Current through November 28, 2024
(a) The provisions
of this section apply to a small facility that
(1) had 4,000 or fewer acute care patient
days at an general acute care, specialty, or inpatient psychiatric hospital or
at a combined general acute care hospital-nursing facility or had 15,000 or
fewer Medicaid nursing facility days at a nursing facility that is not combined
with a general acute care hospital during the small facility's fiscal year that
ended 12 months before the beginning of the prospective year;
(2) elects to participate in rate setting
under (c) of this section; and
(3)
is not a general acute care hospital reimbursed under the Diagnosis Related
Groups (DRG) payment methodology under
7
AAC 150.250.
(b) The department will use the methodology
and criteria set out in this section to review and set prospective payment
rates for a small facility that elects rate setting under (c) of this
section.
(c) A small facility
without a rate agreement may not elect to participate in a rate agreement under
(d) of this section until after a re-basing occurs under
7
AAC 150.160. A small facility that does not elect to
participate in a new rate agreement after a rate agreement expires may not
elect to participate in a rate agreement under (d) of this section until after
a re-basing occurs under
7
AAC 150.160. A small facility that elects to
participate in rate setting under this section must
(1) make an affirmative election to do so;
and
(2) notify the department staff
that oversees Medicaid payment rates of the facility's election on the written
notification form provided by the department under this section and return the
form to the department staff that oversees Medicaid payment rates not later
than 30 days after the date of the department's providing the notification by
mail or electronic mail.
(d) The department will not establish
prospective payment rates under this section for a small facility unless the
(1) small facility enters into a rate
agreement with the department that contains at least the following terms:
(A) the rate agreement between the department
and the small facility may not expire or lapse before four facility fiscal
years have elapsed;
(B) the small
facility may not revoke its election to participate in rate setting under this
section until after the last day of the small facility's fourth fiscal year;
and
(2) department
determines that the rate agreement does not conflict with the public concern
that needy persons in the state receive uniform and high quality medical care;
factors that the department will consider in making that determination include
(A) the distribution of medical services and
resources in the communities of the state; and
(B) whether during the term of the rate
agreement, appropriations to the department are expected to be available in
amounts adequate to pay the Medicaid rates proposed in the small facility rate
agreement.
(e)
A prospective payment rate established under this section is not subject to
7
AAC 150.220, except as provided by (k) of this section
and is not subject to
7
AAC 150.150.
(f) Except as otherwise specified under
(l) of this section, the department will base the small
facility prospective payment rate for a rate agreement made under (d) of this
section on the rate calculated under
7
AAC 150.160 after the election of the small facility
is exercised under (c) of this section. For the eligible small facilities'
fiscal year beginning in calendar year 2003, each small facility may
(1) terminate its current small facility rate
agreement and enter into a new rate agreement in which the prospective payment
rate is based on the rate calculated under
7
AAC 150.160, using fiscal year 2000 as the base year
for facilities whose fiscal year ends on December 31, and using fiscal year
2001 as the base year for all other facilities; or
(2) enter into a rate agreement in which the
prospective payment rate based on the rate calculated under
7
AAC 150.160, using fiscal year 2000 as the base year
for facilities whose fiscal year ends on December 31, and using fiscal year
2001 as the base year for all other facilities.
