Section 405 IAC 1-14.6-6 - Active providers; rate reviewAuthority: IC 12-15-1-10; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 6.
(a) While performing a provider's annual rate review the office shall determine the following for each provider:(1) normalized average allowable cost of the median patient day for the direct care component as of the July 1st that falls after the first calendar quarter following the provider's reporting year-end; and(2) average allowable cost of the median patient day for the indirect, administrative, and capital components as of the July 1st that falls after the first calendar quarter following the provider's reporting year-end.(b) While performing a provider's annual rate review the office shall determine the following for each provider:(1) normalized allowable per patient day cost for the direct care component based on the annual financial report used to establish the annual rate review; and(2) allowable per patient day costs for the therapy, indirect care, administrative, and capital components based on the annual financial report used to establish the annual rate review.(c) Beginning October 1, 2007, the rate effective date of the annual rate review shall be the first October 1 that falls after the first calendar quarter following the provider's reporting year-end. Beginning July 1, 2008, the rate effective date of the annual rate review shall be the first July 1 that falls after the first calendar quarter following the provider's reporting year-end. The rate effective date of the annual rate review for all providers shall be July 1 of each year thereafter.(d) Subsequent to the annual rate review, the direct care component of the Medicaid rate will be adjusted quarterly to reflect changes in the provider's case mix index for Medicaid residents. If the facility has no Medicaid residents during a quarter, the facility's average case mix index for all residents will be used in lieu of the case mix index for Medicaid residents. This adjustment will be effective on the first day of each of the following three (3) calendar quarters beginning after the effective date of the annual rate review.(e) The case mix index for Medicaid residents in each facility shall be:(1) updated each calendar quarter; and(2) used to adjust the direct care component that becomes effective on the second calendar quarter following the updated case mix index for Medicaid residents.(f) All rate-setting parameters and components used to calculate the annual rate review, except for the case mix index for Medicaid residents in that facility, shall apply to the calculation of any change in Medicaid rate that is authorized under subsection (d).(g) When the number of nursing facility beds licensed by ISDH is changed after the annual reporting period, the provider may request in writing before the effective date of their next annual rate review an additional rate review effective on the first day of the calendar quarter on or following the date of the change in licensed beds. This additional rate review shall be determined using all rate-setting parameters in effect at the provider's latest annual rate review, except that the number of beds and associated bed days available for the calculation of the rate-setting limitations shall be based on the newly licensed beds.Office ofthe Secretary of Family and Social Services; 405 IAC 1-14.6-6; filed Aug 12, 1998, 2:27p.m.: 22 IR 73, eff Oct 1, 1998; filed Mar 2, 1999, 4:42 p.m.: 22 IR 2243; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; filed Mar 18, 2002, 3:30p.m.: 25 IR 2468; filed Oct 10, 2002, 10:47 a.m.: 26 IR 712; filed Jul 29, 2003, 4:00p.m.: 26 IR 3872; readopted filed Sep 19, 2007, 12:16p.m.: 20071010-IR-405070311RFA; filed Oct 4, 2007, 2:05p.m.: 20071031-IR-405070150FRA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFAFiled 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRAFiled 10/13/2017, 12:09 p.m.: 20171108-IR-405160327FRAReadopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA