405 Ind. Admin. Code 1-12-9
Authority: IC 12-15-1-10; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 9.
During rebasing years and for base rate reviews, the Medicaid reimbursement system is based on recognition of the provider's allowable costs plus a potential profit add-on payment. The payment rate established during rebasing years and for base rate reviews is subject to the following limitations:
TABLE I
Profit Add-On
The profit add-on is equal to the percent (Column A) of the difference (if greater than zero (0)) between a provider's inflated allowable per patient or resident day cost, and the ceiling (Column B) times the average inflated allowable per patient or resident day cost of the median patient or resident day. Under no circumstances shall a provider's per patient or resident day profit add-on exceed the cap (Column C) times the average inflated allowable per patient or resident day cost of the median patient or resident day.
Level of Care | (A) Percent | (B) Ceiling | (C) Cap |
Sheltered living Intensive training Child rearing Nonstate-operated ICF/IID | 40% 40% 40% 40% | 105% 120% 130% 125% | 10% 10% 12% 12% |
Developmental training Child rearing with a specialized program Small behavior management residences for children Basic developmental Small extensive medical needs residences for adults Extensive support needs residences for adults | 40% 40% 40% 40% 40% 40% | 110% 120% 120% 110% 110% 110% | 10% 12% 12% 10% 10% 10% |
TABLE II
Overall Rate Limit
Level of Care | (A) Percent |
Sheltered living Intensive training Child rearing | 115% 120% 130% |
Developmental training Child rearing with a specialized program Small behavior management residences for children Basic developmental | 120% 120% 120% 120% |
Small extensive medical needs residences for adults Extensive support needs residences for adults Nonstate-operated ICF/IID | 120% 120% 107% |
405 IAC 1-12-9