Current through Register Vol. 48, No. 38, September 20, 2024
a) Any change in rates due to program
enhancements submitted for the reasons cited below in relation to current cost
impacts, either positive or negative, as a result of the review process, will
be reflected in a contract amendment. Under no circumstances will the
Department be responsible for enhancements that were implemented outside of the
following process.
1) The Department and the
provider have reached mutual agreement that substantive changes and/or
enhancement of the current program are necessary and/or desirable and have been
approved by the Director;
2) It is
necessary and/or desirable to adjust the licensed capacity of a facility or
program;
3) The Department required
substantial program changes as a result of mandated licensing requirements;
and
4) State and federal regulatory
requirements have generated a substantial increase in reimbursable cost during
the current contract year.
b) Procedures for Requesting a Program
Enhancement
A request shall be submitted in writing to the Administrator of
the Region where the program is located with a copy to the central office
manager responsible for the administration of reimbursement rates. If needed,
the central office manager responsible for the administration of reimbursement
rates shall supply, upon request, the name and mailing address of the Lead
Regional Administrator. The request shall include, but not be limited
to:
1) The current approved
reimbursable costs and the reimbursable costs sought pursuant to the
request;
2) A clear, concise
statement of the reasons for the request;
3) A detailed statement of financial,
statistical and related information in support of the request that clearly
indicates current outcomes and the relationship between the additional costs
submitted and the change of circumstances or other reasons for the higher
cost;
4) A citation to any
statutory, regulatory, or contractual requirement pertinent to the
appeal;
5) Crucial elements that
will be outlined and analyzed for every program enhancement include but are not
limited to:
A) Summary document or letter
explaining the reason for the request for a new rate;
B) Certified audit report for most recent
provider prior fiscal year;
C)
Consolidated Financial Reports for most recent provider prior fiscal year
(reporting all programs);
D) The
new rate being sought;
E) Data
identifying the individual cost of each item for which additional reimbursement
is being sought;
F) Detailed
explanation of why the petitioned costs cannot be funded within the current
rate;
G) Beginning date the costs
are planned to occur;
H)
Quantifiable programmatic outcomes occurring as a result of a rate
change;
I) Reporting activities
that will be implemented to ensure program outcomes occur at committed
levels;
J) Quantification of past
program performances for current and preceding 2 fiscal years, including, where
applicable:
i) Number of children
successfully completing program treatment;
ii) Rate of children leaving without
completion of treatment;
iii)
Number of incidents of psychiatric hospitalizations;
iv) Number of runaways;
v) Number of incidences requiring police
intervention; and
vi) Number of
unusual incident reports;
K) Organization charts reflecting pre-request
and post-request funds for additional staffing;
6) Certification under penalty of perjury by
either the chief executive officer or the financial officer of the provider
that the application and all the information reports, schedules, budgets, books
and records submitted are true, correct and accurate.
c) Regional Review Process
1) Within 30 days after filing a request for
enhancements with associated cost increases, the regional contract
administrator responsible for administration of the contract shall acknowledge
in writing that the request has been received.
2) The responsible regional contract
administrator will review each request for adequacy of documentation and
appropriateness of the request.
3)
The responsible regional contract administrator may request a meeting. The
purposes of the meetings may include:
A)
Clarification, formulation, and simplification of issues;
B) Resolution of matters in
controversy;
C) Exchange of
documents and information;
D)
Stipulations of facts; and
E) Such
other matters as may aid in the simplification of the evidence and disposition
of the issue.
d) The decision of the Director of the
Department shall constitute final action. Decision of the Director shall be
made within 150 days after the enhancement request.
e) Rate Setting for Approved Program
Enhancements
A summary of enhancements and costs approved by the Director of
the Department shall be forwarded to the central office manager responsible for
the administration of reimbursement rates. The central office manager
responsible for the administration of reimbursement rates will determine, based
on standard Department rate setting methodology, the change to the reimbursable
unit costs.
