Missouri Code of State Regulations
Title 13 - DEPARTMENT OF SOCIAL SERVICES
Division 70 - MO HealthNet Division
Chapter 10 - Nursing Home Program
Section 13 CSR 70-10.016 - Global Per Diem Adjustments to Nursing Facility and HIV Nursing Facility Reimbursement Rates
Universal Citation: 13 MO Code of State Regs 70-10.016
Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This amendment provides for a per diem increase to nursing facility and HIV nursing facility per diem reimbursement rates of ten dollars and eighteen cents ($10.18), effective for dates of service July 1, 2021 through June 30, 2022, for increases in costs associated with staffing, supplies, social distancing standards, and other factors due to the COVID-19 national emergency. This per diem adjustment corresponds to the State Fiscal Year (SFY) 2022 appropriation for nursing facilities and is approved by the Centers for Medicare and Medicaid Services (CMS).
(1) Authority. This regulation is established pursuant to the authorization granted to the Department of Social Services (department), MO HealthNet Division (division), to promulgate rules and regulations.
(2) Purpose. This regulation sets forth the global per diem adjustments to be applied to nursing facility reimbursement rates, established in 13 CSR 70-10.015, and Human Immunodeficiency Virus (HIV) nursing facility reimbursement rates, established in 13 CSR 70-10.080. All principles and definitions set forth in 13 CSR 70-10.015 are applicable to nursing facilities, and all principles and definitions set forth in 13 CSR 70-10.080 are applicable to HIV nursing facilities. The terms "facility" or "facilities" as used in this regulation shall apply to both nursing facilities and HIV nursing facilities.
(3) Adjustments to the Reimbursement Rates. Subject to the limitations prescribed in 13 CSR 70-10.015, a nursing facility's reimbursement rate may be adjusted as described in this section. Subject to the limitations prescribed in 13 CSR 70-10.080, an HIV nursing facility's reimbursement rate may be adjusted as described in this section.
(A)
Global Per Diem Rate Adjustments. A facility with either an interim rate or a
prospective rate may qualify for the global per diem rate adjustments. Global
per diem rate adjustments shall be added to the specified cost component
ceiling.
1. FY-96 negotiated trend factor-
A. Facilities with either an interim rate or
prospective rate in effect on October 1, 1995, shall be granted an increase to
their per diem effective October 1, 1995, of four and six-tenths percent (4.6%)
of the cost determined in paragraphs (11)(A)1., (11)(B)1., (11)(C)1., and the
property insurance and property taxes detailed in subsection (11)(D) of
13 CSR
70-10.015; or
B. Facilities that were granted a prospective
rate based on paragraph (12)(A)2. of
13 CSR
70-10.015 that is in effect on October 1, 1995, shall
have their increase determined by subsection (3)(S) of
13 CSR
70-10.015.
2. FY-97 negotiated trend factor-
A. Facilities with either an interim rate or
prospective rate in effect on October 1, 1996, shall be granted an increase to
their per diem effective October 1, 1996, of three and seven-tenths percent
(3.7%) of the cost determined in paragraphs (11)(A)1., (11)(B)1., (11)(C)1.,
and the property insurance and property taxes detailed in subsection (11)(D) of
13 CSR
70-10.015; or
B. Facilities that were granted a prospective
rate based on paragraph (12)(A)2. of
13 CSR
70-10.015 that is in effect on October 1, 1995, shall
have their increase determined by subsection (3)(S) of
13 CSR
70-10.015.
3. Nursing Facility Reimbursement Allowance
(NFRA). Effective October 1, 1996, all facilities with either an interim rate
or a prospective rate shall have its per diem adjusted to include the current
NFRA as an allowable cost in its reimbursement rate calculation.
