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

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

(2)  The federally qualified health center or ruralhealth clinic submits data, documentation, and schedules that substantiate anychanges in services and the related adjustment of reasonable costs followingmedicare principles of reimbursement; and

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

(b)  This proposed projected adjusted rate issubject to departmental approval.  The proposed projected adjusted rate shallbe calculated based on a consolidated basis where the federally qualifiedhealth center or rural health clinic takes all costs for the center that wouldinclude both the costs included in the base rate, as well as the additionalcosts, provided that the federally qualified health center or rural healthclinic calculated the baseline prospective payment system rate based on totalconsolidated costs.  A net change in the federally qualified health center's orrural health clinic's rate shall be calculated by subtracting the federallyqualified health center's or rural health clinic's previously assignedprospective payment system rate from its projected adjusted rate.

(c)  Within one hundred twenty days of itsreceipt of the projected adjusted rate and all additional documentationrequested by the department, the department shall notify the federallyqualified health center or rural health clinic of its acceptance or rejectionof the projected adjusted rate.  Upon approval by the department, the federallyqualified health center or rural health clinic shall be paid the projectedrate, which shall be effective from the date of the change in scope of servicesthrough the date that a rate is calculated based upon the first full fiscalyear that includes the change in scope of services.

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

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

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

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

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

(3)  A change in service resulting from relocation;

(4)  A change in type, intensity, duration, or amountof service resulting from a change in applicable technology and medicalpractice used;

(5)  An increase in service intensity, duration, oramount 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 inthe provider mix of a federally qualified health center or a rural healthclinic or one of its sites;

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

(8)  Changes in operating costs due to capitalexpenditures associated with a modification of the scope of any of theservices, including new or expanded service facilities, regulatory compliance,or changes in technology or medical practices at the federally qualified healthcenter 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 allowableunder medicaid principles of reimbursement and the net change in the federallyqualified health center's or rural health clinic's per visit rate equals orexceeds three per cent for the affected federally qualified health center orrural health clinic site.  For federally qualified health centers or ruralhealth clinics that filed consolidated cost reports for multiple sites toestablish their baseline prospective payment system rates, the net change ofthree per cent shall be applied to the average per visit rate of all the sitesof the federally qualified health center or rural health clinic for purposes ofcalculating the costs associated with a scope of service change.  For thepurposes of this section, "net change" means the per visit changeattributable to the cumulative effect of all increases or decreases for aparticular fiscal year.

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

 

Note

 

  Section effective upon approval of the Hawaii medicaidstate 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 healthcenter or rural health clinic shall submit a prospective payment system rateadjustment request under section [346-53.63], Hawaii Revised Statutes, withinone hundred fifty days of the beginning of the calendar year occurring afterthe department of human services first adopts forms and issues writteninstructions for applying for a prospective payment system rate adjustmentunder section [346-53.63], Hawaii Revised Statutes, if, during the prior fiscalyear, the federally qualified health center or rural health clinic experienceda decrease in the scope of services; provided that the federally qualifiedhealth center or rural health clinic either knew or should have known the rateadjustment would result in a significantly lower per-visit rate.  As used inthis paragraph, "significantly lower" means an average rate decreasein excess of three per cent.

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