Medicaid Nursing Facility Program by delontewest

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									                                              SENIOR AND LONG TERM CARE DIVISION
                                       DIRECT CARE WORKER WAGE AND BENEFITS INCREASES
                                                Medicaid Nursing Facility Program
                                                         State Fiscal Year 2008
                                                EXPLANATION AND INSTRUCTIONS

Intent: The 2007 Montana legislature authorized the Department of Public Health and Human Services funding for a Direct Care Worker Wage
Increase. Funds in the Direct Care Worker Wage Increase may be used to raise direct care worker wages and related benefits through an increase in
provider rates. Funds in Direct Care Worker Wage Increase may not be used to offset any other wage increase mandated by any other laws,
contracts, or written agreements, which will go into effect at the same time as or after implementation of the appropriation included in
Direct Care Worker Wage Increase.            1.    Funds in Direct Care Worker Wage Increase must first be used to raise the certified nursing aide
and personal care attendant direct care worker wages to $8.50 per hour and to raise related benefits. 2. Any remaining funds must be used to raise
wages, and related benefits, for direct care workers and other low paid staff.

Distribution Methodology: The Department will pay Medicaid certified nursing facilities located in Montana who submit an approved application,
an add-on to their computed Medicaid payment rate to be used only for wage and benefit increases for direct care workers in nursing facilities. The
department will determine a per day add-on payment, commencing July 1, 2007, as a pro rata share of appropriated funds allocated for increases in
direct care wages and benefits. This amount will be in addition to the computed formula rate that is established for each facility on July 1 of the rate
year using the price based reimbursement methodology.

Pro Rata Add-On: Each facility's pro rata add-on will be computed by dividing the total appropriated funding for direct care wages and benefits
increase by the total projected Medicaid days for fiscal year 2007 to determine the Medicaid per day add-on amount per Medicaid day. This pro rata
amount will be determined after all direct care worker wages have been increased to the $8.50 wage level. The amount that the department
determines payable to each facility as specified in this paragraph will be final. No adjustments will be made in the payment amount to account for
subsequent changes or adjustments in utilization data or for any other purpose, except that amounts paid are subject to recovery if the facility fails to
maintain the required records or to spend the funds in the manner specified in the request.

Request for Funding: To receive Direct Care Worker Wage increase funds, a nursing facility must submit the attached application for Department
approval. The application includes two forms: Form A: Detail for direct care workers under $8.50 and Form B: Summary for Direct Care Workers
with Attachments. The provider shall submit all of the information required in these attachments in order to receive Direct Care Worker Wage
increase funds. Each facility must complete and submit this application to the Department on or before June 18, 2007 and sign the Medicaid
Provider Certification Agreement (see below). If the Department does not approve a request, it will return the request to the facility with a statement
of the reason for disapproval. The facility will then have a limited time within which to provide justification for its proposed use of the funds.
Regardless of whether the cost of a proposal approved by the Department exceeds the amount of funds payable to that facility, the Department will
not be obligated to and will not reimburse the facility any more than the per Medicaid day share of the available funding, calculated as described
above.

Recovery of Funds: A facility that does not submit a qualifying application for use of the funds distributed under this program as requested by the
Department within the time established by the Department, or a facility that does not wish to participate in this additional funding amount, shall not
be entitled to their share of the funds. The Department will make retroactive adjustment to the payment rate established on July 1, 2007, which will
reduce the Medicaid per day payment amount that has been designated for the direct care wage add-on for any nonparticipating or non-qualifying
facility. Any facilities that were not eligible to receive funds for the direct care wage add-on up to that time will be recovered by the Department.

Records and Documentation: A facility that receives funds under this program must maintain appropriate records documenting the expenditure of
the funds. This documentation must be maintained and made available to authorized governmental entities and their agents to the same extent as
other required records and documentation under applicable Medicaid record requirements, including but not limited to ARM 37.40.345, 37.40.346,
and 37.85.414. Reports will be requested on a semi-annual basis and as necessary.

Direct Care Worker Definition: A direct care worker for this distribution is defined as: Certified Nurse Assistant, Registered Nurse or Licensed
Professional Nurse.

Other Low-Paid Staff Definition: Other Low-Paid Staff for this distribution is defined as: Activities, Social Services, Laundry, Dietary,
Housekeeping, Feeding Assistants.

Effective Date: The Department will consider wage increases as meeting the legislative intent for this direct care wage add-on if the wage increases
occur after July 1, 2007. The Department will not consider increases that occurred prior to July 1, 2007 nor any wage increases that occur from other
laws, contracts, or written agreements, which go into affect at the same time as or after implementation of the Direct Care Worker Wage Increase
appropriation, as meeting the intent of the legislature. These increases cannot be used as documentation in support of wage increases for purposes of
receiving the add-on to the nursing facility payment rate.

