Section 16.03.10.263 - NURSING FACILITY: DISTRESSED FACILITY01.Determination. If the Department determines that a facility is located in an under-served area, or addresses an under-served need, the Department may negotiate a reimbursement rate different than the rate then in effect for that facility.02.Discretionary Factors. The fact that a facility may be located in an under-served area or meets an under-served need does not guarantee increased reimbursement. In exercising its discretion to apply a higher rate, the Department will consider the factors as described in Subsections 263.02.a. through 263.02.e. of this rule.a. Prudent Spending Patterns. The facility has exercised prudent spending and cost allocation practices, as evidenced by a thorough and comprehensive review of the facility's accounts by the Department.b. Reasonable Attempts to Remedy Problems. The facility must persuade the Department that it has conscientiously and diligently attempted to cover its costs of care, hire qualified staff and otherwise operate effectively and efficiently, but for causes beyond the facility's reasonable control, it has not been able to do so.c. Facility Already Receives Special Rates. When a facility already receives special rates for certain difficulty-of-care patients from the Department, the same costs of care that were used to determine special rates will not be applied toward a determination of distressed facility status, because the special rate meets that need.d. Direct and Indirect Costs of Care Apportioned to Patient Care. The Department reimburses the costs of patient care, and does not pay for indirect costs not associated with patient care. The determination of distressed status will focus on whether the facility's distress stems from patient care costs, or whether the distress arises from expenses unrelated to patient care costs.e. Existing Cost Limits.Under no circumstances may a facility's reimbursement exceed the lower of its actual costs or customary charge to private-pay patients, as required by federal law, subject to the exceptions in federal law. The Department's cost caps can be exceeded through the distressed facility process, but to an amount no greater than the federal upper payment limit.03.Annual Review. Distressed facility payments are assumed to be short-term in nature. Each distressed payment must be re-requested and re-justified for each subsequent fiscal year that the facility desires the distressed facility rate.04.Prospective Application. Distressed facility status will be applied only to facilities that are currently distressed or entering a period of distress. Distressed facility status will not be applied to retroactive rate years.05.Facility-by-Facility Basis. Each facility must independently establish distress on its own merits, whether or not other facilities with a common owner may also be experiencing distress.Idaho Admin. Code r. 16.03.10.263