Md. Code Regs. 10.09.10.09

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.10.09 - Rate Calculation - Administrative and Routine Costs

A. The Administrative and Routine cost center includes:

(1) Administrative expenses;

(2) Medical records expenses;

(3) Training expenses;

(4) Dietary;

(5) Laundry;

(6) Housekeeping;

(7) Operation and maintenance; and

(8) Capitalized organization and start-up costs.

B. The Department shall initially establish cost center prices for the rate period January 1, 2015 through June 30, 2015, and thereafter rebase the cost center prices between every 2 and 4 rate years. Prices may be rebased more frequently if the Department determines that there is an error in the data or in the calculation that results in a substantial difference in payment, or, if a significant change in provider behavior or costs has resulted in payment that is inequitable, across providers. The Department shall rebase based on the following steps:

(1) The price database shall be established using the most recent desk reviewed Nursing Home Uniform Cost Report for each current provider, or the immediately prior owner of that nursing facility, that is available 2 months before the period for which prices are being established or rebased;

(2) If no desk reviewed cost report is available, that provider shall be excluded from the price database;

(3) The total cost center expenses for each cost report in the price database shall be adjusted from the midpoint of each cost reporting period to the midpoint of the rate year for which the price is being established based on the following steps:

(a) A monthly market basket index shall be calculated based on the following calculations:

Market Basket Index Quarter	Assigned Month	Monthly Index
Quarter 1	January	33 percent of Quarter 4 prior year index plus 67 percent of Quarter 1 index
Quarter 1	February	100 percent of Quarter 1 index
Quarter 1	March	67 percent of Quarter 1 index plus 33 percent of Quarter 2 index
Quarter 2	April	33 percent of Quarter 1 index plus 67 percent of Quarter 2 index
Quarter 2	May	100 percent of Quarter 2 index
Quarter 2	June	67 percent of Quarter 2 index plus 33 percent of Quarter 3 index
Quarter 3	July	33 percent of Quarter 2 index plus 67 percent of Quarter 3 index
Quarter 3	August	100 percent of Quarter 3 index
Quarter 3	September	67 percent of Quarter 3 index plus 33 percent of Quarter 4 index
Quarter 4	October	33 percent of Quarter 3 index plus 67 percent of Quarter 4 index
Quarter 4	November	100 percent of Quarter 4 index
Quarter 4	December	67 percent of Quarter 4 index plus 33 percent of Quarter 1 next year index

(b) The index factor for each cost reporting period shall be calculated by dividing the index associated with the midpoint of the rate year by the index associated with the midpoint of the cost reporting period; and

(c) The indexed costs shall be calculated as total cost center expenses times the index factor;

(4) Each cost report's indexed Administrative and Routine costs shall be divided by the greater of total resident days or days at full occupancy times an occupancy standard calculated as the Statewide average occupancy, not including providers with occupancy waivers, plus 1.5 percent to arrive at the Administrative and Routine cost per diem; and

(5) For each reimbursement class, each cost report's Medicaid resident days shall be used in the array of Administrative and Routine cost per diems identified in §B(4) of this regulation to calculate the Administrative and Routine Medicaid day weighted median as follows:

(a) Array the Administrative and Routine cost per diems for each geographic region from low to high;

(b) For each Administrative and Routine cost per diem, identify the Medicaid days from the nursing facilities' cost reports;

(c) Calculate a cumulative Medicaid day total; and

(d) Identify the median Administrative and Routine cost per diem as the Administrative and Routine per diem associated with the cumulative Medicaid days that first equals or exceeds half the number of total Medicaid days for the geographic region.

C. The final price for Administrative and Routine costs for each reimbursement class shall be calculated as the geographic regional Medicaid day weighted median multiplied by 1.025.

D. For years between periods when the prices are rebased, the final cost center price shall be adjusted by the change in the indexes as calculated in §B(3) of this regulation that correspond to midpoint of the prior rate year to the midpoint of the new rate year.

E. The final Administrative and Routine rate for each nursing facility is the Administrative and Routine price for its reimbursement class.

F. The reimbursement classes for the Administrative and Routine cost center are specified under Regulation .30A of this chapter.

G. Kosher Kitchen Add-on.

(1) Nursing facilities that maintain kosher kitchens and have Administrative and Routine costs in excess of the Administrative and Routine price in their reimbursement class that are attributable to dietary expense shall receive an add-on to its final price in an amount up to 15 percent of the median per diem cost for dietary expense in its reimbursement class.

(2) For years between periods when the kosher kitchen add-ons are rebased, the kosher kitchen add-on shall be calculated as the prior year kosher kitchen add-on multiplied by the rate year monthly index divided by the prior year monthly index as identified in §B(3)(a) of this regulation.

