[§346-53.63]  Federally qualified health
center or rural health clinic; adjustment for changes to scope of services. 
(a)  Prospective payment system rates may be adjusted for any increases or
decreases in the scope of services furnished by a participating federally
qualified health center or rural health clinic, provided that:



(1)  The federally qualified health center or rural
health clinic notifies the department in writing of any changes to the scope of
services and the reasons for those changes within sixty days of the effective
date of the changes;



(2)  The federally qualified health center or rural
health clinic submits data, documentation, and schedules that substantiate any
changes in services and the related adjustment of reasonable costs following
medicare principles of reimbursement; and



(3)  The federally qualified health center or rural
health clinic proposes a projected adjusted rate within one hundred fifty days
of the changes to the scope of services.



(b)  This proposed projected adjusted rate is
subject to departmental approval.  The proposed projected adjusted rate shall
be calculated based on a consolidated basis where the federally qualified
health center or rural health clinic takes all costs for the center that would
include both the costs included in the base rate, as well as the additional
costs, provided that the federally qualified health center or rural health
clinic calculated the baseline prospective payment system rate based on total
consolidated costs.  A net change in the federally qualified health center's or
rural health clinic's rate shall be calculated by subtracting the federally
qualified health center's or rural health clinic's previously assigned
prospective payment system rate from its projected adjusted rate.



(c)  Within one hundred twenty days of its
receipt of the projected adjusted rate and all additional documentation
requested by the department, the department shall notify the federally
qualified health center or rural health clinic of its acceptance or rejection
of the projected adjusted rate.  Upon approval by the department, the federally
qualified health center or rural health clinic shall be paid the projected
rate, which shall be effective from the date of the change in scope of services
through the date that a rate is calculated based upon the first full fiscal
year that includes the change in scope of services.



(d)  The department shall review the calculated
rate of the first full fiscal year cost report if the change of scope of
service is reflected in more than six months of the report.  For those
federally qualified health centers or rural health clinics in which the change
of scope of services is in effect for six months or less of the cost report
fiscal year, review of the next full fiscal year cost report also is required. 
The department shall review the calculated inflated weighted average rate of
these two cost reports.  The total costs of the first year report shall be
adjusted to the Medical Economic Index of the second year report.  Each report shall
be weighted based upon number of patient encounters.



(e)  Upon receipt of the cost reports, the
prospective payment system rate shall be adjusted following a review by the
fiscal agent of the cost reports and documentation.  Adjustments shall be made
for payments for the period from the effective date of the change in scope of
services through the date of the final adjustment of the prospective payment
system rate.



(f)  For the purposes of prospective payment
system rate adjustment, a change in scope of services provided by a federally
qualified health center or rural health clinic means the following:



(1)  The addition of a new service, such as adding
dental services or any other medicaid covered service, that is not incorporated
in the baseline prospective payment system rate or a deletion of a service that
is incorporated in the baseline prospective payment system rate;



(2)  A change in service resulting from amended
regulatory requirements or rules;



(3)  A change in service resulting from relocation;



(4)  A change in type, intensity, duration, or amount
of service resulting from a change in applicable technology and medical
practice used;



(5)  An increase in service intensity, duration, or
amount of service resulting from changes in the types of patients served,
including but not limited to populations with human immunodeficiency virus,
acquired immunodeficiency syndrome, or other chronic diseases, or homeless,
elderly, migrant, or other special populations;



(6)  A change in service resulting from a change in
the provider mix of a federally qualified health center or a rural health
clinic or one of its sites;



(7)  Any changes in the scope of a project approved by
the federal Health Resources and Services Administration where the change
affects a covered service; or



(8)  Changes in operating costs due to capital
expenditures associated with a modification of the scope of any of the
services, including new or expanded service facilities, regulatory compliance,
or changes in technology or medical practices at the federally qualified health
center or rural health clinic.



(g)  No change in costs, in and of itself,
shall be considered a scope of service change unless the cost is allowable
under medicaid principles of reimbursement and the net change in the federally
qualified health center's or rural health clinic's per visit rate equals or
exceeds three per cent for the affected federally qualified health center or
rural health clinic site.  For federally qualified health centers or rural
health clinics that filed consolidated cost reports for multiple sites to
establish their baseline prospective payment system rates, the net change of
three per cent shall be applied to the average per visit rate of all the sites
of the federally qualified health center or rural health clinic for purposes of
calculating the costs associated with a scope of service change.  For the
purposes of this section, "net change" means the per visit change
attributable to the cumulative effect of all increases or decreases for a
particular fiscal year.



(h)  All references in this section to
"fiscal year" shall be construed to be references to the fiscal year
of the individual federally qualified health center or rural health clinic, as
the case may be. [L Sp 2008, c 8, pt of §2]



 



Note



 



  Section effective upon approval of the Hawaii medicaid
state plan by the Centers for Medicare and Medicaid Services. L Sp 2008, c 8,
§9.



  L Sp 2008, c 8, §4 provides:



  "SECTION 4.  A federally qualified health
center or rural health clinic shall submit a prospective payment system rate
adjustment request under section [346-53.63], Hawaii Revised Statutes, within
one hundred fifty days of the beginning of the calendar year occurring after
the department of human services first adopts forms and issues written
instructions for applying for a prospective payment system rate adjustment
under section [346-53.63], Hawaii Revised Statutes, if, during the prior fiscal
year, the federally qualified health center or rural health clinic experienced
a decrease in the scope of services; provided that the federally qualified
health center or rural health clinic either knew or should have known the rate
adjustment would result in a significantly lower per-visit rate.  As used in
this paragraph, "significantly lower" means an average rate decrease
in excess of three per cent.



Notwithstanding any law to the contrary, the first full
fiscal year's cost reports shall be deemed to have been submitted in a timely
manner if filed within one hundred fifty days after the department of human
services adopts forms and issues written instructions for applying for a
prospective payment system rate adjustment for changes to scope of service
under section [346-53.63], Hawaii Revised Statutes."