Current through Register Vol. 50, No. 9, September 20, 2024
A.
Resident per diem rates are calculated based on information reported on the
cost report. ICFs-MR will receive a rate for each resident. The rates are based
on cost components appropriate for an economic and efficient ICF-MR providing
quality service. The resident per diem rates represent the best judgment of the
state to provide reasonable and adequate reimbursement required to cover the
costs of economic and efficient ICFs-MR.
B. The cost data used in setting base rates
will be from the latest available audited or desk reviewed cost reports. The
initial rates will be adjusted to maintain budget neutrality upon transition to
the ICAP reimbursement methodology. For rate periods between rebasing, the
rates will be trended forward using the index factor contingent upon
appropriation by the legislature.
C. For dates of service on or after August 1,
2005, a resident's per diem rate will be the sum of:
1. direct care per diem rate;
2. care related per diem rate;
3. administrative and operating per diem
rate;
4. capital rate;
and
5. provider fee.
D. Determination of Rate
Components
1. The direct care per diem rate
shall be a set percentage over the median adjusted for the acuity of the
resident based on the ICAP, tier based on peer group. The direct care per diem
rate shall be determined as follows.
a.
Median Cost. The direct care per diem median cost for each ICF-MR is determined
by dividing the facility's total direct care costs reported on the cost report
by the facility's total days during the cost reporting period. Direct care
costs for providers in each peer group are arrayed from low to high and the
median (50th percentile) cost is determined for each peer group.
b. Median Adjustment. The direct care
component shall be adjusted to 105 percent of the direct care per diem median
cost in order to achieve reasonable access to care.
c. Inflationary Factor. These costs shall be
trended forward from the midpoint of the cost report period to the midpoint of
the rate year using the index factor.
d. Acuity Factor. Each of the ICAP levels
will have a corresponding acuity factor. The median cost by peer group, after
adjustments, shall be further adjusted by the acuity factor (or multiplier) as
follows.
|
ICAP Support Level
|
Acuity Factor
(Multiplier)
|
|
Pervasive
|
1.35
|
|
Extensive
|
1.17
|
|
Limited
|
1.00
|
|
Intermittent
|
.90
|
2. The care related per diem rate shall be a
statewide price at a set percentage over the median and shall be determined as
follows.
a. Median Cost. The care related per
diem median cost for each ICF-MR is determined by dividing the facility's total
care related costs reported on the cost report by the facility's actual total
resident days during the cost reporting period. Care related costs for all
providers are arrayed from low to high and the median (50th percentile) cost is
determined.
b. Median Adjustment.
The care related component shall be adjusted to 105 percent of the care related
per diem median cost in order to achieve reasonable access to care.
c. Inflationary Factor. These costs shall be
trended forward from the midpoint of the cost report period to the midpoint of
the rate year using the index factor.
3. The administrative and operating per diem
rate shall be a statewide price at a set percentage over the median, tier based
on peer group. The administrative and operating component shall be determined
as follows.
a. Median Cost. The administrative
and operating per diem median cost for each ICF-MR is determined by dividing
the facility's total administrative and operating costs reported on the cost
report by the facility's actual total resident days during the cost reporting
period. Administrative and operating costs for all providers are arrayed from
low to high and the median (50th percentile) cost is determined.
b. Median Adjustment. The administrative and
operating component shall be adjusted to 103 percent of the administrative and
operating per diem median cost in order to achieve reasonable access to
care.
c. Inflationary Factor. These
costs shall be trended forward from the midpoint of the cost report period to
the midpoint of the rate year using the index factor.
4. The capital per diem rate shall be a
statewide price at a set percentage over the median, tier based on peer group.
The capital per diem rate shall be determined as follows.
a. Median Cost. T he capital per diem median
cost for each ICF-MR is determined by dividing the facility's total capital
costs reported on the cost report by the facility's actual total resident days
during the cost reporting period. Capital costs for providers of each peer
group are arrayed from low to high and the median (50th percentile) cost is
determined for each peer group.
b.
Median Adjustment. The capital cost component shall be adjusted to 103 percent
of the capital per diem median cost in order to achieve reasonable access to
care.
c. Inflationary Factor.
Capital costs shall not be trended forward.
d. The provider fee shall be calculated by
the Department in accordance with state and federal rules.
E. The rates for the 1-8 bed peer
group shall be set based on costs in accordance with
§10377. B -D. The
reimbursement rates for peer groups of larger facilities will also be set in
accordance with
§10377. B -D.; however,
the rates will be limited as follows.
1. The
9-15 peer group reimbursement rates will be limited to 95 percent of the 1-8
bed peer group reimbursement rates.
2. The 16-32 bed peer group reimbursement
rates will be limited to 95 percent of the 9-15 bed peer group reimbursement
rates.
3. The 33 and greater bed
peer group reimbursement rates will be set in accordance with
§10377 B-D, limited to 95 percent of the
16-32 bed peer group reimbursement rates.
F. Rebasing of rates will occur at least
every three years utilizing the most recent audited and/or desk reviewed cost
reports.
G. Adjustments to the
Medicaid daily rate may be made when changes occur that eventually will be
recognized in updated cost report data (such as a change in the minimum wage or
FICA rates). These adjustments would be effective until such time as the data
base used to calculate rates fully reflect the change. Adjustments to rates may
also be made when legislative appropriations would increase or decrease the
rates calculated in accordance with this rule. The secretary of the Department
of Health and Hospitals makes the final determination as to the amount and when
adjustments to rates are warranted.
H
. A facility requesting a Pervasive Plus rate supplement shall
bear the burden of proof in establishing the facts and circumstances necessary
to support the supplement in a format and with supporting documentation
specified by the DHH ICAP Review Committee.
1. The DHH ICAP Review Committee shall make a
determination of the most appropriate staff required to provide requested
supplemental services.
2. The
amount of the pervasive plus supplement shall be calculated using the Louisiana
Civil Service pay grid for the appropriate position as determined by the DHH
ICAP Review Committee and shall be the 25th percentile salary level plus 20
percent for related benefits times the number of hours approved.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
