Reimbursement rate for nursing care services--not revised on change ofownership, management, operation--assignment to new facilitiesentering program--calculation--determination of trend factor,effect--expiration date of certain provisions.
208.169. 1. Notwithstanding other provisions of this chapter,including but not limited to sections 208.152, 208.153, 208.159 and208.162:
*(1) There shall be no revisions to a facility's reimbursement ratefor providing nursing care services under this chapter upon a change inownership, management control, operation, stock, leasehold interests bywhatever form for any facility previously licensed or certified forparticipation in the Medicaid program. Increased costs for the successorowner, management or leaseholder that result from such a change shall notbe recognized for purposes of reimbursement;
*(2) In the case of a newly built facility or part thereof which isless than two years of age and enters the Title XIX program under thischapter after July 1, 1983, a reimbursement rate shall be assigned based onthe lesser of projected estimated operating costs or one hundred tenpercent of the median rate for the facility's class to include urban andrural categories for each level of care including ICF only and SNF/ICF.The rates set under this provision shall be effective for a period oftwelve months from the effective date of the provider agreement at whichtime the rate for the future year shall be set in accordance with reportedcosts of the facility recognized under the reimbursement plan and asprovided in subdivisions (3) and (4) of this subsection. Rates set underthis section may in no case exceed the maximum ceiling amounts in effectunder the reimbursement regulation;
*(3) Reimbursement for capital related expenses for newly builtfacilities entering the Title XIX program after March 18, 1983, shall becalculated as the building and building equipment rate, movable equipmentrate, land rate, and working capital rate.
(a) The building and building equipment rate will be the lower of:
a. Actual acquisition costs, which is the original cost to constructor acquire the building, not to exceed the costs as determined in section197.357, RSMo; or
b. Reasonable construction or acquisition cost computed by applyingthe regional Dodge Construction Index for 1981 with a trend factor, ifnecessary, or another current construction cost measure multiplied by onehundred eight percent as an allowance for fees authorized as architecturalor legal not included in the Dodge Index Value, multiplied by the squarefootage of the facility not to exceed three hundred twenty-five square feetper bed, multiplied by the ratio of forty minus the actual years of the ageof the facility divided by forty; and multiplied by a return rate of twelvepercent; and divided by ninety-three percent of the facility's totalavailable beds times three hundred sixty-five days.
(b) The maximum movable equipment rate will be fifty-three cents perbed day.
(c) The maximum allowable land area is defined as five acres for afacility with one hundred or less beds and one additional acre for eachadditional one hundred beds or fraction thereof for a facility with onehundred one or more beds.
(d) The land rate will be calculated as:
a. For facilities with land areas at or below the maximum allowableland area, multiply the acquisition cost of the land by the return rate oftwelve percent, divide by ninety-three percent of the facility's totalavailable beds times three hundred sixty-five days.
b. For facilities with land areas greater than the maximum allowableland area, divide the acquisition cost of the land by the total acres,multiply by the maximum allowable land area, multiply by the return rate oftwelve percent, divide by ninety-three percent of the facility's totalavailable beds times three hundred sixty-five days.
(e) The maximum working capital rate will be twenty cents per day;
*(4) If a provider does not provide the actual acquisition cost todetermine a reimbursement rate under subparagraph a. of paragraph (a) ofsubdivision (3) of subsection 1 of this section, the sum of the buildingand building equipment rate, movable equipment rate, land rate, and workingcapital rate shall be set at a reimbursement rate of six dollars;
(5) For each state fiscal year a negotiated trend factor shall beapplied to each facility's Title XIX per diem reimbursement rate. Thetrend factor shall be determined through negotiations between thedepartment and the affected providers and is intended to hold the providersharmless against increase in cost. In no circumstances shall thenegotiated trend factor to be applied to state funds exceed the health carefinance administration market basket price index for that year. Theprovisions of this subdivision shall apply to fiscal year 1996 andthereafter.
2. The provisions of subdivisions (1), (2), (3), and (4) ofsubsection 1 of this section shall remain in effect until July 1, 1989,unless otherwise provided by law.