4. Minimum wage adjustment. All facilities
with either an interim rate or a prospective rate in effect on November 1,
1996, shall be granted an increase to their per diem effective November 1,
1996, of two dollars and forty-five cents ($2.45) to allow for the change in
minimum wage. Utilizing Fiscal Year 1995 cost report data, the total industry
hours reported for each payroll category was multiplied by the fifty-cent
(50¢) increase, divided by the patient days for the facilities reporting
hours for that payroll category, and factored up by eight and sixty-seven
hundredths percent (8.67%) to account for the related increase to payroll
taxes. This calculation excludes the director of nursing, the administrator,
and assistant administrator.
5.
Minimum wage adjustment. All facilities with either an interim rate or a
prospective rate in effect on September 1, 1997, shall be granted an increase
to their per diem effective September 1, 1997, of one dollar and ninety-eight
cents ($1.98) to allow for the change in minimum wage. Utilizing Fiscal Year
1995 cost report data, the total industry hours reported for each payroll
category was multiplied by the forty-cent (40¢) increase, divided by the
patient days for the facilities reporting hours for that payroll category, and
factored up by eight and sixty-seven hundredths percent (8.67%) to account for
the related increase to payroll taxes. This calculation excludes the director
of nursing, the administrator, and assistant administrator.
6. FY-98 negotiated trend factor-
A. Facilities with either an interim rate or
prospective rate in effect on October 1, 1997, shall be granted an increase to
their per diem effective October 1, 1997, of three and four-tenths percent
(3.4%) of the cost determined in paragraphs (11)(A)1., (11)(B)1., (11)(C)1.,
and the property insurance and property taxes detailed in subsection (11)(D) of
13 CSR
70-10.015 for nursing facilities and 13 CSR 70-10.080
for HIV nursing facilities; or
B.
Facilities that were granted a prospective rate based on paragraph (12)(A)2. of
13 CSR
70-10.015 that is in effect on October 1, 1995, shall
have their increase determined by subsection (3)(S) of
13 CSR
70-10.015.
7. FY-99 negotiated trend factor-
A. Facilities with either an interim rate or
prospective rate in effect on October 1, 1998, shall be granted an increase to
their per diem effective October 1, 1998, of two and one-tenth percent (2.1%)
of the cost determined in paragraphs (11)(A)1., (11)(B)1., (11)(C)1., the
property insurance and property taxes detailed in subsection (11)(D) of
13 CSR
70-10.015 for nursing facilities and 13 CSR 7010.080
for HIV nursing facilities, and the minimum wage adjustments detailed in
paragraphs (3)(A)4. and (3)(A)5. of this regulation; or
B. Facilities that were granted a prospective
rate based on paragraph (12)(A)2. of
13 CSR
70-10.015 that is in effect on October 1, 1998, shall
have their increase determined by subsection (3)(S) of
13 CSR
70-10.015.
8. FY-2000 negotiated trend factor-
A. Facilities with either an interim rate or
prospective rate in effect on July 1, 1999, shall be granted an increase to
their per diem effective July 1, 1999, of one and ninety-four hundredths
percent (1.94%) of the cost determined in subsections (11)(A), (11)(B),
(11)(C), the property insurance and property taxes detailed in subsection
(11)(D) of 13 CSR 70-10.015 for nursing
facilities and 13 CSR 70-10.080 for HIV nursing facilities, and the minimum
wage adjustments detailed in paragraphs (3)(A)4. and (3)(A)5. of this
regulation; or
B. Facilities that
were granted a prospective rate based on paragraph (12)(A)2. of
13 CSR
70-10.015 that is in effect on July 1, 1999, shall
have their increase determined by subsection (3)(S) of
13 CSR
70-10.015.
9. FY-2004 nursing facility operations
adjustment-
A. Facilities with either an
interim rate or prospective rate in effect on July 1, 2003, shall be granted an
increase to their per diem effective for dates of service beginning July 1,
2003, through June 30, 2004, of four dollars and thirty-two cents ($4.32) for
the cost of nursing facility operations. Effective for dates of service
beginning July 1, 2004, the per diem adjustment shall be reduced to three
dollars and seventy-eight cents ($3.78); and
B. The operations adjustment shall be added
to the facility's current rate as of June 30, 2003, and is effective for
payment dates after August 1, 2003.
