(1)
Nursing Facility Capital Payments. Effective October
1, 2023, nursing facilities will receive capital payments calculated as
follows, with exceptions as described in
101
CMR 206.05(2) through
101
CMR 206.05(5).
(a) Calculate the sum of the allowable
portion of capital costs during the base year, less any recoverable fixed cost
income. Apply a cost adjustment factor as described in
101
CMR 206.03(1)(b).
(b) Multiply the number of beds by the number
of days in the rate year and then multiply the product by the greater of 90% or
the actual utilization rate in the base year.
(c) EOHHS will calculate the provider's
capital payment by dividing the result of
101
CMR 206.05(1)(a) by the
result of
101
CMR 206.05(1)(b), subject to
the limitations described in
101
CMR 206.05(4).
(2)
Nursing Facility
Capital Payment Adjustments. Effective October 1, 2023, nursing
facilities will receive capital payment adjustments calculated as follows.
(a) If a nursing facility's capital payment
as calculated in
101
CMR 206.05(1) is less than
90% of its capital payment as of September 30, 2021, the facility will receive
the capital payment listed in
101
CMR 206.05(1), plus an
upward adjustment equal to the difference between the capital payment as
calculated in
101
CMR 206.05(1) and 90% of
the facility's capital payment as of September 30, 2021, subject to the
limitations described in
101
CMR 206.05(4).
(b) If a nursing facility's capital payment
as calculated in
101
CMR 206.05(1) is greater
than 130% of its capital payment as of September 30, 2021, the facility will
receive the capital payment calculated in
101
CMR 206.05(1), less a
downward adjustment equal to the difference between the capital payment as
calculated in
101
CMR 206.05(1) and 130% of
the facility's capital payment as of September 30, 2021.
(3)
Revised Capital
Payment.
(a)
General
Notification Requirements. All providers must notify the Center
when they open, add new beds, renovate, or reopen beds. The notification must
contain the provider's name, address, vendor payment number, date of bed
change, type of change, and description of project.
(b)
Request for Revised Capital
Payment. Eligible providers may request a revised capital payment
for capital costs associated with the change or renovation of licensed beds.
Facilities that may request a revised capital payment include
1. new facilities that open pursuant to a
determination of need and facilities with newly licensed beds that are added
pursuant to a determination of need;
2. facilities with renovations made pursuant
to a determination of need;
3.
facilities that submitted detailed architectural or engineering plans for, or
evidence of, applications made to local government agencies for planning,
zoning, or building permits or other regulatory approvals, including approvals
required by the Department of Public Health, required in connection with
conversion of rooms with three or more residents to one- and two-bedded rooms
or two-bedded rooms to one-bedded rooms.
(c)
Eligibility
Requirements. A nursing facility specified in
101
CMR 206.05(3)(b)2. will be
eligible for a revised capital payment if the facility has expended at least
50% of the maximum capital expenditure for an approved determination of need,
or in the instance of a second request, at least 25% additional from the
previous approved request and in the instance of a third request, only upon
completion of the project.
(d)
Required Documentation. Providers meeting the criteria
in 101 CMR 206.05(3)(b)
must submit the following to the Center with
its request for a revised capital payment, as well as any additional
information that EOHHS determines necessary to calculate a revised capital
payment:
1. a copy of the approved
determination of need and any approved amendments, or, in the case of capital
projects that do not require a determination of need, a detailed description of
the project;
2. a copy of the
construction contract;
3. a listing
of construction costs;
4. copies of
invoices and cancelled checks for construction costs;
5. a copy of the Department of Public
Health's licensure notification associated with the increase or decrease in
licensed beds, as applicable;
6. a
copy of the mortgage or financing obtained;
7. a copy of the calculation of the requested
increase, the format of which may be specified by EOHHS; and
8. a listing of any assets such as land,
building, improvements, or equipment that are either destroyed or no longer
used for patient care.
(e)
Revised Capital
Payment. Nursing facilities that meet the criteria listed in
101
CMR 206.05(3)(b) and that
have submitted all required documentation under
101
CMR 206.05(3)(d) will be
eligible for a revised capital payment in place of the capital rates calculated
under
101
CMR 206.05(1), subject to
the limitations of
101
CMR 206.05(4):
1. Adding the following costs:
a. the allowed capital expenses associated
with a project described in
101
CMR 206.05(3)(b), subject to
the divisor described in
101
CMR 206.05(1)(b) adjusted
for any increase or decrease in licensed beds; and
b. the lesser of the following costs, subject
to the divisor described in
101
CMR 206.05(1)(b) adjusted
for any increase or decrease in licensed beds,
i.
101
CMR 206.05(1); or
ii. The sum of the amount calculated in
101
CMR 206.05(1) and the
amount calculated in
101
CMR 206.05(2).
2. The revised capital
payment shall be the total calculated in
101
CMR 206.05(3)(c), and shall
be the new capital rate, in place of the rate calculated under
101
CMR 206.05(1) or
101
CMR 206.05(2), effective on
the later of the date the facility submits their request for the revised
capital payment, including all required documentation, or the effective date of
the change in licensed beds.
(4)
Maximum Capital
Payment. Capital payments shall not exceed $50.00.
(5)
New or Relocated Nursing
Facilities. A nursing facility that becomes operational on or
after October 1, 2023, an existing nursing facility that replaces its current
building on or after October 1, 2023, or an existing nursing facility that
fully relocates to a newly constructed location on or after October 1, 2023,
will be eligible for a capital payment in the amount of $50.00. Such facility
will not be eligible for additional capital payments as listed
101
CMR 206.05(1) or for an
adjustment to its capital payment as described in
101
CMR 206.05(2).
(6)
Licensed Bed
Changes. A nursing facility will not receive an adjustment to its
capital payment rate solely because of an increase or decrease in its number of
licensed beds, except as described in
101
CMR 206.05(3)(b)3.
(7)
Rate
Adjustments. EOHHS may adjust any capital payment upon EOHHS's
determination that there was a material error in the calculation of the payment
or in the facility's documentation of its capital costs.
