DAR File No. 39299

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-401-3

Assessment

Notice of Proposed Rule

(Amendment)

DAR File No.: 39299
Filed: 04/27/2015 08:37:22 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to update the annual assessment amounts for nursing care facilities and intermediate care facilities for persons with intellectual disabilities (ICFs/ID) for state fiscal year (SFY) 2016.

Summary of the rule or change:

In Subsection R414-401-3(2), every nursing facility is assessed at the uniform rate of $18.32 per patient day, which is an increase from the previous $15.40 per patient day assessment, based upon projected days and a one-time increase in the budget. In Subsection R414-401-3(2), ICFs/ID are assessed at the uniform rate of $8.46 per patient day, which is a decrease from the previous $8.48 per patient day assessment, based upon projected days and an assessment target from the 2015 General Session. These updates are based on estimates of patient days for SFY 2016 and the appropriation amounts.

State statutory or constitutional authorization for this rule:

• Section 26-18-3

Anticipated cost or savings to:

the state budget:

The update to the facility assessment rate is anticipated to be budget neutral as it updates the collection rate based on projected days in SFY 2016 and the appropriation amount. The update to the ICF/ID assessment rate is not budget neutral as it updates the collection rate based on projected days in SFY 2016 and the appropriation amount.

local governments:

Inasmuch as swing beds are variable, it is not possible to determine the cost or savings to local hospital and swing bed facilities.

small businesses:

Medicaid nursing facility providers will realize 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. Inasmuch as patient days are variable, it is not possible to determine the increased cost that will be realized by these facilities. ICFs/ID will realize an increased cost based upon the increase in the assessment rate. However, with the federal drawdown of funds, they will receive higher reimbursements. Inasmuch as patient days are variable, it is not possible to determine the increased cost that will be realized by these facilities.

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

Medicaid nursing facility providers will realize 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. Inasmuch as patient days are variable, it is not possible to determine the increased cost that will be realized by these facilities. ICFs/ID will realize an increased cost based upon the increase in the assessment rate. However, with the federal drawdown of funds, they will receive higher reimbursements. Inasmuch as patient days are variable, it is not possible to determine the increased cost that will be realized by these facilities.

Compliance costs for affected persons:

Compliance costs include an increased collection of $2.92 per non-Medicare patient day from each nursing facility and an increase of $0.02 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 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 amendment will affect business due to the increase in costs to non-Medicaid certified facilities. However, ICFs/ID that realize an increase in costs will receive higher Medicaid reimbursements due to the federal drawdown of funds. It is not possible to determine the actual increase for business because the number of patient days are 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
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 cdevashrayee@utah.gov

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:

06/15/2015

This rule may become effective on:

07/01/2015

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 $[15.40]18.32 per non-Medicare patient day provided by the facility, except that intermediate care facilities for people with intellectual disabilities shall be assessed at the uniform rate of $[8.48]8.46 per patient day. Swing bed facilities shall be assessed the uniform rate for nursing facilities. 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, 2014]2015

Notice of Continuation: April 7, 2014

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