E-1.__If the department, in implementing periodic |
reassessments of residents under this section, imposes on |
nursing facilities the obligation to request reassessment of |
a resident on a due date set by the department, penalties |
for failure or delay in meeting that obligation must be |
limited in accordance with this paragraph.__The department |
may not impose penalties for failure or delay in requesting |
reassessments that exceed 10% of the reimbursement that |
would otherwise be paid for the services rendered to the |
resident for whom a reassessment is overdue during the |
period between the due date set by the department and the |
date on which the reassessment request is made.__If, upon |
reassessment, the resident is determined no longer medically |
eligible under the standards duly adopted in the |
department's rules, then the reimbursement otherwise payable |
by the department for the services provided after the |
reassessment due date may be reduced to the rate provided in |
the department's rules for days awaiting placement to a |
residential care facility.__When a resident is determined |
medically eligible upon reassessment, the resident is |
presumed to have been medically eligible during the period |
between the due date for the reassessment and the date on |
which the reassessment was actually conducted, unless the |
department establishes by clear and convincing evidence that |
the nursing facility intentionally deferred its request for |
reassessment of the resident for the purpose of avoiding a |
determination of medical ineligibility. |