PURPOSE: This rule establishes a reimbursement plan for nursing facility and HIV nursing facility services required by the Code of Federal Regulations. The plan describes principles to be followed by Title XIX nursing facility and HIV nursing facility providers in preparing and submitting cost reports and sets forth the principles and methodology for determining the reimbursement for nursing facility and HIV nursing facility providers. This rule provides for a rebasing of nursing facility and HIV nursing facility per diem rates using on a more current cost report year and incorporates acuity and value based purchasing adjustments in determining the per diem rate.
PUBLISHER'S NOTE: The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here.
Owner Compensation Guidelines | ||||
Year | Bed Size | Low | High | Median |
2019 | 0 - 74 | $55,917 | $100,415 | $71,552 |
75 - 99 | $42,080 | $102,208 | $72,151 | |
100 - 149 | $60,132 | $121,451 | $78,162 | |
150 - 200 | $62,536 | $122,652 | $96,202 | |
200+ | $72,151 | $180,379 | $99,203 |
Certification of Officer or Administrator of Provider I hereby certify that I have read the above statement and that I have examined the accompanying cost report and supporting schedules prepared by (provider name) for the cost report period beginning (date/year) and ending (date/ year), and that to the best of my knowledge and belief, it is a true, correct, and complete statement prepared from the books and records of the provider in accordance with applicable instructions, except as noted. ____________________________________ _____________________________________________ Notary Public Authorized Signature _____________________________ (Title) My Commission Expires ___________________ ________________________________________ |
Description | Total Allowable Cost | Ceiling | Lower of Ceiling /Per Diem | |
Total Patient Care Costs | $3,285,275 | |||
Aides & Orderlies | $918,303 | |||
Dietary Salaries | $248,776 | |||
Total | $1,167,079 | |||
Salary Adjustment | 2% | $23,342 | ||
Adjusted Patient Care | $3,308,617 | |||
Trend | 7.69% | |||
Trended Cost | $3,563,050 | |||
Statewide Average Total CMI | .8744 | |||
Cost Report Total CMI | .9664 | |||
Total CMI Adjusted Costs ($3,563,050* .8744/.9664) | $3,223,852 | |||
Total Patient Days | 30,475 | |||
Base Patient Care Per Diem | $105.79 | $127.12 | $105.79 | |
Medicaid CMI | .8206 | |||
Medicaid CMI Adjusted Patient Care Per Diem ($105.79* .8206/.8744) | $99.28 |
Description | Total Allowable Cost | Ceiling | Lower of Ceiling / Per Diem | |
Total Ancillary Costs | $454,281 | |||
Laundry Salaries | $58,002 | |||
Housekeeping Salaries | $137,329 | |||
Beauty & Barber Salaries | $0 | |||
Total | $195,331 | |||
Salary Adjustment | 2% | $3,907 | ||
Adjusted Ancillary | $458,188 | |||
Trend | 7.69% | |||
Trended Cost | $493,423 | |||
Total Patient Days | 30,475 | |||
Ancillary Per Diem | $16.19 | $21.48 | $16.19 |
Description | Total Allowable Cost | Ceiling | Lower of Ceiling / Per Diem | |
Total Administration Costs | $1,772,163 | |||
Trend | 7.69% | |||
Trended Cost | $1,908,442 | |||
Total Patient Days | 30,475 | |||
Minimum Utilization Days | 44,384 | |||
Greater of Total Patient Days or Min. Utilization Days | 44,384 | |||
Administration Per Diem | $43.00 | $35.73 | $35.73 |
Historical Base Data * | |||
Total Facility Size | Age | Age x Beds | |
Licensed Beds | 75 | ||
Bed Equivalents | 0 | ||
Totals | 75 | 30 | 2,250 |
* The is the cumulative, historical data previously used to determine existing nursing facilities' prospective rates under 13 CSR 70-10.015.
Licensure History * | ||||
Licensure Year | No. of Bed Incr/(Decr) | Age From 2019 | Age x Beds | |
Bed Increases / Decreases: | 2003 | 15 | 16 | 240 |
2004 | 5 | 15 | 75 | |
2006 | 10 | 13 | 130 | |
2008 | (5) | 30 | (150) | |
Totals (Bed Incr/(Decr thru 2019) | 25 | 295 | ||
Total Licensed Beds (Base Data + Bed Incr/(Decr)) | 100 |
* This is the licensure history from 2002-2019 which reflects the licensure changes subsequent to the Historical Base Data shown above.
Capital Expenditure History * | |||||
Year | Allowable Capital Expenditures for Bed Equiv | Asset Value - Year of Capital Expenditures | Bed Equivalents | Age From 2019 | Age x Beds |
2002 | $1,677,164 | $35,325 | 47 | 17 | 799 |
2009 | $170,824 | $47,948 | 3 | 10 | 30 |
2014 | $310,351 | $52,042 | 5 | 5 | 25 |
2018 | $84,308 | $53,769 | 1 | 1 | 1 |
2019 | $145,692 | $64,701 | 2 | 0 | 0 |
Totals (Bed Equiv. thru 2019) | 58 | 855 | |||
Total Bed Eqiv. (Base Data + Bed Equiv thru 2019) | 58 |
* This is the capital expenditure and bed equivalency history from 2002-2019 which reflects the changes subsequent to the Historical Base Data shown above.
