As used in this subchapter:

(1) [Repealed].

(2) “CMS” means as defined in § 6501 of Title 30.

(3) “Managed care company under contract to the Medicaid agency” means an entity as defined in § 6501 of Title 30.

(4) “Medicaid” means as defined in § 6501 of Title 30.

(5) “Medicaid-enrolled nursing facility” means a nursing facility enrolled in the Medicaid program or enrolled with a managed care company under contract to the Medicaid agency for the purpose of providing nursing facility services to Medicaid eligible residents, but excludes the Delaware Veterans Home and any state, federal, or other public government-owned facilities and any facilities that exclusively serve children.

(6) “Medicaid resident day” means as defined in § 6501 of Title 30.

(7) “Medicaid share of the quality assessment” means for each nursing facility, the assessment cost applicable to Medicaid residents.

(8) “Nursing facility” means as defined in § 6501 of Title 30.

(9) “Nursing facility services” means as defined in § 6501 of Title 30.

78 Del. Laws, c. 286, §  2;  81 Del. Laws, c. 206, § 49; 

(a) There shall be established in the State Treasury and in the accounting system of the State a special fund to be known as the Nursing Facility Quality Assessment Fund (the “Fund”).

(b) All of the following revenue must be deposited into the Fund:

(1) As specified in § 6502(e)(1) of Title 30, 90% of the quality assessment collected.

(2) On the last day of each month, the State Treasurer shall credit the Fund with interest on the average balance in the Fund for the preceding month. The interest to be paid to the Fund must be that proportionate share, during such preceding month, of interest to the State as the Fund’s and the State’s average balance is to the total State’s average balance.

78 Del. Laws, c. 286, §  2;  81 Del. Laws, c. 206, § 50; 

(a) Funds deposited into the Nursing Facility Quality Assessment Fund must be used by the Department exclusively to secure federal matching funds available through the state Medicaid plan and any applicable waivers, and together with the Federal funds must be used exclusively by the Department including any managed care companies under contract to the Medicaid agency to do all of the following:

(1) Provide for per diem rate adjustments in accordance with § 1183 of this title to Medicaid enrolled nursing facilities.

(2) Reimburse the Medicaid share of the quality assessment in accordance with § 1183 of this title.

(3) Reimburse any funds advanced from the Department Medicaid budget appropriation that were used to make the payments referred to under paragraphs (a)(1) and (2) of this section.

(b) If the quality assessment imposed by § 6502 of Title 30 and the payments referred to by paragraphs (a)(1) and (2) of this section are repealed, any funds remaining in the Nursing Facility Quality Assessment Fund must:

(1) First reimburse the Department if the total of all quality assessment payments received from nursing facilities are equal to or less than the state share of all of the payments referred to by paragraphs (a)(1) and (2) of this section made by the Department including managed care companies under contract to the Medicaid agency to nursing facilities.

(2) If the total of all quality assessments received is greater than the state share of the payments issued referred to by paragraphs (a)(1) and (2) of this section, the remaining funds must be distributed back to the nursing facilities generally and proportionately on the same basis as the assessments were collected in the last calendar quarter.

78 Del. Laws, c. 286, §  2;  81 Del. Laws, c. 206, § 51; 

(a) Medicaid enrolled nursing facilities that are not subject to penalties under § 6503 of Title 30 shall be eligible for per diem rate adjustments referred to by § 1182(a)(1) and (2) of this title. Nursing facilities subject to penalties under § 6503 of Title 30 shall be eligible for per diem rate adjustments only after all penalties and past due quality assessments are paid in full.

(b) Effective April 1, 2012, nursing facilities are paid for services rendered to Medicaid patients directly by DHSS as well as by managed care companies under contract to the Medicaid agency. The per diem rate adjustments referred to by § 1182(a)(1) and (2) of this title will be incorporated into the DHSS nursing facility level of reimbursement rate schedules. Unless a facility is subject to penalties as described in subsection (a) of this section, DHSS and the managed care companies will pay no lower than the adjusted per diem rates in these schedules.

(c) The rate adjustments referred to by § 1182(a)(1) and (2) of this title shall be a rate paid on a per Medicaid resident day basis. The rate paid will be the same per diem amount for each facility other than the per diem to reimburse the Medicaid share of the assessment.

(d) The rate adjustments referred to by § 1182(a)(1) and (2) of this title will be retroactive for dates of service on or after June 1, 2012. Upon CMS notification to DHSS of waiver approval and, if required, state plan amendment approval, the per diem rates in effect as of June 1, 2012, will be increased by the rate adjustments referred to by § 1182(a)(1) and (2) of this title. The retroactive rate adjustments for Medicaid paid claims for service dates between June 1, 2012, and the date of CMS notification of waiver and, if required, plan amendment approval, must be paid within 30 days of CMS approval.

78 Del. Laws, c. 286, §  2;