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 17-1739.2-18 - Adjustments to the basic PPS rates

(a) Each proprietary provider is eligible to receive the ROE adjustment. The ROE adjustment shall be calculated by identifying the appropriate amounts from the base year cost report or other sources, and dividing those amounts by the provider's base year patient days to obtain a base year ROE per diem. The base year ROE adjustments shall receive the same increase to reflect inflation as all other base year costs.

(b) All proprietary providers shall receive the GET adjustment. The GET adjustment shall be paid by increasing the basic PPS rates plus all applicable adjustments by 1.04167.

(c) Nursing facilities who qualify shall receive the capital incentive adjustment, the G&A incentive adjustment, or both. Due to the limited number of ICF/MRs, those facilities shall not be eligible to receive either the Capital Incentive or G&A incentive adjustments.

(d) Beginning with PPS rate year July 1, 1995 to June 30, 1996, qualifying NFs shall receive the G&A small facility adjustment.

(e) All facilities will have a per diem dental allowance add-on added to the basic PPS rate. This amount will be the same for all facilities, based on historical paid dental claims data, as determined by the department.

(f) Total PPS rates - A provider's basic PPS rates shall equal the sum of its direct nursing, G&A and capital per diem components for each acuity level as calculated under this chapter. A new provider's basic PPS rate shall be the per diem rate calculated under section 17-1739.2-10. The basic PPS rate for a provider with new beds shall be the per diem rate calculated under section 17-1739.2-11.

(g) A provider's adjusted PPS rate shall be the product of the following formula:

Basic PPS Rate + Capital Incentive Adjustment (if applicable)

+ G&A Incentive Adjustment (if applicable)

+ ROE Adjustment (if applicable)

+ G&A Small Facility Adjustment (if applicable)

Subtotal

x GET Adjustment (if applicable)

= Adjusted PPS Rate

(h) A provider's total PPS rate shall be the adjusted PPS rate.