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TITLE 405 OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES

Final Rule
LSA Document #08-602(F)

DIGEST

Amends 405 IAC 1-14.6-7 to describe the institutions that qualify for a capital component rate add-on, the calculation of a capital component rate add-on, and the funding exemptions that apply to the capital component rate add-on. Effective 30 days after filing with the Publisher.



SECTION 1. 405 IAC 1-14.6-7 IS AMENDED TO READ AS FOLLOWS:

405 IAC 1-14.6-7 Inflation adjustment; minimum occupancy level; case mix indices

Authority: IC 12-8-6-5; IC 12-15-1-10; IC 12-15-21-2


Sec. 7. (a) For purposes of determining the average allowable cost of the median patient day and a provider's annual rate review, each provider's cost from the most recent completed year will be adjusted for inflation by the office using the methodology in this subsection. All allowable costs of the provider, except for mortgage interest on facilities and equipment, depreciation on facilities and equipment, rent or lease costs for facilities and equipment, and working capital interest shall be adjusted for inflation using the CMS Nursing Home without Capital Market Basket index as published by DRI/WEFA. The inflation adjustment shall apply from the midpoint of the annual financial report period to the midpoint prescribed as follows:
  Effective Date  Midpoint Quarter 
  January 1, Year 1  July 1, Year 1 
  April 1, Year 1  October 1, Year 1 
  July 1, Year 1  January 1, Year 2 
  October 1, Year 1  April 1, Year 2 

(b) Notwithstanding subsection (a), beginning July 1, 2007, the inflation adjustment determined as prescribed in subsection (a) shall be reduced by an inflation reduction factor equal to three and three-tenths percent (3.3%). The resulting inflation adjustment shall not be less than zero (0). Any reduction or elimination of the inflation reduction factor shall be made effective no earlier than permitted under IC 12-15-13-6(a).

(c) In determining prospective allowable costs for a new provider that has undergone a change of provider ownership or control through an arm's-length transaction between unrelated parties, when the first fiscal year end following the change of provider ownership or control is less than six (6) full calendar months, the previous provider's most recently completed annual financial report used to establish a Medicaid rate for the previous provider shall be utilized to calculate the new provider's first annual rate review. The inflation adjustment for the new provider's first annual rate review shall be applied from the midpoint of the previous provider's most recently completed annual financial report period to the midpoint prescribed under subsection (a).

(d) Allowable fixed costs per patient day for direct care, indirect care, and administrative costs shall be computed based on an occupancy rate equal to the greater of eighty-five percent (85%) or the provider's actual occupancy rate from the most recently completed historical period.

(e) Notwithstanding subsection (d), the office or its contractor shall reestablish a provider's Medicaid rate effective on the first day of the quarter following the date that the conditions specified in this subsection are met, by applying all provisions of this rule, except for the eighty-five percent (85%) minimum occupancy requirement, if both of the following conditions can be established to the satisfaction of the office:
(1) The provider demonstrates that its current resident census has:
(A) increased to eighty-five percent (85%) or greater since the facility's fiscal year end of the most recently completed and desk reviewed cost report utilizing total nursing facility licensed beds as of the most recently completed desk reviewed cost report period; and
(B) remained at such level for not fewer than ninety (90) days.
(2) The provider demonstrates that its resident census has:
(A) increased by a minimum of fifteen percent (15%) since the facility's fiscal year end of the most recently completed and desk reviewed cost report; and
(B) remained at such level for not fewer than ninety (90) days.

(f) Allowable fixed costs per patient day for capital-related costs shall be computed based on an occupancy rate equal to the greater of ninety-five percent (95%) or the provider's actual occupancy rate from the most recently completed historical period.

(g) The CMIs contained in this subsection shall be used for purposes of determining each resident's CMI used to calculate the facility-average CMI for all residents and the facility-average CMI for Medicaid residents.
RUG-III Group  RUG-III Code  CMI Table 
Rehabilitation  RAD  2.02 
Rehabilitation  RAC  1.69 
Rehabilitation  RAB  1.50 
Rehabilitation  RAA  1.24 
Extensive Services  SE3  2.69 
Extensive Services  SE2  2.23 
Extensive Services  SE1  1.85 
Special Care  SSC  1.75 
Special Care  SSB  1.60 
Special Care  SSA  1.51 
Clinically Complex  CC2  1.33 
Clinically Complex  CC1  1.27 
Clinically Complex  CB2  1.14 
Clinically Complex  CB1  1.07 
Clinically Complex  CA2  0.95 
Clinically Complex  CA1  0.87 
Impaired Cognition  IB2  0.93 
Impaired Cognition  IB1  0.82 
Impaired Cognition  IA2  0.68 
Impaired Cognition  IA1  0.62 
Behavior Problems  BB2  0.89 
Behavior Problems  BB1  0.77 
Behavior Problems  BA2  0.67 
Behavior Problems  BA1  0.54 
Reduced Physical Functions  PE2  1.06 
Reduced Physical Functions  PE1  0.96 
Reduced Physical Functions  PD2  0.97 
Reduced Physical Functions  PD1  0.87 
Reduced Physical Functions  PC2  0.83 
Reduced Physical Functions  PC1  0.76 
Reduced Physical Functions  PB2  0.73 
Reduced Physical Functions  PB1  0.66 
Reduced Physical Functions  PA2  0.56 
Reduced Physical Functions  PA1  0.50 
Unclassifiable  BC1  0.48 
Delinquent  BC2  0.48 

(h) The office or its contractor shall provide each nursing facility with the following:
(1) Two (2) preliminary CMI reports. These preliminary CMI reports:
(A) serve as confirmation of the MDS assessments transmitted by the nursing facility; and
(B) provide an opportunity for the nursing facility to correct and transmit any missing or incorrect MDS assessments.
The first preliminary report will be provided by the seventh day of the first month following the end of a calendar quarter. The second preliminary report will be provided by the seventh day of the second month following the end of a calendar quarter.
(2) Final CMI reports utilizing MDS assessments received by the fifteenth day of the second month following the end of a calendar quarter. These assessments received by the fifteenth day of the second month following the end of a calendar quarter will be utilized to establish the facility-average CMI and facility-average CMI for Medicaid residents utilized in establishing the nursing facility's Medicaid rate.

