D.C. Mun. Regs. tit. 29, r. 29-6502

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 29-6502 - COMPUTATION OF PRICE AND FLOOR

6502.1

DHCF shall classify each nursing facility operating in the District and participating in the Medicaid program into three (3) peer groups:

(a) Peer Group One - All freestanding nursing facilities, with more than seventy- five (75) Medicaid certified beds;

(b) Peer Group Two - All freestanding nursing facilities with seventy- five (75) or fewer Medicaid certified beds; and

(c) Peer Group Three - All hospital-based nursing facilities.

6502.2

The routine and support per diem price for each peer group shall be the day-weighted median cost per diem as described in § 6506 multiplied by a peer group specific factor. The peer group specific factors used in this formula will be posted on the DHCF website athttps://dhcf.dc.gov/page/medicaid-reimbursement-nursing-facilities-participating-district-columbia-medicaid-program . To the extent that changes to these factors are needed in future, DHCF will publish notice in the D.C. Register thirty (30) days in advance of any changes and post the updated factors on the DHCF website at the link noted above.

6502.3

The nursing and resident care price for each peer group shall be the day-weighted median case mix neutralized cost per diem as described in § 6505 multiplied by a peer group specific factor. The peer group specific factors used in this formula will be posted on the DHCF website at https://dhcf.dc.gov/page/medicaid-reimbursement-nursing-facilities-participating-district-columbia-medicaid-program. To the extent that changes to these factors are needed in future, DHCF will publish notice in the D.C. Register thirty (30) days in advance of any changes and post the updated factors on the DHCF website at the link noted above.

6502.4

For the rate period beginning February 1, 2018, DHCF has applied a fixed percentage of the peer group price in calculating the peer group floor. Each facility's case mix adjusted Medicaid cost per day is subject to the floor, which is a fixed percentage of the peer group price. The fixed percentage used in this calculation will be posted on the DHCF website at: https://dhcf.dc.gov/page/medicaid-reimbursement-nursing-facilities-participating-district-columbia-medicaid-program. To the extent that changes to this percentage are needed in future, DHCF will publish notice in the D.C. Register thirty (30) days in advance of any changes and post the updated percentage on the DHCF website at the link noted above.

6502.5

Once nursing facilities have been classified into peer groups for the purpose of establishing the peer group prices, the nursing facility price for each peer group shall apply to all facilities in that peer group until Medicaid rates are rebased, or until DHCF makes an adjustment to the price or floor.

6502.6

DHCF shall publish a public notice in the D.C. Register and on the DHCF website setting forth the reimbursement methodology for each District nursing facility at least thirty (30) calendar days prior to implementation. In addition, DHCF shall issue individualized notices that detail facility-specific reimbursement rates to each participating nursing facility at least thirty (30) days prior to February 1, 2019. DHCF shall post notice of the final rates on the DHCF website upon approval of the reimbursement methodology by the U.S. Health and Human Services, Centers for Medicare and Medicaid Services (CMS). A public notice of any changes to the reimbursement rates shall be published in the D.C. Register at least thirty (30) calendar days in advance of the changes.

D.C. Mun. Regs. tit. 29, r. 29-6502

Final Rulemaking published at 53 DCR 1370 (February 24, 2006); amended by Final Rulemaking published at 66 DCR 13664 (10/18/2019)