Current through August, 2024
(a) Each provider's
per diem cost components, as calculated in accordance with section 17-1739.2-8,
shall be subject to component rate ceilings in determining a provider's basic
PPS rates.
(b) For each
classification identified in section 17-1739.2-5, component rate ceilings shall
be established as follows:
(1) For each
provider, multiply the provider-specific per diem component cost by the
provider's total census days in the base period to determine total cost per
component by provider. Any per diem component cost that is greater than two
standard deviations above or below the statewide mean of the component cost
shall be excluded in calculating the component rate ceilings;
(2) For each classification identified in
section 17-1739.2-5, sum the providers and totals calculated in paragraph (1)
to determine the total cost per component for each classification;
(3) Divide the classification component costs
calculated in paragraph (2) by the total census days reported in the base year
cost reports for all providers in the classification to determine an average
cost per component by provider classification; provided, however, that if any
per diem costs are excluded because they deviate more than two standard
deviations from the statewide mean, then the days associated with those per
diem costs shall also be deleted in calculating the average cost per component
for the peer group; and
(4)
Multiply the results of paragraph (3) above by the following factors to
determine the cost component rate ceilings by each provider classification:
(A) General and Administrative-1.1;
(B) Capital-1.1; and
(C) Direct Nursing-1.15.
(c) Generally, each per diem cost
component of a provider's basic PPS rates shall be the lesser of the provider's
per diem cost component rate calculated under section 17-1739.2-8 or the per
diem ceiling for that component, except as noted in section 17-1739.2-19(f). In
the case of the capital component, no provider shall receive less than $1.50 a
day regardless of its cost per day.
(d) If a provider's rate includes a
substitute direct nursing component, then all three of the component ceilings
that apply to the acuity level for which the rate is being calculated shall be
applied.
(e) The component ceilings
shall not be applied in the following circumstances:
(1) To a grandfathered PPS rate;
(2) To a grandfathered capital component if a
provider meets the provisions of section 17-1739.2-10;
(3) To grandfathered direct nursing and
G&A components; and
(4) To a
new provider or provider with new beds whose basic PPS rates are, in whole or
in part, calculated under the special provisions defined in sections
17-1739.2-10 and 17-1739.2-11. That section defines the circumstances in which
either the component ceilings or some other ceilings will be applied.
(f) For the FY 98 rebasing only,
the rate calculation for all providers shall include the higher of the rates
calculated under the following two options:
(1) Sections 17-1739.2-8 and 17-1739.2-9 and
increased by the GET and ROE adjustments and capital and G&A incentives, if
applicable; or
(2) The
grandfathered PPS rate, which excludes OBRA 1987 payments, but includes rate
reconsideration;
(3) If the
grandfathered PPS rate is the lower of the two options, then the provider shall
receive the basic PPS rate and all other appropriate adjustments that are
defined in this chapter.
(4) If the
grandfathered PPS rate is the higher of the two options, then the provider
shall also receive the following adjustments or increases to that rate:
(A) For FY 98, one-half of the inflation
adjustment. For all subsequent PPS years, the provider shall receive the same
inflation adjustments that are received by all other providers.
(B) The GET adjustment, however, shall only
be applied to the incremental increase to the total PPS rates that results from
the adjustments or increases noted above.