Md. Code Regs. 10.09.10.09

Regulation .09 amended effective August 17, 1977 (4:17 Md. R. 1298)
Regulation .09A amended effective September 29, 1976 (3:20 Md. R. 1143)
Regulation .09B amended as an emergency provision effective April 1, 1977 (4:8 Md. R. 631); emergency status extended at 4:17 Md. R. 1291
Regulation .09B, D amended effective January 30, 1976 (3:4 Md. R. 216)
Regulation .09A amended as an emergency provision effective July 1, 1977 (4:15 Md. R. 1143); amended permanently effective October 21, 1977 (4:22 Md. R. 1671)
Regulation .09A amended as an emergency provision effective June 13, 1978 (5:13 Md. R. 1039)
Regulations .09 amended as an emergency provision effective March 15, 1978 (5:9 Md. R. 681)
Regulations .09 amended as an emergency provision effective January 14, 1992 (19:3 Md. R. 299); emergency status expired June 30, 1992
Regulations .09 amended as an emergency provision effective July 1, 1992 (19:14 Md. R. 1272); amended permanently effective November 1, 1992 (19:21 Md. R. 1891)
Regulations .09 amended as an emergency provision effective July 1, 2005 (32:19 Md. R. 1584); emergency status expired August 31, 2005
Regulations .09 amended and new Regulation .09-1 adopted as an emergency provision effective October 1, 1999 (26:23 Md. R. 1775); adopted permanently effective January 9, 2000 (26:27 Md. R. 2015)
Regulations .09 amended as an emergency provision effective December 1, 2001 (29:1 Md. R. 17)
Regulations .09 amended as an emergency provision effective July 1, 1995 (22:15 Md. R. 1114); emergency status expired November 1, 1995; amended permanently effective November 6, 1995 (22:22 Md. R. 1658)
Regulations .09 amended as an emergency provision effective July 1, 1996 (23:15 Md. R. 1081); amended permanently effective November 4, 1996 (23:22 Md. R. 1496)
Regulations .09 amended as an emergency provision effective July 1, 1997 (24:16 Md. R. 1149) (Emergency provisions are temporary and not printed in COMAR)
Regulations .09 amended as an emergency provision effective July 1, 1998 (25:15 Md. R. 1181); amended permanently effective October 19, 1998 (25:21 Md. R. 1574)
Regulations .09 amended as an emergency provision effective July 1, 1999 (26:16 Md. R. 1237 and 26:18 Md. R. 1369); emergency status expired September 30, 1999
Regulations .09E amended as an emergency provision effective January 6, 1994 (21:2 Md. R. 95); emergency status extended at 21:9 Md. R. 744; emergency status expired June 5, 1994
Regulations .09E amended as an emergency provision effective July 1, 1994 (21:16 Md. R. 1379); emergency status expired November 7, 1994
Regulation .09B amended effective July 1, 1993 (20:12 Md. R. 996); October 20, 1997 (24:21 Md. R. 1449)
Regulation .09E amended effective July 1, 1993 (20:12 Md. R. 996); June 6, 1994 (21:11 Md. R. 951); November 7, 1994 (21:22 Md. R. 1876); October 20, 1997 (24:21 Md. R. 1449)
Regulation .09E amended as an emergency provision effective July 1, 2003 (30:15 Md. R. 990); emergency status expired December 31, 2003
Regulation .09E amended effective February 16, 2004 (31:3 Md. R. 207); December 9, 2005 (32:24 Md. R. 1904)
Regulation .09E amended as an emergency provision effective July 1, 2007 (34:15 Md. R. 1345); emergency status extended at 35:3 Md. R. 286; emergency status expired June 24, 2008
Regulation .09E amended as an emergency provision effective April 1, 2008 (35:9 Md. R. 892); emergency status expired September 3, 2008
Regulation .09E amended effective April 6, 2009 (36:7 Md. R. 523); December 27, 2010 (37:26 Md. R. 1787); November 28, 2011 (38:24 Md. R. 1502)
Regulation .09E, F amended effective March 18, 2013 (40:5 Md. R. 411)
Regulation .09E, H amended effective September 22, 2008 35:19 Md. R. 1716)
Regulation .09H adopted effective September 11, 2006 (33:18 Md. R. 1505)
Regulation .09H repealed as an emergency provision effective July 1, 2007 (34:15 Md. R. 1345); emergency status extended at 35:3 Md. R. 286
Regulation .09H repealed as an emergency provision effective April 1, 2008 (35:9 Md. R. 892); emergency status expired September 3, 2008
Regulations .09 amended effective 42:7 Md. R. 567, eff.4/13/2015; amended and recodified from .08-1 effective 45:13 Md. R. 664, eff. 7/2/2018