D.C. Mun. Regs. tit. 29, r. 29-6501
Each nursing facility located in the District of Columbia shall be reimbursed by Medicaid for a patient specific per diem rate for each resident in accordance with the formula set forth in § 6501.2. The rate shall be prospective and only include allowable cost described in §§ 6501.9, 6501.10, and 6501.11.
The Medicaid reimbursable patient specific per diem rate shall equal the sum of:
In addition to the patient specific rate described in § 6501.2, each nursing facility may receive an add-on payment for each resident who is:
The patient specific rate described in § 6501.2 is developed by establishing a base year facility specific per diem rate using three (3) cost categories as described in § 6501.8.
Each nursing facility shall be classified into three (3) peer groups as described in § 6502.
The base year per diem price for each peer group is a per diem rate that is calculated using the allowable costs for the base year for all Medicaid-participating nursing facilities in the District. The base year used to establish February 1, 2018 rates is the 2015 cost report year.
Except for depreciation, amortization, and interest on capital-related expenditures, the base year allowable costs calculated for each nursing facility shall be adjusted to a common end date, the mid-point of the District rate year, using the Centers for Medicare and Medicaid Services (CMS) Prospective Payment System Skilled Nursing Facility Input Price Index.
The base year per diem rate for nursing and resident care services and routine and support services for each peer group and the facility specific capital cost per diem is based on the allowable base year costs and shall be developed using three (3) cost categories:
Routine and support expenditures shall include expenditures for:
Nursing and resident care costs shall include the costs of:
Capital-related costs shall include the costs of:
Provider tax expenses shall not be included in calculating the base year costs.
The costs attributable to paid feeding assistants provided in accordance with the requirements set forth in 42 CFR parts 483 and 488 shall be included in nursing and resident care costs for base years beginning on or after October 27, 2003.
When necessary, each facility specific per diem rate will be reduced by the same percentage to maintain compliance with the Medicare upper payment limit requirement.
DHCF may approve an adjustment to the facility specific per diem rate if the facility demonstrates that it incurred higher costs due to extraordinary circumstances beyond its control, including but not limited to a strike, fire, flood, earthquake, or similar unusual occurrences with substantial cost effects.
Each adjustment pursuant to § 6501.15 shall be made only to the extent the costs are reasonable, attributable to the circumstances specified, separately identified by the facility, and verified by DHCF. Any such adjustment will be applicable only to the affected facility, shall be time limited, and shall not impact the peer group price.
D.C. Mun. Regs. tit. 29, r. 29-6501