Cessation of Payment for Improper Level of Care

Section 140 Section 140.503  Cessation of Payment for Improper Level of Care The Department may cease payments for the care of a resident in a long term care facility, who is eligible under the Medical Assistance Program, effective 30 days following the Department's decision that the facility does not provide a level of care commensurate with the level of care needed by that resident, unless the Department shall have determined that payments should be continued for that resident. The Department has sole discretion to continue payment when there are circumstances affecting the health, safety and welfare of the resident that justify continued payment.  Such circumstances include, but are not limited to, alternate facility placement cannot be found or transfer of a resident, as certified by a physician, may endanger the resident's life.