Reimbursement rate for nursing care services--not revised on change ofownership, management, operation--assignment to new facilitiesentering program--calculation--determination of trend factor,effect--expiration date of certain provisions.
208.169. 1. Notwithstanding other provisions of this chapter,including but not limited to sections 208.152, 208.153, 208.159 and208.162:
*(1) There shall be no revisions to a facility's reimbursement ratefor providing nursing care services under this chapter upon a change inownership, management control, operation, stock, leasehold interests bywhatever form for any facility previously licensed or certified forparticipation in the Medicaid program. Increased costs for the successorowner, management or leaseholder that result from such a change shall notbe recognized for purposes of reimbursement;
*(2) In the case of a newly built facility or part thereof which isless than two years of age and enters the Title XIX program under thischapter after July 1, 1983, a reimbursement rate shall be assigned based onthe lesser of projected estimated operating costs or one hundred tenpercent of the median rate for the facility's class to include urban andrural categories for each level of care including ICF only and SNF/ICF.The rates set under this provision shall be effective for a period oftwelve months from the effective date of the provider agreement at whichtime the rate for the future year shall be set in accordance with reportedcosts of the facility recognized under the reimbursement plan and asprovided in subdivisions (3) and (4) of this subsection. Rates set underthis section may in no case exceed the maximum ceiling amounts in effectunder the reimbursement regulation;
*(3) Reimbursement for capital related expenses for newly builtfacilities entering the Title XIX program after March 18, 1983, shall becalculated as the building and building equipment rate, movable equipmentrate, land rate, and working capital rate.
(a) The building and building equipment rate will be the lower of:
a. Actual acquisition costs, which is the original cost to constructor acquire the building, not to exceed the costs as determined in section197.357, RSMo; or
b. Reasonable construction or acquisition cost computed by applyingthe regional Dodge Construction Index for 1981 with a trend factor, ifnecessary, or another current construction cost measure multiplied by onehundred eight percent as an allowance for fees authorized as architecturalor legal not included in the Dodge Index Value, multiplied by the squarefootage of the facility not to exceed three hundred twenty-five square feetper bed, multiplied by the ratio of forty minus the actual years of the ageof the facility divided by forty; and multiplied by a return rate of twelvepercent; and divided by ninety-three percent of the facility's totalavailable beds times three hundred sixty-five days.
(b) The maximum movable equipment rate will be fifty-three cents perbed day.
(c) The maximum allowable land area is defined as five acres for afacility with one hundred or less beds and one additional acre for eachadditional one hundred beds or fraction thereof for a facility with onehundred one or more beds.
(d) The land rate will be calculated as:
a. For facilities with land areas at or below the maximum allowableland area, multiply the acquisition cost of the land by the return rate oftwelve percent, divide by ninety-three percent of the facility's totalavailable beds times three hundred sixty-five days.
b. For facilities with land areas greater than the maximum allowableland area, divide the acquisition cost of the land by the total acres,multiply by the maximum allowable land area, multiply by the return rate oftwelve percent, divide by ninety-three percent of the facility's totalavailable beds times three hundred sixty-five days.
(e) The maximum working capital rate will be twenty cents per day;
*(4) If a provider does not provide the actual acquisition cost todetermine a reimbursement rate under subparagraph a. of paragraph (a) ofsubdivision (3) of subsection 1 of this section, the sum of the buildingand building equipment rate, movable equipment rate, land rate, and workingcapital rate shall be set at a reimbursement rate of six dollars;
(5) For each state fiscal year a negotiated trend factor shall beapplied to each facility's Title XIX per diem reimbursement rate. Thetrend factor shall be determined through negotiations between thedepartment and the affected providers and is intended to hold the providersharmless against increase in cost. In no circumstances shall thenegotiated trend factor to be applied to state funds exceed the health carefinance administration market basket price index for that year. Theprovisions of this subdivision shall apply to fiscal year 1996 andthereafter.
2. The provisions of subdivisions (1), (2), (3), and (4) ofsubsection 1 of this section shall remain in effect until July 1, 1989,unless otherwise provided by law.
