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Pursuant to V.D.R.S.R. §1.8(d), the Nursing Facility Practices and Procedures Manual contains interpretations of the Nursing Facility Rules and other materials describing the manner in which those rules are carried out. The Manual also contains forms prescribed by the Division. The Practices and Procedures Manual is compiled and maintained pursuant to 33 V.S.A. §3.
Table of Contents and Index
 
92-2 Forms - Representation of Nursing Facilities
To enable the Division to identify the official representative of the provider and to know where communications should be sent, a written notification must be filed by the provider, pursuant to V.D.R.S.R. §1.11(b).
92-2 Form - Notice of Representation - General (formfill)
This form may be accessed for completion directly on the computer screen by clicking on the link. Please be advised that once the PDF form is completed onscreen, it can not be saved, but these forms can be printed.
92-2 Form - Notice of Representation - Special (formfill)
This form may be accessed for completion directly on the computer screen by clicking on the link. Please be advised that once the PDF form is completed onscreen, it can not be saved, but these forms can be printed.
92-3 Form - Extensions of Time
The Division's rules contain a number of time limits for providers. Because it is not always possible to meet these deadlines, the rules also contain provisions to permit the extension of time limits, at V.D.R.S.R. §§1.10(d) and 3.3(c).
92-3 Extensions of Time - Form (formfill)
This form may be accessed for completion directly on the computer screen by clicking on the link. Please be advised that once the PDF form is completed onscreen, it can not be saved, but these forms can be printed.
92-4 Procedures for Administrative Review of Cost Report Findings and of Findings on Applications for Rate Adjustments
This issuance is intended to describe the steps necessary to appeal actions of the Division taken after review or audit of providers' cost reports or decisions on applications for rate adjustments, pursuant to V.D.R.S.R. §§15.1-15.3. Each step of this review procedure must be completed before further review is available. No appeal of cost report findings may be taken pursuant to 33 V.S.A. §909(a) unless the Division's administrative review procedures have first been exhausted.
92-5 Form - Request for Work Papers
This form should be used whenever the provider needs to have access to the Division's work papers in order to review the calculations. Normally this form will be used to help the provider review draft cost report findings pursuant to V.D.R.S.R. §15.1(b) and for that purpose the form must be filed at the Division within 10 days after the provider receives the draft findings. The filing of a Request for Work Papers pursuant to V.D.R.S.R. §15.1(b) will automatically extend the time in which to file a Request for Informal Conference to 15 days after the provider's receipt of the work papers.
92-5 Form - Request for Work Papers (formfill)
This form may be accessed for completion directly on the computer screen by clicking on the link. Please be advised that once the PDF form is completed onscreen, it can not be saved, but these forms can be printed.
92-6 Form - Request for Informal Conference
This form should be used to initiate all administrative reviews of the Division's cost report findings. (V.D.R.S.R. §15.2) If a timely Request for Informal Conference is not filed, the provider is not entitled to any further administrative or judicial review of the cost report findings for the period in question.
92-6 Form -Request for Informal Conference (formfill)
This form may be accessed for completion directly on the computer screen by clicking on the link. Please be advised that once the PDF form is completed onscreen, it can not be saved, but these forms can be printed.
92-7 Form - Notice of Request for Reconsideration
This form should be used to initiate a formal administrative review of the Division's cost report findings (official action) issued after an informal conference. The form must be filed within 30 days of the provider's receipt of the new cost report findings. If no timely Notice of Request for Reconsideration is filed, the provider is not entitled to further administrative or judicial review of the cost report findings for the period in question.
92-8 Form - Request for Reconsideration - Supporting Information
This form consists of a cover sheet with a number of schedules. If it is not filed with all the required schedules within 10 days of filing the Notice of Request for Reconsideration, the Request for Reconsideration will be dismissed, the cost report findings will immediately become final and no further appeals will be available. (V.D.R.S.R. §15.3(d))
92-12 Public Availability of Funding Applications and Other Financial Information Filed with the Division
Previously, under Vermont public records law, providers' financial records filed with the Division were not public records and were not generally available for inspection or copying. Vermont Health Care Association, Inc. v. State, Slip. Op. Washington Superior Court, Docket No. S-379-83WnC, March 14, 1984 and V.D.R.S.R. §2.5(d). For cost reports filed on or after October 1, 1990, Vermont law was preempted by the federal requirement that all cost reports be treated as public information. 42 U.S.C. §1396(g)(5)(A)(ii).
Cost Report Template
 
92-13 Information on Cost Report for Nursing Facilities
The Cost Report form prescribed by this Practice and Procedure Issuance is required to be used by nursing facilities for all annual cost reports and for the special cost reports that may be required in conjunction with a rebase. V.D.R.S.R. §§3.2 and 5.6(c).
92-14 Form - Supporting Financial Documentation for Nursing Facilities
The Supporting Financial Documentation form prescribed by this Practice and Procedure Issuance is required to be filed by nursing facilities whenever a cost report is filed. V.D.R.S.R. §§3.2(d) and (e).
92-16 Resident Eligibility for Special Case-Mix Weight for Atypically Severe Challenging Behaviors
The Division of Licensing and Protection has developed criteria for a special case-mix weight of 1.843, which is restricted to residents who present unusually severe and challenging behaviors irrespective of whether or not there is a diagnosis of mental illness. (V.D.R.S.R. §7.1(a)(2).)