(g) The first year payment rate established
under a rate agreement made under (d) of this section will be calculated as
follows, except that the adjustment factors identified in
7
AAC 150.150 will not be applied:
(1) the first year payment rate for inpatient
acute care services will be expressed as a per-day rate calculated under
7
AAC 150.160(b); for each complete
fiscal year of the small facility that begins during the period after the first
payment year of the rate agreement made under (d) of this section and that ends
at the expiration of the rate agreement, the first year payment rate will be
increased by updating the noncapital portion of the payment rate annually at
the rate of three percent per year and by updating the capital portion of the
payment rate annually at the rate of 1.1 percent per year; for state fiscal
year 2018, the department will not apply the rate increases described in this
paragraph;
(2) a prospective
payment rate for all outpatient acute care services will be expressed as the
percentage of charges component calculated under
7
AAC 150.160(c);
(3) a first year payment rate for long-term
care will be expressed as a per-day rate as calculated in
7
AAC 150.160(g); for each complete
fiscal year of the small facility that begins during the period after the first
payment year of the rate agreement made under (d) of this section and that ends
at the expiration of the rate agreement, the first year payment rate will be
increased by updating the noncapital portion of the payment rate annually at
the rate of three percent per year and by updating the capital portion of the
payment rate annually at the rate of 1.1 percent per year;
(4) the department will allow an increase in
the capital component under (1) or (3) of this subsection of the prospective
payment rate for new assets that the small facility places in service after its
base year as set out in
7
AAC 150.160(h), if
(A) the assets that are placed in service by
the small facility have a value of at least $5,000,000;
(B) the small facility obtains one or more
certificates of need for the assets that will be placed in service;
and
(C) no later than 60 days
before the effective date of the increase in the prospective payment rate for
the small facility, the small facility provides to the department a detailed
capital budget in accordance with
7
AAC 150.130(b) that reflects the
allowance for the new assets that have been placed in service.
(h) Notwithstanding (g)
of this section, the prospective per-day payment rate established for a small
facility may not exceed the charges made by the small facility. The charges
will be compared in the aggregate.
(i) If, after execution of a rate agreement
made under (d) of this section, federal or state law mandates a change to a
prospective payment rate, the department will consider recommendations made by
the small facility before amending the prospective payment rate for the small
facility.
(j) If a small facility
elects rate setting under this section, the reporting requirements of
7
AAC 150.130 and
7
AAC 150.140 that are applicable to the small facility
during the rate agreement period under (d) of this section are modified as
follows:
(1) the small facility shall submit
the Medicare cost report and forms YET-1, T-2, SS-1A, SS-1B, and SS-1C of the
required financial reporting forms from the
Medicaid Hospital and
Long-Term Care Facility Reporting Manual, adopted by reference in
7
AAC 160.900;
(2) except if the small facility requests a
prospective payment rate adjustment for new assets under (g)(4) of this
section, the small facility is not required to submit the budget
report;
(3) in place of the audited
financial statement, the small facility may submit a review of the small
facility's financial statements; the department will accept the review that is
submitted if the review
(A) was conducted by
an independent certified public accountant; and
(B) includes the balance sheet and related
statements of income, retained earnings, and cash flows in accordance with the
Statement on Standards for Accounting and Review Services No. 7 (1992) issued
by the American Institute of Certified Public Accountants.
(k) If a small facility elects
rate setting under this section,
(1) except
as otherwise specifically provided in (2) of this subsection, the exceptional
relief process set out in
7
AAC 150.240 is the sole administrative review and
appeals process available to a small facility; and
(2) small facility use of the administrative
appeal provisions of
7
AAC 150.220 is limited to appeal of an action or
decision of the department that relates to
(A) the small facility's eligibility to elect
rate setting under this section;
(B) the violation of a term of the rate
agreement made under (d) of this section; or
(C) denial of an increase in the prospective
payment rate based on a determination made under (g)(4) of this
section.
(l) A
small facility general acute care hospital may elect a new four-year rate
agreement under (d) of this section if the facility becomes a combined general
acute care hospital-nursing facility. The combined facility may choose this
option no more than 30 days after the combination of the two facilities. The
payment rate changes become effective the date the facilities combine and will
be calculated as follows:
(1) the small
facility acute care per-day rate and the nursing facility per-day rate will be
calculated at the statewide weighted average of the payment rates in effect for
small facilities qualified under (a) of this section as of the date the
facilities combine;
(2) the
outpatient acute care percentage rate will be calculated as the statewide
average of the outpatient payment rates in effect for all qualified general
acute care hospital small facilities as of the date the facilities
combine.
(m) A rate
agreement made under (d) of this section may be renewed if the small facility
still qualifies under this section. The department will perform a re-basing in
accordance with
7
AAC 150.160 for rates for renewed rate agreements
established under this section.
Authority:AS
47.05.010
AS 47.07.070
AS 47.07.071
AS
47.07.073