Reimbursement rate for nursing care services--not revised on change ofownership, management, operation--assignment to new facilitiesentering program--calculation--determination of trend factor,effect--expiration date of certain provisions.
208.169. 1. Notwithstanding other provisions of this chapter,including but not limited to sections 208.152, 208.153, 208.159 and208.162:
*(1) There shall be no revisions to a facility's reimbursement ratefor providing nursing care services under this chapter upon a change inownership, management control, operation, stock, leasehold interests bywhatever form for any facility previously licensed or certified forparticipation in the Medicaid program. Increased costs for the successorowner, management or leaseholder that result from such a change shall notbe recognized for purposes of reimbursement;
*(2) In the case of a newly built facility or part thereof which isless than two years of age and enters the Title XIX program under thischapter after July 1, 1983, a reimbursement rate shall be assigned based onthe lesser of projected estimated operating costs or one hundred tenpercent of the median rate for the facility's class to include urban andrural categories for each level of care including ICF only and SNF/ICF.The rates set under this provision shall be effective for a period oftwelve months from the effective date of the provider agreement at whichtime the rate for the future year shall be set in accordance with reportedcosts of the facility recognized under the reimbursement plan and asprovided in subdivisions (3) and (4) of this subsection. Rates set underthis section may in no case exceed the maximum ceiling amounts in effectunder the reimbursement regulation;
*(3) Reimbursement for capital related expenses for newly builtfacilities entering the Title XIX program after March 18, 1983, shall becalculated as the building and building equipment rate, movable equipmentrate, land rate, and working capital rate.
(a) The building and building equipment rate will be the lower of:
a. Actual acquisition costs, which is the original cost to constructor acquire the building, not to exceed the costs as determined in section197.357, RSMo; or
b. Reasonable construction or acquisition cost computed by applyingthe regional Dodge Construction Index for 1981 with a trend factor, ifnecessary, or another current construction cost measure multiplied by onehundred eight percent as an allowance for fees authorized as architecturalor legal not included in the Dodge Index Value, multiplied by the squarefootage of the facility not to exceed three hundred twenty-five square feetper bed, multiplied by the ratio of forty minus the actual years of the ageof the facility divided by forty; and multiplied by a return rate of twelvepercent; and divided by ninety-three percent of the facility's totalavailable beds times three hundred sixty-five days.
(b) The maximum movable equipment rate will be fifty-three cents perbed day.
(c) The maximum allowable land area is defined as five acres for afacility with one hundred or less beds and one additional acre for eachadditional one hundred beds or fraction thereof for a facility with onehundred one or more beds.
(d) The land rate will be calculated as:
a. For facilities with land areas at or below the maximum allowableland area, multiply the acquisition cost of the land by the return rate oftwelve percent, divide by ninety-three percent of the facility's totalavailable beds times three hundred sixty-five days.
b. For facilities with land areas greater than the maximum allowableland area, divide the acquisition cost of the land by the total acres,multiply by the maximum allowable land area, multiply by the return rate oftwelve percent, divide by ninety-three percent of the facility's totalavailable beds times three hundred sixty-five days.
(e) The maximum working capital rate will be twenty cents per day;
*(4) If a provider does not provide the actual acquisition cost todetermine a reimbursement rate under subparagraph a. of paragraph (a) ofsubdivision (3) of subsection 1 of this section, the sum of the buildingand building equipment rate, movable equipment rate, land rate, and workingcapital rate shall be set at a reimbursement rate of six dollars;
(5) For each state fiscal year a negotiated trend factor shall beapplied to each facility's Title XIX per diem reimbursement rate. Thetrend factor shall be determined through negotiations between thedepartment and the affected providers and is intended to hold the providersharmless against increase in cost. In no circumstances shall thenegotiated trend factor to be applied to state funds exceed the health carefinance administration market basket price index for that year. Theprovisions of this subdivision shall apply to fiscal year 1996 andthereafter.
2. The provisions of subdivisions (1), (2), (3), and (4) ofsubsection 1 of this section shall remain in effect until July 1, 1989,unless otherwise provided by law.
