TITLE 405 OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES
Final Rule
LSA Document #07-150(F)
DIGEST
Amends
405 IAC 1-14.6-6 and
405 IAC 1-14.6-23 to revise Medicaid reimbursement methodology for payment to nursing facilities, change the annual rate effective date to July 1 for all providers, and impose a maximum annual rate increase per annum, before adjusting for case mix. Effective 30 days after filing with the Publisher.
Authority:
IC 12-8-6-5;
IC 12-15-1-10;
IC 12-15-21-2
Sec. 6. (a) The:
(1) normalized average allowable cost of the median patient day for the direct care component; and the
(2) average allowable cost of the median patient day for the indirect, administrative, and capital components;
shall be determined once per year for each provider for the purpose of performing the provider's annual rate review.
(b) The:
(1) normalized allowable per patient day cost for the direct care component; and the
(2) allowable per patient day costs for the therapy, indirect care, administrative, and capital components;
shall be established once per year for each provider based on the annual financial report.
(c) Beginning October 1, 2007, the rate effective date of the annual rate review shall be the first day of October 1 that falls after the second first calendar quarter following the provider's reporting year-end. Beginning July 1, 2008, the rate effective date of the annual rate review shall be the first July 1 that falls after the first calendar quarter following the provider's reporting year-end. The rate effective date of the annual rate review for all providers shall be July 1 of each year thereafter.
(d) Subsequent to the annual rate review, the direct care component of the Medicaid rate will be adjusted quarterly to reflect changes in the provider's case mix index for Medicaid residents. If the facility has no Medicaid residents during a quarter, the facility's average case mix index for all residents will be used in lieu of the case mix index for Medicaid residents. This adjustment will be effective on the first day of each of the following three (3) calendar quarters beginning after the effective date of the annual
rate review.
(e) The case mix index for Medicaid residents in each facility shall be:
(1) updated each calendar quarter; and shall be
(2) used to adjust the direct care component that becomes effective on the second calendar quarter following the updated case mix index for Medicaid residents.
(f) All rate-setting parameters and components used to calculate the annual rate review, except for the case mix index for Medicaid residents in that facility, shall apply to the calculation of any change in Medicaid rate that is authorized under subsection (d).
(g) When the number of nursing facility beds licensed by the Indiana state department of health is changed after the annual reporting period, the provider may request in writing before the effective date of their next annual rate review an additional rate review effective on the first day of the calendar quarter on or following the date of the change in licensed beds. This additional rate review shall be determined using all rate-setting parameters in effect at the provider's latest annual rate review, except that the number of beds and associated bed days available for the calculation of the rate-setting limitations shall be based on the newly licensed beds.
(Office of the Secretary of Family and Social Services; 405 IAC 1-14.6-6; filed Aug 12, 1998, 2:27 p.m.: 22 IR 73, eff Oct 1, 1998; filed Mar 2, 1999, 4:42 p.m.: 22 IR 2243; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; filed Mar 18, 2002, 3:30 p.m.: 25 IR 2468; filed Oct 10, 2002, 10:47 a.m.: 26 IR 712; filed Jul 29, 2003, 4:00 p.m.: 26 IR 3872; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; filed Oct 4, 2007, 2:05 p.m.: 20071031-IR-405070150FRA)
405 IAC 1-14.6-23 Limitation to Medicaid rate increases for nursing facilities
Authority:
IC 12-8-6-5;
IC 12-15-1-10;
IC 12-15-21-2
Sec. 23. Notwithstanding all other provisions of this rule, for the period
January 1, 2006, October 1, 2007, through June 30,
2007, 2011, nursing facility rates that have been calculated under this rule shall be
reduced by five dollars ($5) per resident per day. limited to a maximum allowable increase as follows:
(1) For annual rate reviews effective October 1, 2007, the maximum allowable increase of seven percent (7%) per annum shall be applied to a provider's latest annual Medicaid rate with an effective date prior to March 31, 2007.
(2) For annual rate reviews effective July 1, 2008, the maximum allowable increase of seven percent (7%) per annum shall be applied to a provider's annual Medicaid rate with an effective date of October 1, 2007.
(3) For annual rate reviews effective July 1, 2009, the maximum allowable increase of three percent (3%) per annum shall be applied to a provider's annual Medicaid rate with an effective date of July 1, 2008.
(4) For annual rate reviews effective July 1, 2010, the maximum allowable increase of three percent (3%) per annum shall be applied to a provider's annual Medicaid rate with an effective date of July 1, 2009.
(5) The therapy rate component shall be excluded for purposes of calculating the maximum allowable increase pursuant to subdivisions (1) through (4) of this section.
(6) A provider's annual Medicaid rate may be in effect for longer or shorter than twelve (12) months. In such cases, the maximum allowable increase percent shall be proportionately increased or decreased to cover the actual time frame their previous annual rate was in effect, using a twelve (12) month period as the basis.
(7) Subsequent to each annual rate review, the direct care component of the Medicaid rate will be adjusted quarterly to reflect changes in the provider's case mix index as described in section 6(d) of this rule. These rate adjustments are not limited to the maximum allowable increase.
(8) Should a provider's quality assessment rate change subsequent to the effective date of their annual Medicaid rate, the office shall restate the provider's Medicaid quality assessment rate add-on and the maximum allowable increase using the new quality assessment rate, applying all provisions of this rule. A provider's Medicaid rate restated under this provision shall be used to calculate their subsequent maximum allowable increase as determined in subdivisions (1) through (4) of this section.
(9) The additional reimbursement authorized by section 7(i) of this rule shall be excluded for purposes of calculating the maximum allowable increase pursuant to subdivisions (1) through (4) of this section when the nursing facility's prior annual Medicaid rate does not include this additional reimbursement.
Hearing Held: May 30, 2007
Approved by Attorney General: October 2, 2007
Approved by Governor: October 4, 2007
Filed with Publisher: October 4, 2007, 2:05 p.m.
Documents Incorporated by Reference: None Received by Publisher
Small Business Regulatory Coordinator: Julia Holloway, Deputy Director, Division of Aging, Indiana Family and Social Services Administration, 402 W. Washington Street, Room W454, Indianapolis, IN 46204, (317) 232-0604, Julia.Holloway@fssa.in.gov
Posted: 10/31/2007 by Legislative Services Agency
DIN: 20071031-IR-405070150FRA
Composed: Apr 24,2024 10:27:38AM EDT
A
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