Md. Code Regs. 10.09.10.11-8

Current through Register Vol. 51, No. 12, June 14, 2024

Section 10.09.10.11-8 - Ventilator Care Nursing Facilities Effective January 1, 2015

Nursing facilities with licensed nursing facility beds, which have been determined by the Department to meet the standards for ventilator care under COMAR 10.07.02, shall be reimbursed as follows:

A. Services for residents receiving ventilator care shall be reimbursed as follows:

(1) The Nursing Service rate identified in Regulation .11-7 of this chapter shall be calculated with a facility average Medicaid case mix index that includes only residents receiving ventilator care; and

(2) An amount of $280 shall be added to the total prospective rate;

B. Rates under § A of this regulation shall be paid in full and are not subject to the phase-in provisions identified in Regulation .07-2B of this chapter;

C. The facility average Medicaid case mix index for rates under §A of this regulation are not subject to the Medicaid case mix index equalizer adjustment in Regulation .11-7F(6) of this chapter;

D. Nursing facilities adding ventilator care services for the first time, which have been determined by the Department to meet the standards for ventilator care under COMAR 10.07.02, shall be reimbursed as described in §A of this regulation, except that the facility average Medicaid case mix index is assumed to be that of RUG classification ES3 (or its future equivalent);

E. The facility should request this rate from the Department at least 60 days before the opening of the ventilator unit;

F. For years between periods when the Nursing Services prices are rebased, the final price for Ventilator costs shall be adjusted as set forth in Regulation .08-1D of this chapter; and

G. Services for residents not receiving ventilator care shall be reimbursed as follows:

(1) The Initial Facility Nursing Service rate identified in Regulation .11-7 of this chapter shall be calculated with a facility average Medicaid case mix index that excludes residents receiving ventilator care;

(2) The 2012 final settlement per diem identified in Regulation .07-2B of this chapter shall be calculated exclusive of ventilator care costs; and

(3) The 2012 final settled per diem for nursing services exclusive of ventilator costs shall be calculated as follows:

(a) Determine the ratio of settled 2012 nursing costs, including incentives and add-ons, to interim payments;

(b) Multiply the ratio by 2012 interim payments for ventilator payments including heavy special daily rate payments and add-on payments included in additional procedures payments;

(c) Subtract the result from the total settled 2012 nursing cost including incentives and add-ons to compute the 2012 final settled per diem for nursing services exclusive of ventilator costs; and

(d) Divide by Medicaid patient days exclusive of Medicaid ventilator days per the 2012 final settlement report for nursing.

Md. Code Regs. 10.09.10.11-8

Regulations .11-8 amended as an emergency provision effective January 14, 1992 (19:3 Md. R. 299); emergency status expired June 30, 1992
Regulations .11-8 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 .11-8 adopted effective 42:7 Md. R. 567, eff.4/13/2015; amended effective 43:25 Md. R. 1384, eff. 12/19/2016; amended effective 45:13 Md. R. 664, eff. 7/2/2018