Section 17-1739-64 - Calculation of base prospective rates for classifications II and III - nonpsychiatric services(a) The facility-specific prospective payment base rates for nonpsychiatric services rendered in facilities in classifications II and III shall be comprised of two separately established rate components, one per diem rate for routine services and one per discharge rate for ancillary services.(b) The facility-specific base routine per diem and per discharge ancillary rate for nonpsychiatric services for each service category (maternity, surgical, and medical) shall be established using the following general methodology: (1) Deduct the capital related costs allocated to nonpsychiatric services and ancillaries on the base year cost report;(2) Determine separately for each service category the ratio of nonpsychiatric claim charges, days, and discharges to total claim charges, days, and discharges associated with routine, special care, and ancillary components;(3) Multiply the ratios determined in paragraph (2) by total medicaid inpatient days, discharges and costs, excluding capital related costs;(4) Determine the routine per diem costs for each service category by dividing the sum of routine and special care costs, excluding capital related costs, by the sum of routine and special care days as derived from the cost report; and(5) Determine the facility ancillary cost per discharge for each service category by dividing the ancillary service costs, excluding capital related costs, by the discharges as derived from the cost report.(c) The base year per diem rate component ceiling shall be calculated for each nonpsychiatric service category for all facilities in classifications II and III as follows: (1) For all facilities within a classification, total for each service category the routine costs, excluding capital related costs, and days identified in subsection (b);(2) Divide total costs calculated in paragraph (1) for each service category by total patient days;(3) Multiply the result of paragraph (2) for each facility classification by the nonpsychiatric classification II and III ceiling factor (one hundred twenty per cent) published annually by the department; and(4) The result shall be the per diem rate component ceiling for nonpsychiatric services for each service category within each facility classification.(d) A facility's prospective payment rate component for routine services for each nonpsychiatric service category shall equal the lesser of either the facility-specific base rate component or the per diem rate ceiling for the appropriate facility classification.(e) The ancillary services per discharge rate component ceiling shall be established separately for each service category in the following manner: (1) For all facilities within a classification, total the ancillary costs, excluding capital related costs, and discharges within each nonpsychiatric service category;(2) Divide the total costs calculated in paragraph (1) by total discharges for each service category;(3) Multiply the result of paragraph (2) for each facility classification by the nonpsychiatric classification II and III ceiling factor (one hundred twenty per cent) published annually by the department; and(4) The result shall be the ancillary rate component ceiling for nonpsychiatric services for each nonpsychiatric service category within each facility classification.(f) A facility's prospective per discharge base payment rate component for ancillary services for each nonpsychiatric service category shall equal the lesser of either the facility-specific per discharge base rate or the per discharge rate ceiling for the appropriate facility classification.Haw. Code R. § 17-1739-64
[Eff 11/13/95] (Auth: HRS § 346-59) (Imp: 42 C.F.R. §447.252 )