92-17 Chart of Accounts Nursing Facility Cost Reporting and Financial Documentation
The Chart of Accounts prescribed by this Practice and Procedure Issuance must be used in completing the following forms: Cost Report for Nursing Facilities Practice and Procedure Issuance No. 92-13 Supporting Financial Documentation for Nursing Facilities Practice and Procedure Issuance No. 92-14
93-1 Allocation of Shared Costs for Hospital-Related Nursing Facilities
This issuance supplements the instructions for completing the Cost Report Form and the Supporting Financial Documentation Form in Practice and Procedure (NF) Issuance 92-15 and describes the proper method of accounting for shared costs of hospital-related nursing facilities.
93-2 Audited Financial Statements - Waivers for Not-for-Profit Nursing Facilities
This issuance permits not-for-profit facilities to apply for a waiver of the requirement in V.D.R.S.R. §3.2(d)(1) for the filing of audited financial statements along with the uniform cost reports.
93-3 Applications for Rate Adjustments Pursuant to V.D.R.S.R. §8
This Practice and Procedure Issuance prescribes the procedures and forms to be used by nursing facilities when applying for rate adjustments pursuant to V.D.R.S.R. §8. Because V.D.R.S.R. §8 allows rate adjustment for a variety of special circumstances, a number of forms are required. Instructions are provided for each type of rate adjustment, and providers should follow the instructions for the particular type of adjustment for which they are applying. However, some general rules apply to all adjustments.
93-4 Application for Rate Adjustment for Large Asset Acquisitions Pursuant to V.D.R.S.R. §4.11(a)
This Practice and Procedure Issuance prescribes the procedures and forms to be used by providers applying for rate adjustments for the individual capital expenditures, pursuant to V.D.R.S.R. §4.11(a). (This Practice and Procedure Issuance does not apply to increased costs resulting from changes in ownership, pursuant to V.D.R.S.R. §§4.7 and 4.11(b).)
93-5 Special Transitional Rates for Residents of the Vermont State Hospital Nursing Facilities
As part of the regionalization of mental health services, the Department of Mental Health and Mental Retardation and the Department of Aging and Disabilities have been working on plans to enhance community capacity for services to elderly Vermonters with severe behavioral problems in nursing homes. Closing the Vermont State Hospital Nursing Facilities will permit resources to be transferred to the community to support the enhanced service system statewide.
93-6 Rate and Accounting Treatment of Health Care Provider Tax Payments
This issuance addresses the cost reporting of the health care provider tax and explains the rate treatment of the tax expense.
93-7 Calculation and Application of the Inflation Factors
Because Medicaid payment rates are based on facility costs incurred during a past reporting period (the Base Year), the Base Year costs must be updated to take into account changes in economic conditions that are expected in the period during which the rates will be in effect. The expected changes in economic conditions are reflected in the Inflation Factors, which are applied to certain categories of Base Year costs. As required by V.D.R.S.R. §5.8(f), this Practice and Procedure Issuance explains how the inflation factors are calculated and applied to the Base Year costs.
94-2 Notification of Provider's Customary Charges
The Medicaid per diem rate for a provider may not exceed the provider's average customary charges to the general public for nursing facility services in semi-private rooms. V.D.R.S.R. §5.3(a). To determine whether a facility's Medicaid rate exceeds its charges, the Division must maintain current information on the facility's charges.
94-5 Vermont Nursing Facility Resident Days by Payor - Monthly Report
The Division is frequently called upon to provide information, make estimates, and carry out calculations requiring more recent information relating to the resident days for each facility than can be obtained from annual cost reports.
94-5 Vermont Nursing Facility Resident Days by Payor - Monthly Report (MS Excel)
A Microsoft Excel version of the Resident Days by Payor - Monthly Report.
98-2 Form - Notice of Request for Administrative Review
This form must be used to initiate a formal administrative review of the Division's final decision after on cost report findings or on a request for a rate adjustment issued after a Request for Reconsideration. 33 V.S.A. §909(a)(3), V.D.R.S.R. §15.5. Two copies of this form must be filed at the Division of Rate Setting, 103 South Main Street, Waterbury, VT 05671-2201, within 30 days of the provider's receipt of the Final Order.
99-1 Quality Incentive Awards
This issuance describes the Quality Incentive Awards program and criteria for supplemental payments available, pursuant to V.D.R.S.R. 17.3(a), to Vermont nursing homes participating in the Medicaid program. Up to five awards will be made annually in May, during National Nursing Home Week, to nursing facilities providing and sustaining a superior quality of care in an efficient and effective manner. The awards must be used to enhance the quality of service provided to residents of the facility.
99-2 The Determination of Allowable Costs for Nursing Facility Employees
Some salaried employees of certain providers devote some of their time to activities other than those directly related to their duties for the nursing facility. In many cases the provider does not maintain time records for those employees. This lack of documentation makes it difficult for the Division to make an accurate determination of the amount of time those employees spend on duties related to nursing home resident care and consequently the amount of their salaries that are allowable costs as required by V.D.R.S.R. §4.2.
13-1 Rebasing of Nursing Care Costs
This Practice and Procedure Issuance announces the rebase of Nursing Care costs for services provided on and after July 1, 2013.
15-1 Rebasing of Nursing Facility Costs pursuant to V.D.R.S.R. § 5.6
This Practice and Procedure Issuance announces the rebase of all nursing facility costs used for the setting of Medicaid rates for services provided on and after July 1, 2015, and describes the methodology used in the rebase.
17-1 Rebasing of Nursing Care Costs
This Practice and Procedure Issuance announces the rebase of Nursing Care costs for services provided on and after July 1, 2017.