Total Facility Size and Weighted Average Age | ||
Total Facility Size (Licensed Beds + Bed Equiv.) | 158 | 3,400 |
Weighted Average Age (3,495 / 158) | 22 |
Total facility size | 158 |
x Asset value - 2019 | $64,701 |
Total asset value | $10,222,758 |
Total asset value | $10,222,758 |
x Age of beds x 1% | 22% |
- Reduction for age (max 40%) | ($2,249,007) |
Facility asset value | $7,973,751 |
Facility asset value | $7,973,751 |
x Rental value percent | x 6.375% |
Rental value | $508,327 |
** Assumption: facility occupancy from the rate setting cost report = 56.63%
Rental value | $11.02 |
Pass-through expenses | $2.23 |
Total capital cost component per diem | $13.25 |
Cost Component | Per Diem |
Patient Care | $99.28 |
Ancillary | $16.19 |
Administration | $35.73 |
Capital (FRV) | $13.25 |
Total Cost Component Per Diem | $164.45 |
Patient Care & Ancillary Percent of Total Rate | Incentive |
< 70% | $0.00 |
> or = 70% but < 75% | $0.10 |
> or = 75% but < or = 80% | $0.15 |
> 80% | $0.20 |
Medicaid Utilization Percent | Incentive |
< 85% | $0.00 |
> or = 85% but < 90% | $0.10 |
> or = 90% but < 95% | $0.15 |
> or = 95% | $0.20 |
QM Performance | Threshold | Per Diem Adjustment |
Decline in Late-Loss ADLs | <= 10.0% | $1.00 |
Decline in Mobility on Unit | <= 8.0% | $1.00 |
High-Risk Residents w/ Pressure Ulcers | <= 2.7% | $1.00 |
Anti-Psychotic Medications | <= 6.8% | $1.00 |
Falls w/ Major Injury | <= 1.3% | $1.00 |
In-Dwelling Catheter | <= 1.1% | $1.00 |
Urinary Tract Infection | <= 1.9% | $1.00 |
QM Scoring Tier | Minimum Score | VBP Percentage |
1 | 600 | 100% |
2 | 520 | 75% |
3 | 440 | 50% |
4 | 360 | 25% |
5 | 0 | 0% |
Cost Component | Per Diem |
Patient Care | $99.28 |
Ancillary | $16.19 |
Administration | $35.73 |
Capital (FRV) | $13.25 |
Total Cost Component Per Diem | $164.45 |
Patient Care Incentive | $5.03 |
Multiple Component Incentive | $0.10 |
Total Patient Care & Multiple Component Incentives | $5.13 |
Preliminary Per Diem | $169.58 |
Current Prospective Rate (excluding NFRA) - June 30, 2022 | $163.98 |
Base Rate - Greater of Preliminary Per Diem or June 30, 2022 Prospective Rate | $169.58 |
NFRA - July 1, 2022 | $12.93 |
Total Rebased Rate | $182.51 |
VBP Incentive | $2.00 |
VBP Payment Percent | 75% |
VBP Add-On Per Diem Rate | $1.50 |
Mental Illness Diagnosis Add-On | $0.00 |
Total Prospective Rate - July 1, 2022 | $184.01 |
APPENDIX A
COVERED SUPPLIES AND SERVICES
PERSONAL CARE
Baby powder
Bedside tissues
Bibs, all types
Deodorants
Disposable underpads of all types
Gowns, hospital
Hair care, basic including washing, cuts, sets, brushes, combs, nonlegend shampoo
Lotion, soap, and oil
Oral hygiene including denture care, cups, cleaner, mouthwashes, toothbrushes, and paste
Shaves, shaving cream, and blades
Nail clipping and cleaning routine
EQUIPMENT
Arm slings
Basins
Bathing equipment
Bed frame equipment including trapeze bars and bedrails
Bed pans, all types
Beds, manual, electric
Canes, all types
Crutches, all types
Foot cradles, all types
Glucometers
Heat cradles
Heating pads
Hot pack machines
Hypothermia blanket
Mattresses, all types
Patient lifts, all types
Respiratory equipment: compressors, vaporizers, humidifiers, IPPB machines, nebulizers, suction equipment, and related supplies, etc.
Restraints
Sand bags
Specimen container, cup or bottle
Urinals, male and female
Walkers, all types
Water pitchers
Wheelchairs, standard, geriatric, and rollabout
NURSING CARE/PATIENT CARE SUPPLIES
Catheter, indwelling and nonlegend supplies
Decubitus ulcer care: pads, dressings, air mattresses, aquamatic K pads (water heated pads), alternating pressure pads, flotation pads, and/or turning frames, heel protectors, donuts and sheepskins
Diabetic blood and urine testing supplies
Douche bags
Drainage sets, bags, tubes, etc.
Dressing trays and dressings of all types
Enema supplies
Gloves, nonsterile and sterile
Ice bags
Incontinency care including pads, diapers, and pants
Irrigation trays and nonlegend supplies
Medicine droppers
Medicine cups
Needles including, but not limited to, hypodermic, scalp, vein Nursing services: regardless of level, administration of oxygen, restorative nursing care, nursing supplies, assistance with eating and massages provided by facility personnel
Nursing supplies: lubricating jelly, betadine, benzoin, peroxide, A and D Ointment, tapes, alcohol, alcohol sponges, applicators, dressings and bandages of all types, cottonballs, and aerosol merthiolate, tongue depressors
Ostomy supplies: adhesive, appliance, belts, face plates, flanges, gaskets, irrigation sets, night drains, protective dressings, skin barriers, tail closures, and bags
Suture care including trays and removal kits
Syringes, all sizes and types including ascepto
Tape for laboratory tests
Urinary drainage tube and bottle
THERAPEUTIC AGENTS AND SUPPLIES
Supplies related to internal feedings
I.V. therapy supplies: arm boards, needles, tubing, and other related supplies
Oxygen (portable or stationary), oxygen delivery systems, concentrators, and supplies
Special diets
13 CSR 70-10.020