Current through Register Vol. 63, No. 9, September 1, 2024
Rate establishment process. At least annually, the Medicaid
intermediary will establish an interim Medicaid per diem rate for each
participating psychiatric hospital, separate cost entity or distinct program
within a hospital:
(1) A hospital may
request an interim per diem rate or rates. If a review of the hospital's prior
year Medicaid cost report (adjusted for inflation, changes in patient
populations and programs and other relevant factors) does not justify the
requested rate(s), the Medicaid Intermediary may establish different interim
rate(s):
(a) Actual expenditures for the most
recent fiscal period available will be used to determine salary and wage and
total expense distribution for each cost center included in the total
expenditures. Any other directly relevant event, such as facility
restructuring, will be considered as well;
(b) The Division will apply the proportions
from subsection (a) of this section to total anticipated expenditures for the
new period to determine salary and wage expense distribution for each cost
center during the new period;
(c)
The Division will establish and apply capital allowances and other adjustments
to total anticipated expenditures for the new period from subsection (b) of
this section;
(d) If the hospital
has separate cost entities or distinct programs, the hospital will provide
estimates to the Division of a weighted average interim rate. The average will
be developed by multiplying each proposed interim rate by estimated Medicaid
patient days for that rate, summing all of the products, and dividing that sum
by the total annual estimated Medicaid patient days for the hospital;
(e) The interim or weighted average interim
per diem rate may not exceed the maximum allowable rate unless the hospital
meets the criteria for reimbursement above the maximum allowable rate as a
disproportionate share hospital (see OAR
309-015-0035(5)).
In that case, the interim or average interim Disproportionate Share adjusted
Medicaid Rate (DSR) may include estimated costs up to 135 percent of the
maximum allowable Medicaid rate except for hospitals meeting criteria set forth
in the following paragraph;
(f) If
a psychiatric hospital has a low-income rate of 60 percent and also receives 60
percent or more of its service revenue from any combination of the following:
(A) Public funds, excluding Medicare and
Medicaid;
(B) Bad debts;
or
(C) Free care.
(g) The hospital qualifies to
receive disproportionate share payment at a rate based on 100 percent of the
costs of uncompensated care during the facility's previous fiscal year, subject
to a disproportionate share allotment established for Oregon by the Health Care
Financing Administration;
(h) The
Division will base quarterly disproportionate share reimbursements on the
estimated costs for each facility during the current fiscal year and will
review and adjust the reimbursements, after conclusion of the fiscal period, to
correspond with actual costs encountered during the period. Total reimbursement
from disproportionate share and other sources will not exceed actual
costs.
(2) If a hospital
does not request an interim rate, the Medicaid Intermediary will establish an
interim rate based on the hospital's prior year cost report using the same
factors listed in section (1) of this rule.
Stat. Auth.: ORS
413.042
Stats. Implemented: ORS
414.025 &
414.065
