Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This amendment updates the rule to mirror
the 2010 federal "Rosa's Law" (
Pub. L.
111-256), which removes the term "mentally
retarded" from federal health policy and replaces it will the term "individual
with intellectual disabilities." Additionally, this amendment updates the rule
to mirror section
630.006,
RSMo Supp. 2014, which replaced the term "mental retardation" with the more
current terminology of "intellectual disability."
PURPOSE: This rule establishes the formula to
determine the Federal Reimbursement Allowance for each Intermediate Care
Facility for Individuals with Intellectual Disabilities (ICF/IID) operated
primarily for the care and treatment of individuals with intellectual and
developmental disabilities. This rule applies to both private ICF/IIDs and
ICF/IID facilities operated by the Department of Mental Health and requires
these facilities to pay for the privilege of engaging in the business of
providing ICF/IID services to individuals in Missouri.
(1) The following words and terms, as used in
this rule, mean:
(A) Base cost report. MO
HealthNet cost report for the second prior fiscal year relative to the State
Fiscal Year (SFY) for which the assessment is being calculated (For example,
the SFY 2009 Federal Reimbursement Allowance (FRA) assessment will be
determined using the Intermediate Care Facility for Individuals with
Intellectual Disabilities (ICF/IID) cost report from FY 2007.);
(B) Department. Department of Mental
Health;
(C) Director. Director of
the Department of Mental Health;
(D) Division. Division of Developmental
Disabilities, Department of Mental Health;
(E) Engaging in the business of providing
residential habilitation care. Accepting payment for ICF/IID services
rendered;
(F) Fiscal period.
Twelve- (12-) month reporting period determined by the State Fiscal
Year;
(G) Intermediate Care
Facility for Individuals with Intellectual Disabilities (ICF/IID). A private or
department facility that admits individuals with intellectual and developmental
disabilities for residential habilitation and other services pursuant to
Chapters 630 and 633, RSMo, and that has been certified to meet the conditions
of participation under 42 CFR 483, Subpart I;
(H) Intermediate Care Facility for
Individuals with Intellectual Disabilities Federal Reimbursement Allowance
ICF/IID FRA. The assessment paid by each ICF/IID;
(2) Each ICF/IID operated primarily for the
care and treatment of individuals with intellectual and developmental
disabilities engaging in the business of providing residential habilitation and
other services in Missouri shall pay an ICF/IID FRA. The ICF/IID FRA shall be
calculated by the department as follows:
(A)
Beginning on July 1, 2008, and each year thereafter, the ICF/IID FRA annual
assessment shall be five and forty-nine hundredths percent (5.49%) of the
ICF/IID's net revenues determined from the base cost report relative to the
State Fiscal Year for which the assessment is being calculated. The cost report
shall be trended forward from the second prior year to the current fiscal year
by applying the SNF IPI trend factor for each year under the ICF/IID FRA
calculation;
(B) Beginning on
October 1, 2011, and each year thereafter, the ICF/IID FRA annual assessment
shall be five and ninety-five hundredths percent (5.95%) of the ICF/IID's net
revenues determined from the base cost report relative to the State Fiscal Year
for which the assessment is being calculated. The cost report shall be trended
forward from the second prior year to the current fiscal year by applying the
SNF IPI trend factor for each year under the ICF/IID FRA calculation;
(C) The annual assessment shall be divided
into twelve (12) equal amounts and collected over the number of months the
assessment is effective. The assessment is made payable to the director of the
Department of Revenue to be deposited in the state treasury in the ICF/IID FRA
Fund;
(D) If the assessment amount
determined using the second prior year cost report trended forward for the same
year is greater than the actual assessment maximum amount on the current year
ICF/IID provider tax revenues in the aggregate, then the department will offset
the tax collections for the next year by each provider's pro-rata share of the
difference between the amount of the tax as determined in subsection (2)(A) of
9
CSR 10-31.030 and the actual SFY amount determined
from the current year ICF/IID cost report;
(E) If an ICF/IID does not have a base cost
report, net revenues shall be estimated as follows:
1. Net revenues shall be determined by
computation of the ICF/IID's projected annual patient days multiplied by its
interim established per diem rate; and
(F) The ICF/IID FRA assessment for ICF/IIDs
that merge operation under one (1) MO HealthNet provider number shall be
determined as follows:
1. The previously
determined ICF/IID FRA assessment for each ICF/IID shall be combined under the
active MO HealthNet provider number for the remainder of the State Fiscal Year
after the division receives official notification of the merger; and
2. The ICF/IID FRA assessment for subsequent
fiscal years shall be based on the combined data for both facilities.
(3) The department
shall prepare a notification schedule of the information from each ICF/IID's
second prior year cost report and provide each ICF/IID with this schedule.
(A) The schedule shall include:
1. Provider name;
2. Provider number;
3. Fiscal period;
4. Total number of licensed beds;
5. Total bed days;
6. Net revenues; and
7. Total amount of the assessment for the
State Fiscal Year for which the assessment is being calculated and monthly
assessment amount due each month.
(B) Each ICF/IID required to pay the ICF/IID
FRA shall review this information, and if it is not correct, the ICF/IID must
notify the department of such within fifteen (15) days of receipt of the
notification schedule. If the ICF/IID fails to submit the corrected data within
the fifteen- (15-) day time period, the ICF/IID shall be barred from submitting
corrected data later to have its ICF/IID FRA assessment adjusted.
(4) Payment of ICF/IID FRA
Assessment.
(A) Each ICF/IID may request that
its ICF/IID FRA be offset against any MO HealthNet payment due. A statement
authorizing the offset must be on file with the MO HealthNet Division before
any offset may be made relative to the ICF/IID FRA. Any balance due after the
offset shall be remitted by the ICF/IID to the department. The remittance shall
be made payable to the director of the Department of Revenue. If the remittance
is not received before the next MO HealthNet payment cycle, the MO HealthNet
Division shall offset the balance due from that check.
(B) If no offset has been authorized by the
ICF/IID, the MO HealthNet Division will begin collecting the ICF/IID FRA on the
first day of each month. The ICF/IID FRA shall be remitted by the ICF/IID
facility to the MO HealthNet Division. The remittance shall be made payable to
the director of the Department of Revenue and deposited in the state treasury
to the credit of the ICF/IID FRA Fund.
(C) If the ICF/IID is delinquent in the
payment of its ICF/IID FRA assessment, the director of the Department of Social
Services shall withhold and remit to the Department of Revenue an amount equal
to the assessment from any payment made by the MO HealthNet Division to the
ICF/IID provider.
