition t o the previously submitted implementing methods, t h e S t a t e agency will: 1.

Provide an informational pamphlet t o all persons requesting medical assistance which outlines t h e guarantees afforded them by t h e Civil Rights Act and t h e manner in which those subjected t o discrimination may obtain redress.

2.

Provide a separate pamphlet t o all persons requesting o r providing assistance outlining t h e requirements of t h e Civil Rights Act a s i t relates t~ departmental operations, and t h e rights of all persons receiving services from t h e department o r from vendor agencies and organizations. This pamphlet will also outline grievance procedures which may b e followed in t h e event of alleged discrimination.

3.

Assure t h a t all medical institutions, agencies, and organizations providing services under t h e program have signed a s t a t e m e n t of compliance either as a condition of participation under Title XVIII, a s a condition of receiving other Federal funds o r specifically for this program.

4.

Require a certification on all bills submitted by providers of services who have not signed a s t a t e m e n t of compliance that t h e services were rendered in accordance with t h e provisions of the Civil Rights Acl of 1964.

October 1, 2017 Version. This plan is provided

for informational use only and does not replace the original version.