D.C. Mun. Regs. tit. 29, r. 29-969

Current through Register Vol. 71, No. 36, September 6, 2024

Rule 29-969 - COMPUTATION OF CEILINGS

969.1

A facility's healthcare-related costs per diem, routine and support costs per diem, and administrative and general costs per diem shall not exceed the ceiling established by the Medicaid Program for each of these three (3) per diems.

969.2

To establish the ceiling for healthcare-related costs per diem, routine and support costs per diem, and administrative and general costs per diem, the Program shall compute the median per diem rate for all facilities operating in the District of Columbia and participating in the Medicaid in 1993 for each of the cost categories.

969.3

The median cost per diem for each category shall be calculated based on total patient days, including reserved bed days and shall not be based on Medicaid patient days. The median cost per diem for each category set forth in section 969 shall be indexed for inflation from the District's Fiscal Year 2002 through the District's Fiscal Year 2008 using the using the Centers for Medicare and Medicaid Services Prospective Payment Skilled Nursing Facility Input Price Index and thereafter on an annual basis.

969.4

The ceiling for routine and support costs per diem shall be the median cost per diem for routine and support costs for all facilities.

969.5

The ceiling for administrative and general costs per diem shall be the median cost per diem for administrative and general costs for all facilities.

969.6

The ceiling for healthcare-related costs per diem shall be the median cost per diem for healthcare-care related costs for all facilities.

969.7

A facility can apply for one of two types of special acuity categories for establishing its healthcare related cost per diem rate if they provide services to one or more customers with specialized needs as follows:

(a) Acuity Category One - Individuals with moderate to profound mental retardation who have all of the following characteristics:

(1) Are medically fragile;

(2) Have clearly documented multiple medical concerns; and

(3) Require specialized medical services such as incontinence care, tracheotomies or G-tubes.

(b) Acuity Category Two - Individuals with mental retardation who are dually diagnosed and have all of the following characteristics:

(1) A mental health diagnosis;

(2) Exhibit assaultive, self-abusive or aggressive behaviors; and

(3) Require a behavior management program.

969.8

The healthcare-related median shall be recalculated to exclude the cost of customers who qualify for these acuity categories. The Medicaid Program shall develop and implement a process to identify providers who qualify for inclusion in one of the two acuity categories and recalculate the median.

969.9

Each ICF/MR shall be entitled to an efficiency incentive add-on if the provider's base year administrative and general or routine and support cost per diems are below the median. For the year ended September 30, 1997, the efficiency incentive shall be 50% of the difference between the facility-specific base year cost per diem and the median cost, not to exceed 10% of the median. Efficiency incentives shall be calculated separately for the administrative and general cost category and the routine and support cost category. If a provider's base year per diem costs are below the median in both categories the provider shall be entitled to two (2) separate efficiency incentives.

D.C. Mun. Regs. tit. 29, r. 29-969

Final Rulemaking published at 45 DCR 2333 (April 17, 1998); as amended by Final Rulemaking published at 55 DCR 5275 (May 2, 2008)

Authority: An Act to enable the District of Columbia to receive Federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 744; D.C. Official Code § 1-307.2)); Reorganization Plan No. 4 of 1996, effective January 13, 1997; and Mayor's Order 97-42, dated February 18, 1997.