Section He-E 806.35 - Rate Setting and Payment Limitations For General Nursing Facility Care(a) Rate setting and payment limitations for NF care shall be determined as specified in (b) through (f) below:(b) Each facility's per diem rate shall be reviewed at least annually by the department pursuant to He-E 806 utilizing data submitted on the annual cost report.(c) The per diem rate shall be calculated by dividing allowable costs by the greater of either: (1) The actual days of service rendered, including reserved bed days; or(2) The number of resident days computed at 85% of the certified bed capacity.(d) In no case shall payment exceed the NF's customary charges to the general public for such services, or, where applicable, the Medicare rate of reimbursement, whichever is less;(e) When a Medicaid per diem rate is established as a condition for a health services planning review board approval, pursuant to RSA 151-C, and that rate differs from the Medicaid rate established by the department, payment shall be made at the lesser of the 2 rates; and(f) Where a rate limitation is applied as a health services planning review board condition, an NF provider may, if aggrieved, appeal such limitation in accordance with He-C 200.N.H. Code Admin. R. He-E 806.35
#8547, eff 1-24-06 (formerly He-W 593.37 )