10. FY-2007 quality improvement adjustment-
A. Facilities with either an interim rate or
prospective rate in effect on July 1, 2006, shall be granted an increase to
their per diem effective for dates of service beginning July 1, 2006, of three
dollars and seventeen cents ($3.17) to improve the quality of life for nursing
facility residents; and
B. The
quality improvement adjustment shall be added to the facility's current rate as
of June 30, 2006, and is effective for dates of service beginning July 1, 2006,
and after.
11. FY-2007
trend adjustment-
A. Facilities with either an
interim rate or a prospective rate in effect on February 1, 2007, shall be
granted an increase to their per diem rate effective for dates of service
beginning February 1, 2007, of three dollars and zero cents ($3.00) to allow
for a trend adjustment to ensure quality nursing facility services;
and
B. The trend adjustment shall
be added to the facility's reimbursement rate as of January 31, 2007, and is
effective for dates of service beginning February 1, 2007, for payment dates
after March 1, 2007.
12.
FY-2008 trend adjustment-
A. Facilities with
either an interim rate or a prospective rate in effect on July 1, 2007, shall
be granted an increase to their per diem rate effective for dates of service
beginning July 1, 2007, of six dollars and zero cents ($6.00) to allow for a
trend adjustment to ensure quality nursing facility services; and
B. The trend adjustment shall be added to the
facility's current rate as of June 30, 2007, and is effective for dates of
service beginning July 1, 2007.
13. FY-2009 trend adjustment-
A. Facilities with either an interim rate or
a prospective rate in effect on July 1, 2008, shall be granted an increase to
their per diem rate effective for dates of service beginning July 1, 2008, of
six dollars and zero cents ($6.00) to allow for a trend adjustment to ensure
quality nursing facility services; and
B. The trend adjustment shall be added to the
facility's current rate as of June 30, 2008, and is effective for dates of
service beginning July 1, 2008.
14. FY-2010 trend adjustment-
A. Facilities with either an interim rate or
a prospective rate in effect on July 1, 2009, shall be granted an increase to
their per diem rate effective for dates of service beginning July 1, 2009, of
five dollars and fifty cents ($5.50) to allow for a trend adjustment to ensure
quality nursing facility services; and
B. The trend adjustment shall be added to the
facility's current rate as of June 30, 2009, and is effective for dates of
service beginning July 1, 2009.
15. FY-2012 trend adjustment-
A. Facilities with either an interim rate or
a prospective rate in effect on October 1, 2011, shall be granted an increase
to their per diem rate effective for dates of service beginning October 1,
2011, of six dollars and zero cents ($6.00) to allow for a trend adjustment to
ensure quality nursing facility services;
B. The trend adjustment shall be added to the
facility's current rate as of September 30, 2011, and is effective for dates of
service beginning October 1, 2011; and
C. This increase is contingent upon the
federal assessment rate limit increasing to six percent (6%) and is subject to
approval by the Centers for Medicare and Medicaid Services.
16. FY-2013 trend adjustment-
A. Facilities with either an interim rate or
a prospective rate in effect on July 1, 2012, shall be granted an increase to
their per diem rate effective for dates of services beginning July 1, 2012, of
six dollars and zero cents ($6.00) to allow for a trend adjustment to ensure
quality nursing facility services;
B. The trend adjustment shall be added to the
facility's current rate as of June 30, 2012, and is effective for dates of
service beginning July 1, 2012; and
C. This increase is contingent upon approval
by the Centers for Medicare and Medicaid Services.
