Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.628 - ICF/IID: COSTS EXCLUDED FROM THE CAP

Current through August 31, 2023
Certain costs may be excluded from the ICF/IID cap, may be
				  subject to retrospective settlement at the discretion of the Department, and
				  may result in changes to the prospective rate as provided in this Section to
				  assure equitable reimbursement: (3-17-22)
01.
Increases of More Than One Dollar
				Per Participant Day in Costs
. Increases of more than one dollar ($1) per
				participant day in costs otherwise subject to the cap incurred by a facility as
				a result of changes in State or Federal laws or rules will be reported
				separately on the cost report for reports filed less than thirty (30) months,
				or a greater length of time if so directed by the Department, from the date
				such increases were first required. Such costs will be subdivided into the
				component parts of wages, benefits, contracted services and other costs in the
				amounts equal to costs removed from the respective cost categories subject to
				the cap. The Department may adjust the forecasted rate to include the projected
				per diem related to such costs. (3-17-22)
a.
				The provider will report these costs on a separate schedule or by notations on
				the cost report so that these costs can be identified and reconciled to the
				provider's general ledger. (3-17-22)
b. If more than one (1) increase occurs as a
				result of one (1) or more law or rule change, the costs from each event are to
				be reported separately. (3-17-22)
c. The computation of the cost increase
				amount or amounts is to be presented in detail on a supplementary schedule or
				schedules unless the Department states otherwise. (3-17-22)
d. For interim rate purposes the provider's
				prospective rate may be granted an increase to cover such cost increases. A
				cost statement covering a recent period may be required with the justification
				for the increased costs. The actual amount related to such increases will be
				determined at audit and may be retrospectively settled. (3-17-22)
e. After the initial deadline has passed for
				all providers to file cost reports for reporting periods beginning on or after
				the date certain cost increases were first required, the Department will, at
				it's option, include all of the previously excluded costs related to those
				increases with costs subject to the cap when setting rates or increase the cap
				and individual facility prospective rates following such cost increases. If a
				cap is set with these particular costs included in the cap category, providers
				subject to that cap will not have these costs excluded from the cap for
				prospective rate purposes. The intent of this provision is for costs to be
				exempt from the cap until these costs are able to be fully and equitably
				incorporated in the data base used to project the cap and for these costs to be
				exempt only when they are not included in the data base. In those cases, when
				costs are not incurred immediately after a change in rule or law, delays in
				incorporating the new costs in the cap are warranted. (3-17-22)
f. When cost increases that have been
				excluded from the cap are incorporated in the inflation indices used to set the
				cap, the cost indices will be adjusted to exclude the influence of such changes
				if the amount is included in the index is identified. When the cap is set to
				include previously excluded amounts, any adjustments previously made to the
				indexes related to the previously excluded costs will be removed.
				(3-17-22)