Payment to Licensed Basic Care Facilities 400-29-75

(Revised 5/1/05 ML #2969)

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The Basic Care Assistance Program payment shall be authorized by the county through the Resident Payment System for room and board services received in a licensed basic care facility. The county authorizing the case shall send the "Notice of Action" to the basic care provider and to the recipient.

 

The Basic Care Assistance Program policy for hospital days is similar to the policy used by the Medicaid Program. A maximum of 15 days per occurrence will be allowed for payment for basic care during a time a recipient requires a level of care higher than basic care, including days in a hospital, swing bed, hospice care, or nursing facility, if the care plan provides that the resident will return to the basic care facility and the facility holds the bed until the resident returns. Payment for therapeutic days, or days when the resident is on personal leave, will be limited to 28 days per year. Basic care facilities will receive payment for room and board for leave days but not the payment for personal care services. A facility may charge to hold a bed for a period in excess of the maximums stated in this paragraph if the resident or a person acting on behalf of the resident has requested the bed be held, the facility informs the person making the request the amount of the charge, and the payment comes from a source other than the recipient's monthly income (75-02-07.1-04).

 

The basic care provider uses the Medical Management Information System (MMIS) billing codes to record and bill all resident in days and resident leave days, the date of entry into the basic care facility, and the date the individual left the basic care facility. The payment will be made directly to the provider by the Department based on the provider’s billing. The Department will not pay for billings for services from a basic care provider that are over a year old.

 

The date of entry is billable by the basic care facility, the date of discharge is not.

 

When a person moves from one basic care facility to another facility, the new facility will receive any payment from the resident that was not obligated at the previous facility. MMIS will identify the new facility name and process payment to both facilities if payment to both is required.

 

The facility may charge a higher rate for a private room used by a recipient if (NDAC 75-02-07.1-04):

 

  1. The private room is not necessary to meet the recipient's care needs;
  2. The recipient, or a person acting on behalf of the recipient, has requested a private room;
  3. The facility informs the person making the request of the amount of cost for a private room and that the payment must come from sources other than the recipient's monthly income;
  4. The payment does not exceed the amount charged to private pay individuals; and
  5. Appropriate semiprivate rooms are available at the time the first charges for a private room apply.