(i) The office may increase Medicaid reimbursement to nursing facilities that provide inpatient services to more than eight (8) ventilator-dependent residents. Additional reimbursement shall be made to the facilities at a rate of eight dollars and seventy-nine cents ($8.79) per Medicaid resident day. The additional reimbursement shall:
(1) be effective on the day the nursing facility provides inpatient services to more than eight (8) ventilator-dependent residents; and
(2) remain in effect until the first day of the calendar quarter following the date the nursing facility provides inpatient services to eight (8) or fewer ventilator-dependent residents.

(j) Beginning July 1, 2003, through June 30, 2007, the office will increase Medicaid reimbursement to nursing facilities to encourage improved quality of care to residents based on the nursing home report card score as of July 4, 2003. Medicaid reimbursement increases shall be determined according to the following:
Nursing Home Report Card Score as of July 4, 2003  Per Medicaid Patient Day Rate Add-On 
0 – 50  $3.00 
51 – 105  $2.50 
106 – 200  $2.00 
201 and higher  $1.50 
Facilities that did not have a nursing home report card score published as of July 4, 2003, may receive a per patient day rate add-on equal to two dollars ($2).

(k) Beginning effective July 1, 2003, through June 30, 2007, the office will increase Medicaid reimbursement to nursing facilities that provide specialized care to residents with Alzheimer's disease or dementia and operate a special care unit (SCU) for such residents as demonstrated by resident assessment data as of June 30, 2003. The additional Medicaid reimbursement shall equal ten dollars and eighty cents ($10.80) per Medicaid resident day in their SCU. Only facilities with a SCU for Alzheimer's disease or dementia as demonstrated by resident assessment data as of June 30, 2003, shall be eligible to receive the additional reimbursement.

(l) Nursing facilities that satisfy each of the four (4) conditions listed in this subsection shall qualify for a capital component rate add-on:
(1) Twenty-five percent (25%) or more of its residents as of December 31, 2006, were under the chronological age of twenty-one (21) years of age.
(2) According to the last health facility survey conducted by Indiana state department of health on or before December 31, 2006, the facility was not in compliance with 42 CFR 483.70(d)(1)(i).
(3) The facility bedrooms accommodate no more than four (4) residents.
(4) The facility bedrooms measure at least eighty (80) square feet per resident in multiple resident bedrooms and at least one hundred (100) square feet in single resident rooms.

(m) The capital component rate add-on referenced in subsection (l) shall be calculated by dividing the qualifying facility's debt service associated with financing acquired exclusively to fund any capital costs incurred by the provider to come into compliance with 42 CFR 483.70(d)(1)(i), divided by total patient days from the facility's latest completed annual financial report. For purposes of this provision, debt service shall mean the total annual interest and principal payments required to be paid on any such financing arrangement or arrangements. The capital component rate add-on shall be determined upon qualification for the add-on shall be determined following the provider's demonstration to the office of qualification for this provision, and shall become effective on the date the provider successfully completes the health facility survey of any new beds as conducted by the state department of health. The capital component rate add-on shall not be updated annually. Refinancing shall be recognized only when the interest rate is less than the original financing. The capital component rate add-on shall continue to apply until the associated financing has been fully paid.

(n) The capital component rate add-on described under subsection (m) shall be exempt from the capital component overall rate ceiling as determined under section 9(c)(4) of this rule.

(o) The capital component rate add-on described under subsection (m) shall be exempt from the maximum allowable increase as determined under section 23 of this rule.
(Office of the Secretary of Family and Social Services; 405 IAC 1-14.6-7; filed Aug 12, 1998, 2:27 p.m.: 22 IR 74, 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; errata filed Feb 27, 2003, 11:33 a.m.: 26 IR 2375; filed Jul 29, 2003, 4:00 p.m.: 26 IR 3873; filed Apr 24, 2006, 3:30 p.m.: 29 IR 2978; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; filed Apr 3, 2009, 1:44 p.m.: 20090429-IR-405080602FRA)


LSA Document #08-602(F)
Notice of Intent: 20080723-IR-405080602NIA
Proposed Rule: 20090107-IR-405080602PRA
Hearing Held: January 29, 2009
Approved by Attorney General: April 1, 2009
Approved by Governor: April 3, 2009
Filed with Publisher: April 3, 2009, 1:44 p.m.
Documents Incorporated by Reference: None Received by Publisher
Small Business Regulatory Coordinator: Scott Linneweber, Family and Social Services Administration, Office of General Counsel, Indiana Government Center South, 402 West Washington Street, Room W451, Indianapolis, IN 46204, (317) 233-0024, scott.linneweber@fssa.in.gov

Posted: 04/29/2009 by Legislative Services Agency

DIN: 20090429-IR-405080602FRA
Composed: Nov 22,2017 10:03:33AM EST
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