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 17-1739.2-15 - Limitations on long-term care provider reimbursement

(a) Notwithstanding any other provision of this chapter, aggregate payments to each group of facilities (i.e., nursing facilities or intermediate care facilities for the mentally retarded) may not exceed the amount that can reasonably be estimated would have been paid for those services under Medicare reasonable cost principles of reimbursement (as defined in 42 C.F.R. Chapter 413). In addition, aggregate payments to each group of state-operated providers (i.e., nursing facilities or intermediate care facilities for the mentally retarded) may not exceed the amount that can reasonably be estimated would have been paid under Medicare reasonable cost principles of reimbursement. If a formal and final determination is made that payments in the aggregate exceeded the upper limit and federal financial participation is disallowed, the department may recoup any payments made to providers in excess of the upper limit.

(b) Notwithstanding any other provisions of this chapter, payment for out-of-state long-term care facility services shall be the lesser of the facility's charge, the other state's Medicaid rate, or the statewide weighted average Hawaii Medicaid rate applicable to services provided by comparable Hawaii providers.

(c) Notwithstanding any other provision of this chapter, no payments shall be made for the improper admission of or care for mentally ill or mentally retarded individuals, as those terms are defined in section 4211(e)(7)(G) of OBRA 87.

(d) Notwithstanding any other provisions of the chapter, should federal participation for CAH providers be disallowed, the department may recoup any such payments made to these CAH facilities.