Hawaii Administrative Rules
Title 17 - DEPARTMENT OF HUMAN SERVICES
Department of Human Services
Chapter 1739.2 - AUTHORIZATION, PAYMENT, AND CLAIMS IN THE FEE-FOR-SERVICE MEDICAL ASSISTANCE PROGRAM - LONG TERM CARE PROSPECTIVE PAYMENT SYSTEM
Section 17-1739.2-10 - Treatment of new providers without historical costs

Universal Citation: HI Admin Rules 17-1739.2-10

Current through November, 2024

(a) The following two types of providers shall have their basic PPS rates calculated, in whole or in part, under this section:

(1) A provider that began operating after the base year, and therefore has no base year cost report; or

(2) A provider that began operating a new facility during the base year, and therefore has no base year cost report that reflects a full twelve months of operations.

(b) A provider that qualifies under one of the above criteria shall submit its projected costs to the department on forms and in the format defined by the department.

(c) The qualifying provider shall receive as its basic PPS rate the lesser of: its reasonable projected allowable costs under Medicare reasonable cost principles of reimbursement (as defined in 42 C.F.R. Chapter 413 and modified by this chapter), or one hundred twenty-five per cent of the sum of the statewide weighted averages (including the inflation adjustment) for its peer group in each acuity level.

(d) Commencing on January 1, 1996, the qualifying provider shall receive as its basic PPS rates the lesser of:

(1) Its reasonable projected allowable costs under Medicare reasonable cost principles of reimbursement (as defined in 42 C.F.R. chapter 413 and as modified by this chapter); or

(2) The sum of the component rate ceilings for its peer group in each acuity level.

(3) Subsection (c) shall continue to be applied under the following circumstances:
(A) Facilities that, as of December 31, 1995, qualify for and are receiving the new provider rate; or

(B) New LTC projects with certificate of need (CON) approval (if applicable) as required by the state health and development agency (SHPDA), that either:
(i) have started construction as of December 31, 1995; or

(ii) have not started construction but have a financial commitment as of December 31, 1995 which contains a penalty clause, in which case the department may grant a provider's request for an exception based on a review of the provider's financial situation.

(e) In PPS rate years following the calculation of per diem rates under this section, the provider's basic PPS rates shall receive the same inflation adjustments as other providers.

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