PURPOSE: This amendment provides for an increase to nursing facility and HIV nursing facility per diem reimbursement rates of ten dollars and zero cents ($10.00) and an increase to the Value Based Purchasing per diem adjustments of eighty-seven ($0.87) for qualifying facilities, effective for dates of service beginning July 1, 2023. These per diem adjustments correspond to the state fiscal year (SFY) 2024 appropriation for nursing facilities and was contingent upon approval by the Centers for Medicare and Medicaid Services (CMS).
EMERGENCY STATEMENT: The Department of Social Services (DSS), MO HealthNet Division (MHD), by rule and regulation, must define the reasonable costs, manner, extent, quantity, quality, charges, and fees of medical assistance provided to MO HealthNet participants. The General Assembly included additional funds to nursing facilities' and HIV nursing facilities' reimbursements for SFY 2024. MHD is carrying out the General Assembly's intent by providing for an increase to nursing facility and HIV nursing facility per diem reimbursement rates of ten dollars and zero cents ($10.00) and an increase to the Value Based Purchasing per diem adjustments of eighty-seven ($0.87) for qualifying facilities, effective for dates of service beginning July 1, 2023. The per diem adjustments are necessary to ensure that payments for nursing facility and HIV nursing facility per diem rates are in line with the funds appropriated for that purpose. There are a total of four hundred eighty-four (484) nursing facilities and HIV nursing facilities currently enrolled in MO HealthNet that will receive a per diem increase to its reimbursement rate effective for dates of service beginning July 1, 2023. This emergency amendment will ensure payment for nursing facility and HIV nursing facility services to approximately twenty-two thousand (22,000) MO HealthNet participants in accordance with the appropriation authority. For the SFY 2024 payment to be made, MHD was required to submit a Medicaid State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS). CMS approved the SPA on December 18, 2023. This emergency amendment is necessary to protect the public health and welfare of MO HealthNet participants in nursing facilities and HIV nursing facilities. This emergency amendment is necessary to protect a government interest to reimburse nursing facilities and HIV nursing facilities as required by the General Assembly, and to provide MO HealthNet participants with quality nursing facility services. As a result, MHD finds an immediate danger to public health, safety, and/or welfare and a compelling governmental interest, which requires emergency action. MHD has a compelling government interest in providing continued cash flow for nursing facility and HIV nursing facility services. The scope of this emergency amendment is limited to the circumstances creating the emergency and complies with the protections extended by the Missouri and United States Constitutions. MHD believes this emergency amendment is fair to all interested persons and parties under the circumstances. A proposed amendment covering this same material will be published in the Missouri Register. This emergency amendment was filed February 21, 2024, effective March 6, 2024, and expires September 1, 2024.
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-
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 |
10.015.
* 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 |
The QM Performance Measure threshold, rounded to the nearest tenth, and per diem adjustments are as follows:
QM Performance | Threshold | Per Diem Adjustment |
Decline in Late-Loss ADLs | < or = 10.0% | $1.00 |
Decline in Mobility on Unit | < or = 8.0% | $1.00 |
High-Risk Residents w/ Pressure Ulcers | < or = 2.7% | $1.00 |
Anti-Psychotic Medications | < or = 6.8% | $1.00 |
Falls w/ Major Injury | < or = 1.3% | $1.00 |
In-Dwelling Catheter | < or = 1.1% | $1.00 |
Urinary Tract Infection | < or = 1.9% | $1.00 |
QM Performance | Threshold | Per Diem Adjustment |
Decline in Late-Loss ADLs | < or = 10.0% | $1.87 |
Decline in Mobility on Unit | < or = 8.0% | $1.87 |
High-Risk Residents w/ Pressure Ulcers | < or = 2.7% | $1.87 |
Anti-Psychotic Medications | < or = 6.8% | $1.87 |
Falls w/ Major Injury | < or = 1.3% | $1.87 |
In-Dwelling Catheter | < or = 1.1% | $1.87 |
Urinary Tract Infection | < or = 1.9% | $1.87 |
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