No. 32631 (Amendment): R414-401-3. Assessment

DAR File No.: 32631
Filed: 04/30/2009, 05:01
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The 2009 Utah Legislature increased appropriations for this program through an increase to the assessment on Medicaid beds in nursing facilities and Intermediate Care Facilities for the Mentally Retarded (ICF/MRs). This change implements that assessment increase.

Summary of the rule or change:

In Subsection R414-401-3(2), nonintermediate care facilities for the mentally retarded are assessed at the uniform rate of $10.20 per patient day, which is an increase from the previous $8.96 per patient day assessment. Intermediate care facilities for the mentally retarded are assessed at the uniform rate of $6.53 per patient day, which is an increase from the previous $5.52 per patient day assessment. This change becomes effective July 1, 2009. This increase in assessment allows for the appropriated increase in reimbursement rates.

State statutory or constitutional authorization for this rule:

Section 26-18-3

Anticipated cost or savings to:

the state budget:

Budget neutral due to collection of $2,300,000 from nursing and swing bed facilities and $200,000 from intermediate care facilities for the mentally retarded, and an increase in state funded reimbursement of $2,300,000 to nursing and swing bed facilities and $200,000 to intermediate care facilities for the mentally retarded.

local governments:

Local intermediate care facilities for the mentally retarded will see a net increase in revenue of $500,000 due to increased federal funding. Local hospitals with swing beds will also see increased revenue due to increased federal funding. Funding will be applied for swing bed reimbursement rates beginning in calendar year 2010. Inasmuch as swing beds are variable, it is not possible to determine the additional funding that will be made available to these facilities.

small businesses and persons other than businesses:

Nursing facility providers for small businesses will see a net enhanced revenue of approximately $400,000 as a result of increased federal matching funds. In addition, there is an estimated increase in cost of $12,879 to non-Medicaid certified facilities, based on four facilities and an estimated number of 10,579 patient days.

Compliance costs for affected persons:

Compliance costs include an increased collection of $1.24 per non-Medicare patient day from each nursing facility or a total of $2,300,000, and an increased collection of $1.01 per non-Medicare patient day from each ICF/MR for a total of $200,000. This collection will be used as state funds to draw down about $6,300,000 in federal funds. All Medicaid certified nursing and swing bed facilities will gain from this process. The amount of gain depends on the number of Medicaid patients in the facility. In addition, there is an average cost of $3,220 to four non-Medicaid certified facilities.

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

Facilities will be assessed $2,500,000, which will be matched with $6,300,000 in federal funds and generate total additional reimbursement of $8,800,000 to the Medicaid certified facilities in these two classes. 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:

06/15/2009

This rule may become effective on:

07/01/2009

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

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

R414-401. Nursing Care Facility Assessment.

R414-401-3. Assessment.

(1) The collection agent for the nursing care facility assessment shall be the Department, which is vested with the administration and enforcement of the assessment.

(2) The uniform rate of assessment for every facility is $[8.96]10.20 per non-Medicare patient day provided by the facility, except that intermediate care facilities for the mentally retarded shall be assessed at the uniform rate of $[5.52]6.53 per patient day. Swing bed facilities shall be assessed the uniform rate for nursing facilities effective January 1, 2006. The Utah State Veteran's Home is exempted from this assessment and this rule.

(3) Each nursing care facility must pay its assessment monthly on or before the last day of the next succeeding month.

(4) The Department shall extend the time for paying the assessment to the next month succeeding the federal approval of a Medicaid State Plan Amendment allowing for the assessment, and consequent reimbursement rate adjustments.

 

KEY: Medicaid, nursing facility

Date of Enactment or Last Substantive Amendment: [July 1, 2007]2009

Authorizing, and Implemented or Interpreted Law: 26-1-30; 26-35a