Reporting Requirements: To the extent of available appropriations, the Department shall provide documentation that these funds are used solely
for direct care worker wage and related benefits increases. Providers must report wage information to the Department on a semi-annual basis for the
period beginning July 2007-June 2009 wage information. The documentation must include initial wage rates, wage rates after the rate increases have
been applied, and wage rates every 6 months after the increases have been granted. The report will distinguish wage increases that result from the
Direct Care Wage Increase funding and other planned or contracted wage increases.

Cost Reporting: Increases in wages and benefits provided by facilities will be allowable and reportable on the Medicaid cost report.

Provider Certification and Agreement: By signing this request and in consideration for the payment of funds based upon this application, the
nursing facility provider named below ("Provider") represents and agrees as follows:

1. Provider certifies that statements and information included in this agreement are complete, accurate and true to the best of the undersigned facility
administrator's knowledge. The Provider certifies that any funds received on the basis of this request will be used in the manner represented above to
provide for wage and benefit increases for direct care staff.
2. Provider agrees to the terms and conditions under which this funding is made available, as stated in this form. Provider agrees that it will make,
maintain and provide to authorize governmental entities and their agents, records and documentation in accordance with the requirements specified in
this agreement.
3. Provider understands that payment of funds based upon this request will be from federal and state funds, and that any false claims, statement, or
documents, or concealment of material fact, may be prosecuted under applicable federal or state laws. Provider understands that the payment made
based upon this application is final, that no adjustments will be made in the payment amount to account for subsequent changes in utilization,
appropriation amounts, or for any other purpose, except that amounts paid are subject to recovery in the same manner as other overpayments if the
facility fails to maintain the required records or to use the funds as represented in this request.
4. Provider understands that the worker wage increase may not be used to offset any other wage increase mandated by any other laws, contracts, or
written agreements, which will go into effect at the same time as or after implementation of the appropriation included in Direct Care Worker Wage
Increase.

Requesting Facility Identifying Information

Provider Name: _________________________________________________________________________________

Medicaid Provider #: ________________

Signature of Administrator: ________________________________________________ Date: ___________, 2007
                                                   SENIOR AND LONG TERM CARE
                                           DIRECT CARE WORKER WAGE INITIATIVE FUNDING
                                                          APPLICATION
This application includes two forms (Form A and Form B). All of the forms must be sent in for an application to be complete. NOTE: You must complete Form A
before you complete Form B.

                                                              FORM A INSTRUCTIONS
                                              DIRECT CARE WORKERS UNDER $8.50 PER HOUR
Form A identifies all of the direct care workers who make less than $8.50/hour, without benefits, as of June 30, 2007. You must identify every Direct Care Worker on
this form before you complete Form B. If you do not employ direct care workers who make less than $8.50/hour mark N/A and skip to Form B.

Worker Name: Identify the name as it appears on payroll with last name first, i.e. Doe, John

Worker Type: Identify the worker type using the code on Form B

Position Number: Position number affiliated with this worker by the provider

Column A: Identify the Actual Hourly Wage without Benefits for each direct care worker for FY2007 who is paid less than $8.50 per hour as of June 30, 2007

Column B: Identify the Actual Benefit percent or amount paid for each direct care worker for FY2007. Must use either all percents OR all amounts for all categories!
           See Note 2.

Column C: Identify the Hourly Wage & Benefits for this direct care worker for FY2007. See note3.

Column D: Identify the Actual Full Time Equivalents (FTEs) for this direct care worker for FY 2007, (divide the number of hours provided for the year by 2080).

Column E: Identify the number of hours per week this direct care worker is employed for FY2007

Column F: Identify the Projected Hourly Wage without Benefits for this direct care worker for FY2008 who is paid less than $8.50 per hour in FY07

Column G: Identify the Projected Benefit percent or amount paid for this direct care worker for FY2008. Must use either all percents OR all amounts for all categories!
           See Note 2.

Column H: Identify the Projected Hourly Wage & Benefits for this direct care worker for FY2008. See note3.

Column I:    Identify the Projected Full Time Equivalents (FTEs) for this direct care worker for FY 2008, (divide the number of hours provided for the year by 2080).

Column E: Idenitify the number of hours per week this direct care worker is employed

Column K: Multiply column C by column D by 2080 hours.

Column L: Multiply column H by column I by 2080 hours.

           Direct Care Worker Types for FORM A purposes is defined as only CNA, PAS/SPAS, WAIVER PAS/SPAS, RESPITE/HOMEMAKER

           Average Entry Level Wage after July 1, 2007 will be $8.50 for all direct care worker types who meet the FORM A definition.


