No. 27851 (Amendment): R414-504. Nursing Facility Payments

DAR File No.: 27851
Filed: 05/02/2005, 11:18
Received by: NL

 

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rulemaking is necessary to implement the reimbursement plan for intermediate care facilities for the mentally retarded for fiscal year 2006.

 

Summary of the rule or change:

This rulemaking addresses the implementation of a two-component prospective reimbursement rate for Intermediated Care Facilities for the Mentally Retarded (ICF/MR) facilities beginning on July 1, 2005. It adopts the Fair Rental Value system of property costs as applied to other nursing facilities and makes it applicable to ICF/MR facilities. This rulemaking also specifies rates that will be in effect until July 1, 2005, and rates that will change after that date pending federal approval of submitted rates. Submitted rates are calculated to implement the 2005 amendments to the Utah Nursing Care Facility Assessment Act that includes ICF/MR facilities within its "Nursing Facilities" definition, thereby making the rates subject to facility assessment.

 

State statutory or constitutional authorization for this rule:

Sections 26-1-5 and 26-18-3, and Title 26, Chapter 35a

 

Anticipated cost or savings to:

the state budget:

There is no change to the state budget that results from implementation of the Fair Rental Value component for ICF/MR facilities. Upon implementation of the Nursing Care Facility Assessment Act amendments, that allow assessment of ICF/MR facilities, future rate adjustments will amount to a cost of approximately $1,100,000 to the State General Fund (property costs included) with a federal match of $2,800,000. These funds will be provided through assessment collections from all ICF/MR facilities as intended by the 2005 amendments to the act.

 

local governments:

There is no budget impact to local governments because local governments do not provide ICF/MR services.

 

other persons:

Upon federal approval of the proposed ICF/MR rates, this rule will facilitate a significant increase of $3,900,000 dollars in ICF/MR facility reimbursement.

 

Compliance costs for affected persons:

There are no compliance costs because this rulemaking does not require any action on the part of affected persons.

 

Comments by the department head on the fiscal impact the rule may have on businesses:

At the request of providers, an assessment was imposed by statute that will allow increased Medicaid reimbursement for these providers when approved by the federal regulators. This rule implements that assessment for providers and will have a positive impact on providers. David N. Sundwall, MD, Executive Director

 

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY UT 84116-3231

 

Direct questions regarding this rule to:

Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at [e-mail]

 

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

06/14/2005

 

This rule may become effective on:

06/15/2005

 

Authorized by:

David N. Sundwall, Executive Director

 

 

RULE TEXT

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-504. Nursing Facility Payments.

R414-504-1. Introduction.

(1) This rule adopts a case mix or severity based payment system, commonly referred to as RUGS (Resource Utilization Group System). This system reimburses facilities based on the case mix index of the facility.

(2) This rule is authorized by Utah Code sections 26-1-5[ and], 26-18-3, and 26-35a.

 

R414-504-5. Reimbursement for Intermediate Care Facilities for the Mentally Retarded.

The following principles apply to the payment of community-based intermediate care facilities for the mentally retarded (ICF/MRs) that are licensed under Utah Code 26-21-13.5:

(1) Approximately 93% of total payments paid in aggregate to ICF/MRs are based on a prospective flat rate. The balance of the total payments is attributable to a property cost component of the rate as calculated by the Fair Rental Value system pursuant to R414-504-3(8).

(2) Pending federal approval of the Medicaid rate adjustment for ICF/MRs, the rates in effect on July 1, 2005, will be the same as those in effect on June 30, 2005, inflated by 1%.

(3) Upon federal approval of the ICF/MR rate adjustment, rate components will be adjusted retroactively to July 1, 2005, to reflect additional funding made available.

 

KEY: Medicaid

[September 15, 2004]2005

26-1-5

26-18-3

26-35a