Indiana Administrative Code
Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES
Article 1 - MEDICAID PROVIDERS AND SERVICES
Rule 14.6 - Rate-Setting Criteria for Nursing Facilities
Section 14.6-9 - Rate components; rate limitations; profit add-on
Current through March 20, 2024
Authority: IC 12-15-1-10; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15-13-6
Sec. 9.
(a) The Medicaid reimbursement system is based on recognition of the provider's allowable costs for the direct care, therapy, indirect care, administrative, and capital components, plus a potential profit add-on payment as defined below. The direct care, therapy, indirect care, administrative, and capital rate components are calculated as follows:
(b) The profit add-on payment will be calculated as follows:
Table 1 |
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Children's Nursing Facilities |
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Effective Date |
Direct Care Profit Add-on Percentage |
Direct Care Profit Ceiling Percentage |
||
July 1, 2003, through June 30, 2019 |
July 1, 2019, and after |
July 1, 2003, through June 30, 2019 |
July 1, 2019, and after |
|
Percentage |
30% |
52% |
110% |
105% |
Table 2 |
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Non-Children's Nursing Facilities |
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Effective Date |
Direct Care Profit Add-on Percentage |
Direct Care Profit Ceiling Percentage |
||
July 1, 2003, through June 30, 2019 |
July 1, 2019, and after |
July 1, 2003, through June 30, 2019 |
July 1, 2019, and after |
|
Percentage |
30% |
0% |
110% |
105% |
Table 3 |
|
Total Quality Score |
Percentage |
84 - 100 |
100% |
19 - 83 |
100% + ((Total Quality Score - 84) / 66) |
18 and below |
0% |
In no event shall the allowed direct care profit add-on payment exceed ten percent (10%) of the average allowable cost of the median patient day.
Table 4 |
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Effective Date |
Indirect Care Profit Add-on Percentage |
Indirect Care Profit Ceiling Percentage |
||
July 1, 2003, through June 30, 2019 |
July 1, 2019, and after |
July 1, 2003, through June 30, 2019 |
July 1, 2019, and after |
|
Percentage |
60% |
52% |
105% |
100% |
The allowed indirect care component profit add-on payment is equal to the facility's tentative indirect care component profit add-on payment times the applicable percentage contained in Table 3, based on the facility's total quality score.
Table 5 |
||
Capital Component Profit Ceiling Percentage |
||
Effective Date |
July 1, 2003, through June 30, 2019 |
July 1, 2019, and after |
Percentage |
100% |
80% |
(c) Notwithstanding subsections (a) and (b), in no instance shall a rate component exceed the overall rate ceiling defined as follows:
Table 6 |
||
Direct Care Component Overall Rate Ceiling Percentage |
||
Effective Date |
July 1, 2003, through June 30, 2019 |
July 1, 2019, and after |
Percentage |
120% |
110% |
Table 7 |
||
Indirect Care Component Overall Rate Ceiling Percentage |
||
Effective Date |
July 1, 2003, through June 30, 2019 |
July 1, 2019, and after |
Percentage |
115% |
100% |
Table 8 |
||
Capital Component Overall Rate Ceiling Percentage |
||
Effective Date |
July 1, 2003, through June 30, 2019 |
July 1, 2019, and after |
Percentage |
100% |
80% |
(d) In order to determine the normalized allowable direct care costs from each facility's Financial Report for Nursing Facilities, the office shall determine each facility's CMI for all residents on a time-weighted basis. For a provider's financial report beginning in the month referenced in Table 9, column (a), the calendar quarters used for determining a facility's CMI will begin with the corresponding calendar quarter referenced in Table 9, column (b). The calendar quarters used in determining the facility's CMI will include quarters through the provider's financial report ending in the month referenced in Table 9, column (c), with the corresponding calendar quarter referenced in Table 9, column (d).
Table 9 |
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Cost Report Begin Date (a) |
Beginning Calendar Quarter to Determine CMI (b) |
Cost Report End Date (c) |
Ending Calendar Quarter to Determine CMI (d) |
|
January Year 1 |
1st Quarter Year 1 |
January Year 1 |
1st Quarter Year 1 |
|
February Year 1 |
2nd Quarter Year 1 |
February Year 1 |
1st Quarter Year 1 |
|
March Year 1 |
2nd Quarter Year 1 |
March Year 1 |
1st Quarter Year 1 |
|
April Year 1 |
2nd Quarter Year 1 |
April Year 1 |
2nd Quarter Year 1 |
|
May Year 1 |
3rd Quarter Year 1 |
May Year 1 |
2nd Quarter Year 1 |
|
June Year 1 |
3rd Quarter Year 1 |
June Year 1 |
2nd Quarter Year 1 |
|
July Year 1 |
3rd Quarter Year 1 |
July Year 1 |
3rd Quarter Year 1 |
|
August Year 1 |
4th Quarter Year 1 |
August Year 1 |
3rd Quarter Year 1 |
|
September Year 1 |
4th Quarter Year 1 |
September Year 1 |
3rd Quarter Year 1 |
|
October Year 1 |
4th Quarter Year 1 |
October Year 1 |
4th Quarter Year 1 |
|
November Year 1 |
1st Quarter Year 2 |
November Year 1 |
4th Quarter Year 1 |
|
December Year 1 |
1st Quarter Year 2 |
December Year 1 |
4th Quarter Year 1 |
(e) The office shall publish requirements for use in determining the time-weighted CMI. These requirements:
Any such updates shall be made effective no earlier than permitted under IC 12-15-13-6(a).