                                                              FORM B INSTRUCTIONS
                                                          SUMMARY FOR DIRECT CARE WORKERS

Form B identifies the average rate of pay, benefits, etc by category of direct care worker.
Note: If you completed Form A you must include the new base pay rate of $8.50 for all of those workers. For example, if you listed on Form A worker x, a respite
worker who makes $7.20 and worker y, a respite worker who makes $8.20 you will figure the average rate for all of your respite workers assuming that both worker x
and worker y make $8.50. Each category that was reported from FORM A should receive the additional increase.


Column A: Indicate the Average Hourly Wage for each worker type for FY2007

Column B: Indicate the Average Benefit percent or amount paid for each worker type for FY2007. Must use either all percents OR all amounts for all categories! See
         Note 2.
Column C: Indicate the Average Wage & Benefits for all workers within this type for FY2007. See note3.

Column D: Indicate the number of Full Time Equivalents (FTEs) for each worker type for FY 2007, (divide the number of hours provided for the year by 2080).

Column E: Indicate the number of employees (people) that fill the FTEs in column D

Column F:    Indicate the Average Hourly Wage for each worker type for FY2008 (assuming you receive the direct care wage funding)

Column G: Indicate the Average Benefit percent or amount paid for each worker type for FY2008. See note 2.

Column H: Indicate the Average Wage & Benefits for all workers within this type for FY2008. See note 3.

Column I: Indicate the number of Full Time Equivalents (FTEs) for each worker type for FY2008, (divide the number of hours provided for the year by 2080).

Column J: Indicate the number of employees (people) that fill the FTEs in column D

Column K: Multiply column C by column D by 2080 hours.

Column L: Multiply column H by column I by 2080 hours.

* The projected wage increase is appropriated at 70 cents per hour (50cents wages/20 cents benefits)


     NOTES:

     1) 1 FTE equals 2080 hours per year. If 11 employees will provide approximately 10,500 hours of work, the FTE calculation is 10,500/2080 = 5 FTE

     2) Benefits are insurance, FICA, pension, workers comp, unemployment, payroll taxes, etc., paid by the employer.

     3) To get wage & benefits in column C:
                     If you used benefit amount in Col B, add A + B
                     If you used benefit percent in Col B, multiply A x (1+B), e.g. if the wage is $7.50 and the benefits are 36%, Col C is 7.50 x 1.36
                         = $10.20

     4) Columns F,G,H,I,J,L are projections for FY2008(7/1/07-6/30/08)
                                       DIRECT CARE WAGE FUNDING INCREASE
                                              PROVIDER APPLICATION

                                                       State Fiscal Year 2008




NPI PROVIDER OR MEDICAID PROVIDER #:          ________________________________________

PROVIDER NAME                                 ________________________________________

STREET ADDRESS                                ________________________________________

CITY                                          ________________________________________

CONTACT PERSON                                ________________________________________

EMAIL ADDRESS                                 ________________________________________

PHONE                                         ________________________________________




Bargaining and Collective Agreement Disclosure:

Funds in Direct Care Worker Wage Increase may not be used to offset any other wage increase mandated by any other laws, contracts, or
written agreements, which will go into effect at the same time as or after implementation of the appropriation included in Direct Care
Worker Wage Increase.

In the table below please indicate by category of direct care worker if there are any collective bargaining units and attach the union
contract or other employee agreement with this application.

    Worker Type                Collective                    Union Name                  Effective Date of             Comments
                               Agreement                                                  any negotiated
                                  Y/N                                                     wage increase
        1
      CNA
        2
      LPN
        3
       RN
        4
  ACTIVITIES
        5
SOCIAL SERVICES
        6
 HOUSEKEEPING
        7
   LAUNDRY
        8
       FA
        9
    DIETARY


                                                Direct Care Worker Type Abbreviations:

1 – CNA: Certified Nursing Assistant

2 – LPN: Licensed Practical Nurse

3 – RN: Registered Nurse

4 – ACTIVITIES: Activities

5 - SOCIAL SERVICES: Social Services

6 – HOUSEKEEPING: Housekeeping

7 – LAUNDRY: Laundry

8 – FA: Feeding Assistant

9 – DIETARY: Dietary


                                         PLEASE RETURN THE SIGNED AND DATED
                                       PROVIDER CERTIFICATION/AGREEMENT AND
                                           COMPLETED APPLICATIONSECTIONS
                                                  BY JUNE 18, 2007 TO:

                                            DPHHS -SLTC - Direct Care Wage Initiative
                                                         PO Box 4210
                                                    Helena MT 59604 - 4210
NF APPLICATION AND CERTIFICATION

								
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