No. 34767 (Amendment): Section R414-401-3. Assessment

(Amendment)

DAR File No.: 34767
Filed: 05/02/2011 06:04:11 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The Utah Legislature through H.B. 482 (2011 General Session) increased appropriations for this program through an increase to the assessment on Medicaid beds in nursing facilities. This change implements that assessment increase. (DAR NOTE: H.B. 482 is effective as of 05/10/2011.)

Summary of the rule or change:

In Subsection R414-401-3(2), non-intermediate care facilities for the mentally retarded are assessed at the uniform rate of $12.75 per patient day, which is an increase from the previous $12.25 per patient day assessment. This increase in assessment allows for the appropriated increase in reimbursement rates and for the change in assessment for hospice stays in nursing homes that are paid at the higher, assessment increased, reimbursement rates. In Subsection R414-401-3(2), intermediate care facilities for the mentally retarded (ICF/MR) are assessed at the uniform rate of $6.94 per patient day, which is an increase from the previous $6.53 per patient day assessment. These updates are based on estimates of patient days for state fiscal year 2012 and the appropriation amounts from the Hospital Provider Assessment Special Revenue Fund.

State statutory or constitutional authorization for this rule:

• Section 26-1-30
• Section 26-18-3
• Title 26, Chapter 35a

Anticipated cost or savings to:

the state budget:

This is anticipated to result in collection of an additional $1,870,600 restricted funds from nursing and swing bed facilities resulting in an additional $4,584,200 federal funds. This will result in an additional $6,454,800 in reimbursement to nursing home and swing bed facilities. The update to the ICF/MR assessment rate is anticipated to be budget neutral as it updates the collection rate based on projected days in state fiscal year 2012 and the appropriation amount from the Hospital Provider Assessment Special Revenue Fund.

local governments:

Local hospitals with swing beds may realize increased revenue, as a result of the increased reimbursement monies available. Funding will be applied to swing bed reimbursement rates beginning in calendar year 2012. 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:

Small nursing facility providers will realize a net enhanced revenue as a result of increased federal matching funds. In addition, there would be an increase in cost to non-Medicaid certified facilities as those facilities would be assessed the higher amount and would not realize any payments from Medicaid. ICF/MR facilities will realize an increased cost based upon the increase in the assessment rate. Inasmuch as patient days are variable, it is not possible to determine the additional revenue or cost that will be realized by these facilities.

persons other than small businesses, businesses, or local governmental entities:

Medicaid nursing facility providers will realize a portion of the net enhanced revenue as a result of increased federal matching funds. In addition, there would be an increase in cost to non-Medicaid certified facilities as those facilities would be assessed the higher amount and would not realize any payments from Medicaid. ICF/MR facilities will realize an increased cost based upon the increase in the assessment rate. Inasmuch as patient days are variable, it is not possible to determine the additional revenue or cost that will be realized by these facilities.

Compliance costs for affected persons:

Compliance costs include an increased collection of $0.50 per non-Medicare patient day from each nursing facility and $0.41 per qualifying patient day for the ICF/MR providers. These assessment monies are used to draw down federal matching funds that result in higher reimbursement rates than would be possible without the assessment monies. All Medicaid certified nursing and swing bed facilities have benefited from this process. The amount of overall gain depends on the number of Medicaid patients in the facility. In addition, there would be an increase in cost to non-Medicaid certified facilities as those facilities would be assessed the higher amount and would not realize any payments from Medicaid.

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

This proposed rule adjusts the assessment on nursing facilities. This change reflects 2011 appropriations and the phase out of federal subsidies. The net impact on business is positive, although the impact on each facility is variable.

David Patton, PhD, 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
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:

06/14/2011

This rule may become effective on:

06/21/2011

Authorized by:

David Patton, 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 [$12.25]$12.75 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 [$6.53]$6.94 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, 2010

Notice of Continuation: June 25, 2009

Authorizing, and Implemented or Interpreted Law: 26-1-30; 26-35a; 26-18-3

 

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