17. FY-2014 trend adjustment-
A. Facilities with either an interim rate or
a prospective rate in effect on July 1, 2013, shall be granted an increase to
their per diem rate effective for dates of services beginning July 1, 2013, of
three percent (3.0%) of their current rate, less certain fixed cost items. The
fixed cost items are the per diem amounts included in the facility's current
rate from the following: subsection (2)(O) of
13 CSR
70-10.110, paragraphs (11)(D)1., (11)(D)2., (11)(D)3.,
(11)(D)4., (13)(B)3., and (13)(B)10. of
13 CSR
70-10.015;
B. The trend adjustment shall be added to the
facility's current rate as of June 30, 2013, and is effective for dates of
service beginning July 1, 2013; and
C. This increase is contingent upon approval
by the Centers for Medicare and Medicaid Services.
18. FY-2015 trend adjustment-
A. Facilities with either an interim rate or
a prospective rate in effect on July 1, 2014, shall be granted an increase to
their per diem rate effective for dates of services beginning July 1, 2014, of
one dollar and twenty-five cents ($1.25) to allow for a trend adjustment to
ensure quality nursing facility services;
B. The trend adjustment shall be added to the
facility's current rate as of June 30, 2014, and is effective for dates of
service beginning July 1, 2014; and
C. This increase is contingent upon approval
by the Centers for Medicare and Medicaid Services.
19. January 1, 2016 - June 30, 2016 trend
adjustment-
A. Facilities with either an
interim rate or a prospective rate in effect on January 1, 2016, shall be
granted an increase to their per diem rate effective for dates of services
beginning January 1, 2016, of two dollars and nine cents ($2.09) to allow for a
trend adjustment to ensure quality nursing facility services;
B. The trend adjustment will not be added to
the facility's rate after June 30, 2016; and
C. This increase is contingent upon approval
by the Centers for Medicare and Medicaid Services and sufficient funding
available through the Tax Amnesty Fund.
20. Continuation of FY-2016 trend adjustment
and FY-2017 trend adjustment-
A. Facilities
with either an interim rate or a prospective rate in effect on July 1, 2016,
shall continue to be granted an increase to their per diem rate effective for
dates of service beginning July 1, 2016, of two dollars and nine cents
($2.09);
B. Facilities with either
an interim rate or a prospective rate in effect on July 1, 2016, shall be
granted an increase to their per diem rate effective for dates of services
beginning July 1, 2016, of two dollars and eighty-three cents ($2.83) to allow
for a trend adjustment to ensure quality nursing facility services;
C. The trend adjustment of two dollars and
eighty-three cents ($2.83) shall be added to the facility's rate as of June 30,
2016, which includes the two dollars and nine cents ($2.09) increase, and is
effective for dates of service beginning July 1, 2016; and
D. These increases are contingent upon
approval by the Centers for Medicare and Medicaid Services.
21. FY-2018 per diem adjustment-
A. Facilities with either an interim rate or
a prospective rate in effect on August 1, 2017, shall be subject to a decrease
in their per diem rate effective for dates of services August 1, 2017 through
June 30, 2018, of five dollars and thirty-seven cents ($5.37);
B. The per diem adjustment of five dollars
and thirty-seven cents ($5.37) shall be deducted from the facility's current
rate as of July 31, 2017, and is effective for dates of service beginning
August 1, 2017;
C. Effective for
dates of service beginning July 1, 2018, the per diem decrease shall be reduced
to four dollars and eighty-three cents ($4.83). A per diem adjustment of
fifty-four cents ($0.54) shall be added to the facilities current rate as of
June 30, 2018, which includes the five dollars and thirty-seven cents ($5.37)
decrease, and is effective for dates of service beginning July 1, 2018;
and
D. This decrease is contingent
upon approval by the Centers for Medicare and Medicaid Services.
22. FY-2019 trend adjustment-
A. Facilities with either an interim rate or
a prospective rate in effect on July 1, 2018, shall be granted an increase to
their per diem rate effective for dates of services beginning July 1, 2018, of
seven dollars and seventy-six cents ($7.76) to allow for a trend adjustment to
ensure quality nursing facility services;
B. The rate to which the FY-2019 trend
adjustment of seven dollars and seventy-six cents ($7.76) shall be added is the
facility's rate as of June 30, 2018, plus the fifty-four cents ($0.54) per diem
adjustment effective July 1, 2018, set forth in subparagraph (3)(A)21.C. and is
effective for dates of service beginning July 1, 2018. This trend adjustment
shall result in a rate no greater than eight dollars and thirty cents ($8.30)
higher than the rate in effect on January 1, 2018; and
C. This increase is contingent upon approval
by the Centers for Medicare and Medicaid Services.
