Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 129.00 - Rate And Charge Determination For Certain Intermediate Care Facilities Operated By The Department Of Developmental Services
Section 129.06 - Administrative Adjustment to Inpatient Per Diem Rate
Universal Citation: 101 MA Code of Regs 101.129
Current through Register 1518, March 29, 2024
(1) Timing. An ICF may apply for a discretionary administrative adjustment to its Inpatient Per Diem Rate based upon the grounds set forth in 101 CMR 129.06(1)(a) and (b). Adjustments shall be effective on the later of:
(a) the beginning of the quarter (July
1st, October 1st, January
1st, April 1st) in which
a complete application is received; or
(b) the date the costs shall be
incurred.
(2) Limitations. The following are grounds for an administrative adjustment.
(a)
Mechanical Error. There has been a mechanical error in
calculating the Inpatient Per Diem Rate approved under
101 CMR 129.00.
(b)
Governmental
Requirements. Statutory or regulatory requirements of a
governmental unit or the federal government have generated a substantial change
in allowable costs as adjusted pursuant to
101 CMR
129.05. Documentation shall include written
certification or a copy of an official notice from the governmental unit
detailing the new requirements imposed on the ICF and the verification of the
costs.
(c)
Disaster
Losses. The ICF has incurred disaster losses in excess of
insurance or extraordinary costs related to disaster losses not covered by
outside sources. Documentation shall include verification of loss or
extraordinary cost and the insurance or outside source payment. If, however,
the loss or extraordinary cost is caused by a facility being inadequately
insured according to the standards of the ICF industry, or through negligence
on the part of facility management, such losses or costs shall not be
approved.
(d)
Determination of Need (DON) Operating Costs. An ICF
has incurred or expects to incur an increase in operating costs associated with
a major capital expenditure or substantial change in services that is subject
to and has received a DON pursuant to M.G.L. c. 111, §§ 25B through
25G. In its application, the ICF must segregate the increased costs from other
allowed operating costs and must demonstrate that the increased costs requested
are reasonable. If an approved DON results in increased patient days, those
increased patient days shall be added to the Total Patient Days used in the
Inpatient Rate.
(e)
Substantial Change from Base Year Costs. An ICF may
request an adjustment to its Initial Per Diem Rate if the ICF has determined
that there shall be a substantial variance between base year costs and rate
year costs. The ICF may request that EOHHS set the Initial Per Diem
Rate without the cost adjustment factor determined pursuant to
101 CMR
129.05(3). The ICF may also
request that EOHHS review more recent cost and utilization data to determine a
revised Initial Per Diem Rate.
(3) Submission for Administrative Adjustment.
(a) An application
for administrative adjustment shall be made to the Medicaid Director of EOHHS
in writing and shall contain the following:
1. the name and address of the ICF;
2. the approved Inpatient Rate and change to
be reviewed and the rate or change sought by administrative
adjustment;
3. a clear, concise
statement of the reasons for the application for administrative
adjustment;
4. a detailed statement
of financial, statistical and related information in support of the
application;
5. all information and
documentation required under
101 CMR
129.03;
6. a citation to any statutory, regulatory or
contractual requirement in support of the application.
7. such other books, records and information
as may be required by EOHHS; and
8.
a certification by the chief executive officer or financial officer of the ICF
that the application and all information, reports, schedules, budgets, books,
and records submitted are true, correct, and accurate.
(b) Requests for an administrative adjustment
shall be accompanied by full and complete documentation of the request. EOHHS
may deny any request for an administrative adjustment for which documentation
is not submitted.
(4) Administrative Adjustment Decision. Within 60 days from receipt of a complete and satisfactory application for administrative adjustment, EOHHS shall render a decision. A written statement of reasons for the decision shall be provided upon request.
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