Current through August, 2024
(a) Beginning with
the effective date of these rules, the department will implement a phased in
transition approach from PPS to an acuity based reimbursement system. The
phased approach will be completed by June 30, 2008.
(b) The transition rate methodology uses a
price based system with the following parameters:
(1) For the direct care rate component, the
component price is set at one hundred ten per cent of the day-weighted median.
The rate that is calculated is subject to a case mix adjustment based upon the
change on each facility's overall case mix.
(2) For the administrative and general rate
component, the component price is set at one hundred three per cent of the
day-weighted median. The rate is not subject to a case mix
adjustment.
(3) For the capital
rate component, the component price is set at the day-weighted median. The rate
is not subject to a case mix adjustment.
(4) The Hawaii general excise tax is treated
as a pass-through.
The rate setting parameters will remain constant for all
future rate setting periods. The prices calculated for direct care,
administrative and general, and capital will reflect prices that relate to the
rate period beginning July 1, 2002 and ending June 30, 2003. The component
prices will be updated for each subsequent rate period by the inflation
adjustment for each period.
(c) Effective for rate periods starting the
effective date of these rules and July 1, 2004, the annual cost increases shall
be determined as follows:
(1) Calculate the
blended Acuity A and Acuity C rates for all eligible NF facilities using the
inflation adjustment.
(2) For each
NF, compare the blended rates with the inflation adjustment to the rates that
would have been reimbursed under the acuity based reimbursement
system.
(3) Apply the inflation
adjustment only to the NFs that would have received an increase under the
acuity based reimbursement system. The rate as increased by the inflation
adjustment for the NF shall not exceed the rate the provider would have been
entitled to under the acuity based reimbursement system. Any NF not entitled to
the inflation adjustment shall receive no rate increase or decrease.
(4) For all NFs that are not entitled to an
inflation adjustment, or whose rate is limited by the rate determined by the
acuity based reimbursement system, calculate by facility the annual amount
associated with the inflation adjustment based on the Medicaid bed days from
the latest available cost report.
(5) The total amount of inflation adjustments
calculated in paragraph (4) shall be distributed to NFs whose rates with
inflation adjustments are below the rate calculated under the acuity based
reimbursement system. The total amount shall be divided by the number of
Medicaid bed days for the NFs with rates below those calculated by the acuity
based reimbursement system. A SNF and ICF bed day rate shall be
calculated.
(6) Each NF with rates
below that calculated by the acuity based reimbursement system shall receive an
additional adjustment to its rate. The adjustment shall be applied to each SNF
and ICF bed day, provided the new bed day rate does not exceed the rate that
would have been paid under the acuity based reimbursement system.
(d) Effective for rate periods
starting July 1, 2005, July 1, 2006, and July 1, 2007, the reimbursement
methodology is adjusted each year as follows:
(1) Effective July 1, 2005, seventy-five per
cent of the NF's rates for SNF and ICF are based on the previous year's rate
adjusted for inflation. Twenty-five per cent of the SNF and ICF rates are based
on the acuity based reimbursement system adjusted for inflation.
(2) Effective July 1, 2006, fifty per cent of
the NF's rates for SNF and ICF are based on the previous year's rates adjusted
for inflation. Fifty per cent of the SNF and ICF rates are based on the acuity
based reimbursement system adjusted for inflation.
(3) Effective July 1, 2007, twenty-five per
cent of the NF's rates for SNF and ICF are based on the previous year's rates
adjusted for inflation. Seventy-five per cent of the SNF and ICF rates are
based on the acuity based reimbursement system adjusted for
inflation.
(4) Effective July 1,
2008, one hundred per cent of the NF's rates are based on the acuity based
reimbursement system.