23. FY-2019 additional trend adjustment-
A. Facilities with either an interim rate or
a prospective rate in effect on February 1, 2019, shall be granted an increase
to their per diem rate effective for dates of service February 1, 2019 through
June 30, 2019, of one dollar and twenty-nine cents ($1.29) to allow for a trend
adjustment to ensure quality nursing facility services;
B. The per diem adjustment of one dollar and
twenty-nine cents ($1.29) shall be added to the facility's rate as of January
31, 2019, and is effective for dates of service beginning February 1, 2019
through June 30, 2019;
C. Effective
for dates of service beginning July 1, 2019, the per diem increase shall be
reduced to fifty-four cents ($0.54). A per diem adjustment of seventy-five
cents ($0.75) shall be deducted from the facility's rate as of June 30, 2019,
which includes the one dollar and twenty-nine cents ($1.29) increase, and is
effective for dates of service beginning July 1, 2019.
D. These per diem adjustments are contingent
upon approval by the Centers for Medicare and Medicaid Services.
24. FY-2020 trend adjustment-
A. Facilities with either an interim rate or
a prospective rate in effect on August 1, 2019, shall be granted an increase to
their per diem rate effective for dates of service August 1, 2019 through June
30, 2020, of one dollar and sixty-one cents ($1.61) to allow for a trend
adjustment to ensure quality nursing facility services;
B. The rate to which the FY-2020 trend
adjustment of one dollar and sixty-one cents ($1.61) shall be added is the
facility's rate as of July 31, 2019 set forth in subparagraph (13)(A)23.C. The
FY-2020 trend adjustment shall be effective for dates of service beginning
August 1, 2019 through June 30, 2020.
C. Effective for dates of service beginning
July 1, 2020, the per diem increase shall be reduced to one dollar and
forty-nine cents ($1.49). A per diem adjustment of twelve cents ($0.12) shall
be deducted from the facility's rate as of June 30, 2020, which includes the
one dollar and sixty-one cents ($1.61) increase, and is effective for dates of
service beginning July 1, 2020.
D.
These per diem adjustments are contingent upon approval by the Centers for
Medicare and Medicaid Services
25. FY-2022 COVID-19 National Emergency
adjustment-
A. Facilities with either an
interim rate or a prospective rate in effect on July 1, 2021, shall be granted
an increase to their per diem rate effective for dates of service July 1, 2021
through June 30, 2022, of ten dollars and eighteen cents ($10.18) to allow for
an adjustment for increases in costs associated with staffing, supplies, social
distancing standards, and other factors due to the COVID-19 national
emergency;
B. The rate to which the
FY-2022 adjustment of ten dollars and eighteen cents ($10.18) shall be added is
the facility's rate as of June 30, 2021, set forth in subparagraph (13)(A)24.C.
The FY-2022 adjustment shall be effective for dates of service beginning July
1, 2021, through June 30, 2022.
C.
The FY-2022 adjustment will not be included in the per diem rate for dates of
service after June 30, 2022. A per diem adjustment of ten dollars and eighteen
cents ($10.18) shall be deducted from the facility's rate as of June 30, 2022,
which includes the ten dollars and eighteen cents ($10.18) increase, and is
effective for dates of service beginning July 1, 2022.
*Original authority: 208.153, RSMo 1967, amended 1967, 1973, 1989, 1990, 1991, 2007, 2012; 208.159, RSMo 1979; 208.201, RSMo 1987, amended 2007; and 660.017, RSMo 1993, amended 1995.
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