Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-6 - REIMBURSEMENT TO PROVIDERS › Section 59G-6.045 - Payment Methodology for Services in Facilities Not Publicly Owned and Not Publicly Operated (Facilities Formerly Known as ICF-MR/DD Facilities)

Current through Reg. 50, No. 138; July 16, 2024
(1) This rule applies to participating
				intermediate care facilities for individuals with intellectual disabilities
				(ICF/IID) not publicly owned and not publicly operated rendering Florida
				Medicaid services to recipients in accordance with Rule 59G 4.170, Florida
				Administrative Code (F.A.C.).
(2)
				Definitions.
(a) Acceptable cost report - A
				completed, accurate and legible cost report that contains all relevant
				schedules, worksheets and supporting documents in accordance with cost
				reporting instructions.
(b) AHCA -
				Agency for Health Care Administration.
(c) Eligibility Factor - The percentage of
				days that a provider is in compliance with all conditions of participation
				during the rate period in effect one year prior to the rate period being
				set.
(d) Filing due date (cost
				report) - No later than five calendar months after the close of the ICF/IID's
				cost reporting year.
(e) Incentive
				- An amount paid to providers whose annual rates of cost increase for operating
				costs or resident care costs from one cost reporting period to the next are
				less than 1.4 times the average cost increase for the applicable period
				documented by the ICF/IID Cost Inflation Index.
(f) Interim cost per diem - A reimbursement
				rate or a portion of an overall reimbursement rate that is calculated from
				budgeted cost data divided by the total resident days.
(g) Medicaid Trend Adjustment (MTA) - The MTA
				is a percentage reduction that is uniformly applied to all Florida Medicaid
				providers each rate period when the rate setting unit cost is greater than the
				legislative unit cost and all quality assessment funds have been
				exhausted.
(h) Operating cost per
				diem - Those costs not directly related to resident care, property costs, or
				Return on Equity (ROE). Operating costs include administrative, plant
				operation, laundry, and housekeeping costs divided by the total resident
				days.
(i) Patient Responsibility -
				The amount a recipient is required to pay the ICF/IID, as determined by the
				Department of Children and Families (DCF), based upon the recipient's monthly
				income.
(j) Property cost per diem
				- A calculation based upon those costs related to the ownership or leasing of
				an ICF/IID. Such costs may include property taxes, insurance, interest and
				depreciation, or rent divided by the total resident days.
(k) Quality Assessment - Pursuant to section
				409.9083, Florida Statutes
				(F.S.), a per-resident-day basis assessment is imposed upon each
				ICF/IID.
(l) Rate setting due date
				- February 1 of each year shall be the rate setting due date. All cost reports
				received by AHCA on or before February 1 shall be used to establish the
				reimbursement rates for the upcoming rate period. If February 1 falls on the
				weekend, the due date shall be the first business day following February
				1.
(m) Reimbursement Class -
				Designated provider reimbursement level for the provision of services to
				recipients residing in an ICF/IID, as follows:
1. Developmental Residential and
				Developmental Institutional - A reimbursement level for recipients who are
				ambulatory or self-mobile using mechanical devices and who can transfer
				themselves without human assistance but may require assistance and oversight to
				ensure safe evacuation.
2.
				Developmental Non-ambulatory and Developmental Medical - A reimbursement level
				for recipients who are capable of mobility only with human assistance or
				require human assistance to transfer to or from a mobility device or require
				continuous medical and nursing supervision.
(n) Resident care cost per diem - Those costs
				directly attributed to nursing services, dietary costs, and other costs
				directly related to resident care such as activity costs, social services, and
				all medically-ordered therapies divided by the total resident days.
(o) Return on Equity (ROE) or use allowance
				cost per diem - Net Income or Profits or Shareholder's Equity divided by the
				total resident days.
(p) Target
				Rate Factor - 1.4 times the simple average of the monthly Florida ICF/IID Cost
				Inflation Indices associated with the most recent cost reporting period divided
				by the simple average of the monthly indices associated with the prior cost
				reporting period.