Section R9-11-303. Nursing Care Institution Rates and Charges Schedule

A.      Before a nursing care institution provides services to residents, a nursing care institution administrator or designee shall sub- mit to the Department a rates and charges package that con- tains:

1.        A cover letter that includes:

a.        The name, physical address, mailing address, county, and telephone number of the nursing care institution;

b.        The name, physical address, mailing address, and telephone number of the nursing care institution’s:

i.         Home office, if applicable; and

ii.        Management company, if applicable;

c.        The identification number assigned to the nursing care institution:

i.         By the Department;

ii.        By AHCCCS, if applicable;

iii.      By Medicare, if applicable; and

iv.      As the nursing care institution’s national pro- vider identifier;

d.        The name, telephone number, and e-mail address of:

i.         The nursing care institution administrator,

ii.        The nursing care institution chief financial offi- cer, and

iii.      Another individual involved in the preparation of the rates and charges package whom the Department may contact regarding the rates and charges package; and

e.        The planned implementation date for the rates and charges;

2.        A rates and charges schedule, in a format specified by the Department, containing:

a.        A table of contents;

b.        A description of and the rates and charges for:

i.         Each type of bed; and

ii.        Each unit of service, other than a type of bed, for which a separate rate or charge is billed; and

c.        A copy of any nursing care institution rules or for- mulae which may affect the rate or charge for a type of bed or other unit of service; and

3.        A form provided by the Department, on which the nurs- ing care institution administrator or designee:

a.        Attests that, to the best of the knowledge and belief of the nursing care institution administrator or desig- nee, the information submitted according to subsec- tions (A)(1) and (A)(2) is accurate and complete; or

b.        If the nursing care institution administrator or desig- nee has personal knowledge that the information submitted according to subsections (A)(1) and (A)(2) is not accurate or not complete:

i.         Identifies the information that is not accurate or not complete;

ii.        Describes the circumstances that make the information not accurate or not complete;

iii.      States what actions the nursing care institution is taking to correct the inaccurate information or make the information complete; and

iv.      Attests that, to the best of the knowledge and belief of the nursing care institution administra- tor or designee, the information submitted according to subsections (A)(1) and (A)(2), except the information identified in subsection (A)(3)(b)(i), is accurate and complete.

B.       To change a nursing care institution’s current rates and charges information, a nursing care institution administrator or desig- nee shall submit to the Department:

1.        A cover letter:

a.        Containing the information specified in subsection (A)(1), and

b.        Stating that the accompanying information is chang- ing the nursing care institution’s current rates and charges information;

2.        Either:

a.        The rates and charges schedule specified in subsec- tion (A)(2); or

b.        The following information:

i.         A description of:

(1)     The current and new rate or charge for each type of bed or other unit of service undergoing a change, and

(2)     The current and new rules and formulae for each change to the nursing care institution rules or formulae that may

affect the rate or charge for a type of bed or other unit of service;

ii.        The line number or page number in the nursing care institution’s current rates and charges information for each change listed in subsec- tion (B)(2)(b)(i); and

iii.      A list of each previous change:

(1)     To a rate, charge, rule, or formula being changed;

(2)     That was submitted since the last rates and charges schedule submitted according to subsection (A)(2) or (B)(2)(a); and

(3)     Including:

(a)      The date the rate, charge, rule, or formula was previously changed; and

(b)     A description of how the rate, charge, rule, or formula was previously changed; and

3.        A form provided by the Department, on which the nurs- ing care institution administrator or designee:

a.        Attests that, to the best of the knowledge and belief of the nursing care institution administrator or desig- nee, the information submitted according to subsec- tions (B)(1) and (B)(2) is accurate and complete; or

b.        If the nursing care institution administrator or desig- nee has personal knowledge that the information submitted according to subsections  (B)(1)  and (B)(2) is not accurate or not complete:

i.         Identifies the information that is not accurate or not complete;

ii.        Describes the circumstances that make the information not accurate or not complete;

iii.      States what actions the nursing care institution is taking to correct the inaccurate information or make the information complete; and

iv.      Attests that, to the best of the knowledge and belief of the nursing care institution administra- tor or designee, the information submitted according to subsections (B)(1) and (B)(2), except the information identified in subsection (B)(3)(b)(i), is accurate and complete.

C.      A nursing care institution administrator shall implement rates and charges for a rates and charges schedule, submitted as specified in subsection (A), on a date determined by the nurs- ing care institution but not earlier than:

1.        The date the Department notifies the nursing care institu- tion that the Department has completed a review of the rates and charges schedule, or

2.        Sixty calendar days after the Department notifies the nursing care institution that the Department received the rates and charges schedule.

D.      A nursing care institution administrator shall implement a change in the nursing care institution’s current rates and charges information submitted as specified in subsection (B):

1.        That is:

a.        A new rate, charge, rule, or formula;

b.        An increase in a rate or charge; or

c.        A change to a rule or formula, which results in an increase in a rate or charge; and

2.        On a date determined by the nursing care institution, but not earlier than:

a.        The date the Department notifies the nursing care institution  that  the  Department  has  completed   a

review of the information submitted as specified in subsection (B), or

b.        Sixty calendar days after the Department notifies the nursing care institution that the Department received the information submitted as specified in subsection (B).

E.       A nursing care institution administrator shall implement a change in the nursing care institution’s current rates and charges information submitted as specified in subsection (B):

1.        That is:

a.        A deletion of rate or charge;

b.        A reduction in a rate or charge; or

c.        A change to a rule or formula, which results in a reduction in a rate or charge; and

2.        On a date:

a.        Determined by the nursing care institution, and

b.        Not earlier than the date the Department notifies the nursing care institution that the Department received the information submitted as specified in subsection (B).

F.       When the Department receives from a nursing care institution a rates and charges schedule submitted as specified in subsec- tion (A), or a change in the nursing care institution’s current rates and charges information submitted as specified in sub- section (B), the Department shall:

1.        Provide written notice to the nursing care institution within five business days of receipt of the rates and charges information, and

2.        Provide written notice to the nursing care institution within 60 calendar days that the Department has reviewed the rates and charges information.

G.      A nursing care institution administrator, who receives a request from the Department for a revision of a rates and charges schedule not prepared as specified in subsection (A) or for a revision of a change in the nursing care institution’s cur- rent rates and charges information not prepared as specified in subsection (B), shall ensure that the revised rates and charges schedule or the revised information changing the current rates and charges information is submitted to the Department:

1.        Within 21 calendar days after the date on the Depart- ment’s letter requesting an initial revision, and

2.        Within seven calendar days after the date on the Depart- ment’s letter requesting a second revision.

H.      If a nursing care institution administrator or designee does not submit a rates and charges schedule or information about changes to the nursing care institution’s rates and charges according to this Section, the Department may assess civil penalties as specified in A.R.S. § 36-431.01.

Historical Note

Section recodified from R9-11-105 at 10 A.A.R. 3835, effective August 24, 2004 (Supp. 04-3). Section repealed; new Section made by final rulemaking at 13 A.A.R.

3648, effective December 1, 2007 (Supp. 07-4).