§ 20-47-303 — Multihour daily service rate reimbursement - Definitions

(a) As used in this section: (1) "Congregate setting" means a location within a residential care facility, an assisted living facility, or a designated residential setting of a nonprofit community program as defined in § 20-48-101 or its nonprofit affiliates; (2) "Designated residential setting" includes the following when operated by a nonprofit community program as defined in § 20-48-101 : (A) A group home for individuals with developmental disabilities in operation and licensed by the Division of Developmental Disabilities Services on or before July 1, 1995; (B) A community residential home established after July 1, 1995, that serves individuals with developmental disabilities and provides housing for no more than four (4) unrelated persons; or (C) An apartment complex established after July 1, 1995, that serves individuals with developmental disabilities; and (3) (A) "Intermediate care facility for individuals with developmental disabilities" means a residential institution maintained for the care and training of individuals with developmental disabilities, including without limitation individuals with intellectual disabilities. (B) "Intermediate care facility for individuals with developmental disabilities" has the same meaning as "intermediate care facility for individuals with intellectual disabilities" or "ICF/IID" under federal law. (b) (1) (A) The Department of Human Services shall reimburse residential care facilities, assisted living facilities, and qualified nonprofit community programs with a multihour daily service rate for personal care services delivered in congregate settings as provided in this section and approved by the Centers for Medicare & Medicaid Services. (B) The application of subdivision (b)(1)(A) of this section to nonprofit community programs is subject to available funds. (2) The department shall maintain Medicaid provider rules appropriate for the delivery of personal care services in congregate settings and the related multihour daily service rate reimbursement methodology. (3) The department shall make best efforts to obtain and maintain approval from the Centers for Medicare & Medicaid Services for a multihour daily service rate reimbursement for personal care services delivered in congregate settings. (c) The department shall provide copies to the Administrative Rules Subcommittee of the Legislative Council, providers, and the public of all state plan amendments, documentation, and correspondence submitted to or received from the Centers for Medicare & Medicaid Services in regard to this section and shall work jointly with provider representatives in obtaining and maintaining approval for a multihour daily service rate for personal care services delivered in congregate settings from the Centers for Medicare & Medicaid Services. (d) (1) The Division of Medical Services shall use the same multihour daily service rate reimbursement methodology for personal care services delivered in a congregate setting located in a designated residential setting of a nonprofit community program as defined in § 20-48-101 as for personal care services delivered in a congregate setting located in a residential care facility and an assisted living facility. (2) Reimbursement for personal care services under this section is not available to an individual with a developmental disability who resides in an intermediate care facility for individuals with developmental disabilities.

Legislative History

Amended by Act 2019, No. 315,§ 2145, eff. 7/24/2019. Amended by Act 2019, No. 315,§ 2144, eff. 7/24/2019. Acts 1999, No. 1421, § 3; 2011, No. 560, § 1; 2011, No. 1156, § 2.