Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-401-3

Assessment

Notice of Proposed Rule

(Amendment)

DAR File No.: 36108
Filed: 04/27/2012 02:50:30 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The 2012 Utah Legislature increased appropriations for this program through an increase to the assessment on Medicaid beds in nursing facilities. This change implements that assessment increase.

Summary of the rule or change:

In Subsection R414-401-3(2), intermediate care facilities for people with intellectual disabilities are assessed at the uniform rate of $14.50 per patient day, which is an increase from the previous $12.75 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 people with intellectual disabilities (ICF/ID) are assessed at the uniform rate of $6.80 per patient day, which is a decrease from the previous $6.94 per patient day assessment, based upon projected days. These updates are based on estimates of patient days for state fiscal year 2013 and the appropriation amounts.

State statutory or constitutional authorization for this rule:

• Section 26-18-3

Anticipated cost or savings to:

the state budget:

This is anticipated to result in collection of an additional $1,993,800 restricted funds from nursing and swing bed facilities resulting in an additional $4,643,400 of federal funds. This will result in an additional $6,637,200 in reimbursement to nursing home and swing bed facilities. The update to the ICF/ID assessment rate is anticipated to be budget neutral as it updates the collection rate based on projected days in state fiscal year 2013 and the appropriation amount.

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 2013. 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/ID facilities will realize a decreased cost based upon the decrease in the assessment rate. Inasmuch as patient days are variable, it is not possible to determine the decreased 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/ID facilities will realize a decreased cost based upon the decrease in the assessment rate. Inasmuch as patient days are variable, it is not possible to determine the decreased cost that will be realized by these facilities.

Compliance costs for affected persons:

Compliance costs include an increased collection of $1.75 per non-Medicare patient day from each nursing facility and a decrease of $0.14 per qualifying patient day for the ICF/ID providers. The 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 benefitted 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:

Consistent with Legislative appropriations, this rule updates the nursing facility assessment. For Medicaid certified facilities, the fiscal impact will be positive.

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
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 [email protected]

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:

06/14/2012

This rule may become effective on:

07/01/2012

Authorized by:

David Patton, Executive Director

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 $[12.75]14.50 per non-Medicare patient day provided by the facility, except that intermediate care facilities for [the mentally retarded]people with intellectual disabilities shall be assessed at the uniform rate of $6.[94]80 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: [February 21], 2012

Notice of Continuation: June 25, 2009

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