(a) Each certified nursing facility shall:

1. (1) Provide each month direct care services by direct care staff equivalent to at least three and thirty-six hundredths (3.36) average direct care hours per resident day; and
2. (2) On or before the fifteenth day of each month, report electronically to the Department of Human Services the facility's actual average direct care hours per resident day for the prior month.

(b)

1. (1) Certified nursing facilities shall report aggregate direct care hours for the month using the table provided in the electronic reporting form provided by the department.

2. (2) This table shall consist of:

   1. (A) Rows for each direct care type of position (such as director of nursing, registered nurse, registered nurse with administrative tasks, certified nurse aide, medication assistant, medical director, or nurse practitioner) consistent with the same direct care labor category titles (each with a unique job code number) used in the federal direct care data system; and
   2. (B) Two (2) columns for reporting the aggregate number of direct care hours in the month attributable to each row, as follows:

(c) (c) A facility's direct care hours will be primarily reported under Column A;

1. (ii) Column B for reporting hours that:

(b) (b) Are not reportable quarterly to the federal direct care data system; and

1. (c) (c) Are not reported in Column A; and

   1. (iii) Direct care hours reportable under Column B will not, by themselves, be sufficient to meet the minimum average direct care hours standard.

      1. (c) Within fifteen (15) days of the federal direct care data system reporting deadline for the quarter, the facility shall electronically file an amended report for one (1) or more of the three (3) monthly reports attributable to that quarter, if necessary to correct:
2. (1) Direct care hours reported in Column A, based on the number of hours by type of position (labor category) that the facility reported in its quarterly submission into the federal direct care data system;
3. (2) Direct care hours reported in Column B; or

4. (3) The MDS-based average daily resident census shown in the original monthly report.

   1. (d) The monthly reports shall show the following information:
5. (1) The full name and department-assigned vendor number of the reporting nursing facility;
6. (2) The month and year for which the report is provided and whether the report is an original or amended report for that month;
7. (3) The completed table described in subsection (b) of this section;
8. (4) Grand total of direct care services hours provided in the month, which is the sum of all hours reported in Column A and Column B of the table described in subsection (b) of this section;
9. (5) The number of calendar days in the monthly reporting period;
10. (6) Average daily resident census for the month, which shall equal the facility's minimum data set (MDS) average daily resident census for the month;

11. (7) The average direct care hours per resident day for the month, which is the sum of:

    1. (A) The grand total of direct care hours in the month; divided by
    2. (B) The number of calendar days in the month; and
    3. (C) The MDS-based average daily resident census for the month;

12. (8) For the month, the difference between the actual average direct care hours per resident day and the three and thirty-six hundredths (3.36) average direct care hours per resident day standard required under Arkansas Code § 20-10-1402(a)(2), with an indication of whether the actual hours provided:

    1. (A) Met the standard;
    2. (B) Exceeded the standard; or
    3. (C) Did not meet the standard; and
13. (9) If the report is an amended report, a brief description of the reason for filing an amended report.

(e) The monthly reporting under this subpart is not intended to require reporting:

1. (1) At the level of detail required by the federal direct care data system; or
2. (2) Not otherwise necessary to meet Arkansas Code § 20-10-1402(b).

(f)

1. (1) Consistent with Arkansas Code § 20-10-1402(e), this subpart does not require or advise any specific or minimum number of nursing staff hours, direct care staff hours, or hours of other services for any nursing facility resident.

2. (2) The services an individual resident receives are:

   1. (A) Based on baseline and comprehensive, person-centered care plans required under 42 C.F.R § 483.21; and
   2. (B) Governed by the services and staffing-related requirements in 42 C.F.R pt. 483, subpt. B.

(g) To ensure compliance with the requirements of this section, the department may:

1. (1) Audit the monthly reports and request documentation from a certified nursing facility;
2. (2) Review a facility's quarterly submissions to the federal direct care data system;
3. (3) Compare a facility's monthly reports under this section with its corresponding quarterly submissions to the federal direct care data system;
4. (4) Review the results of federal audits of facility submissions to the federal direct care data system; and
5. (5) Request demonstrations of the vendor payroll and other systems that nursing facilities commonly use to report direct care hours.

(h) To ensure accurate monthly reporting and facilitate efficient auditing by the Division of Provider Services and Quality Assurance, all hours reported in Column A or Column B for a month must be adequately documented in the facility's records:

1. (1)

   1. (A) A facility must avoid any duplication or double counting of hours reported in Column A and Column B or under particular types of direct care positions.

   2. (B)

      1. (i) For example, a specific hour reported under Column B should not be counted in Column A or vice versa.
      2. (ii) However, hours provided by a particular direct care staff person, such as the director of nursing, may be shown split between the columns, with some of the hours reportable in Column A and others reportable in Column B.

   3. (C)

      1. (i) Similarly, specific hours reported for an initial position type should not be duplicated in any other labor category title.
      2. (ii) For example, specific hours reported under "Registered Nurse Director of Nursing”, or "Registered Nurse with Administrative Duties" should not also appear in the "Registered Nurse" row;
2. (2) A facility's payroll system and associated reporting capabilities are sufficient to document direct care hours by employed staff;
3. (3) A facility will need to use other methods to adequately document direct care hours reported under Column A or Column B, provided by contracted staff, consultants, and other nonemployed but licensed or certified health professionals that are providing direct care services in the facility; and

4. (4) Acceptable methods for adequately documenting direct care service hours by nonemployees as reported in Column A or Column B of a monthly report include, without limitation:

   1. (A) A time tracking system the same or similar to that used by employed direct care staff;
   2. (B) Signed time sheets; or
   3. (C) Invoices, in the case of contracted or consultant staff paid by the facility, provided the invoices detail the number of direct care hours provided in the month.