Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-060 - Inpatient Psychiatric Services for Under Age 21 Update #87 & Arkansas Medicaid State Plan Amendment #2007-006

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 4.19-A
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES
				-INPATIENT HOSPITAL SERVICES
1.
			 Inpatient Hospital Services
Inpatient Psychiatric Services For Individuals
				Under
21
Years of Age
Private and Public Providers Excluding
				Arkansas State Operated Psychiatric Hospitals
Effective for dates of service on or after August 8,
				1991
,
inpatient psychiatric hospitals are reimbursed for services
				provided to individuals under
21
years of
				age using hospital-specific prospective per diem rate
s. P
prospective
per diem
rates are
				established using Medicare
P
rinciples of
R
easonable
C
ost
R
eimbursement
(42 CFR Part 413) to
				determine allowable costs.
The rates for inpatient psychiatric hospitals are calculated
				utilizing the lesser of the hospital=s per diem
allowable
cost
				inflated by the consumer price index for all urban consumers (CPI-U), U. S.
				city average for all items, plus a $69 professional component or the
maximum per diem limit
. The $69 professional component is the
				average of the rates for the individual psychotherapy procedure codes as of
				August 8, 1991. Effective for claims with dates of service on or after February
				1, 1994, the
maximum per diem limit
is established annually at the
				60th percentile of all in-state inpatient
				psychiatric hospitals= inflation adjusted per diem
costs
plus the
				$69 professional component. The calculation of the
maximum per diem
				limit
is rounded up (0.5000 or greater) or down (0.4999 or less) if the
				60th percentile is not a whole number. This is a
				prospective rate with no cost settlement.
Rates are calculated annually and are effective for dates of
				service occurring during the next State Fiscal Year (July
				1st through June 30th).
				Per diem costs and the
maximum per diem limit
are calculated from
				the most recent submitted hospital cost reports with ending dates occurring in
				the previous calendar year. Less than full year cost reports and out-of-state
				provider cost reports will not be included when calculating the
				60th percentile. For hospitals with a cost report
				period of less than a full six months, the new State Fiscal Year per diem rate
				is calculated by inflating the previous State Fiscal Year=s per diem rate by
				the CPI-U. The
maximum per diem limit
will not be adjusted after
				being set should new providers enter the program or late cost reports be
				received.
New providers are required to submit a full year=s annual
				budget for the current State Fiscal Year (July 1st
				  through June 30th) at the time of
				enrollment if no cost report is available. This annual budget is used to set
				their interim rate at the lesser of the budgeted allowable cost per day or the
maximum per diem limit
in effect as of the first day of their
				enrollment. The interim rate for new providers will be retroactively adjusted
				to the allowable per diem cost as calculated from the provider=s first
				submitted cost report for a period of at least a full six months.
Inpatient Psychiatric Hospital Services For
				Individuals Under
21
Years of Age
Residential Treatment Units Within Private
				and Public Providers Excluding Arkansas State Operated Psychiatric
				Hospitals
Effective for dates of service on or after July 1, 1993,
Residential Treatment Units located within an inpatient psychiatric
				hospital will be reimbursed based on reasonable cost with interim per diem
				rates and year-end cost settlements.
. The State will reimburse the
				lesser of audited cost or a maximum
per diem limit
of $316.00 per
				day. Medicare Principles of Reasonable Cost Reimbursement (42 CFR Part 413)
				will be used to determine allowable costs, subject to cost settlement.
Allowable costs will include the professional component costs.
				The professional component cost included in the allowable cost is capped at
				$69.00 per day which is the average of the rates for the individual
				psychotherapy procedure codes as of August 8, 1991.
The initial maximum
per diem limit
of $316.00
				represents the average budgeted cost per day of the in-state freestanding
				residential treatment centers for State Fiscal Year 1994. The State will review
				the maximum
per diem limit
annually (July 1 through June 30). The
				budgeted data for the upcoming State Fiscal Year submitted by the instate
				freestanding residential treatment centers prior to the end of the State Fiscal
				Year will be used to determine the new maximum
per diem limit
for
				each new State Fiscal Year. The new maximum
per diem limit
will be
				effective for dates of service on or after July 1 of the new State Fiscal year.
				For each State Fiscal Year after the initial year, the State will set the
				maximum per diem
limit
at the average budgeted cost per day (mean)
				for instate freestanding residential treatment centers (RTCs). If the average
				budgeted cost per day for the in-state freestanding RTCs changes at all, the
				State will calculate a new
maximum per diem limit
, and the new
limit
will be equal to the average of instate freestanding RTCs.
				The
maximum per diem limit
will not be
adjusted
after
				being set should new Residential Treatment Centers enter the program or late
				budgets be received.
Interim reimbursement rates are implemented at the lesser of
				the per diem cost as calculated from the most recent submitted unaudited cost
				report (including the allowable professional component cost) or the
maximum per diem limit
in effect as of the first day after the
				cost report ending date.
New providers are required to submit a full year=s annual
				budget for the current State Fiscal Year (July 1st
				  through June 30th) at the time of
				enrollment if no cost report is available. This annual budget is used to set
				their interim rate of the lesser of the budgeted allowable cost per day or the
maximum per diem limit
in effect as of the first day of their
				enrollment.
Private and Public Providers Excluding
				Arkansas and State Operated Psychiatric Hospitals
Sexual Offender Programs
Sexual Offender Programs are designed specifically for the
				treatment of those patients designated as sexual offenders who cannot be
				treated with other mental health patients. These services are provided in
				separate units in the psychiatric hospital. These units meet all the
				requirements of Subpart D of 42 CFR Part 441 for inpatient psychiatric services
				for individuals under 21. In addition, they must meet any certification
				requirements of the Division of
Behavioral
Health Services.
Effective for cost reporting periods beginning on or after
				September 1, 1995,
Sexual Offender Program
providers will be
				reimbursed
based on reasonable cost with interim per diem rates and
				year-end cost settlements.
Medicare Principles of Reasonable Cost
				Reimbursement (42 CFR Part 413)
will be used to determine allowable
				costs
, subject to cost settlement. The initial interim rates for these
				programs will use reasonable budgeted cost reports. Once audited cost reports
				are available the most recent audited cost report will be used to set the
				interim rate. Interim rates will be adjusted every six months if costs increase
				more than 10%.
New providers are required to submit a full year=s annual
				budget for the current State Fiscal Year (July 1st
				  through June 30th) at the time of
				enrollment if no cost report is available. This annual budget is used to set
				their interim rate at the lesser of the budgeted allowable cost per day or the
maximum per diem limit
in effect as of the first day of their
				enrollment.
Year end cost reports must be submitted and will be audited in
				the same manner as audits for Residential Treatment Units (RTUs) and will be
				cost settled.
Interim rates and cost settlements are calculated using the
				same methodology as Residential Treatment Units with the same professional
				component cap and the same annual State Fiscal Year
maximum
per
				diem
limit
.
Arkansas State Operated Psychiatric
				Hospitals
Arkansas State Operated Psychiatric Hospitals are
				classified as a separate class group. A hospital is an Arkansas State Operated
				Psychiatric Hospital if it has in effect an agreement to participate in the
				Arkansas Medicaid Program as a psychiatric hospital and is operated by the
				State of Arkansas.
Effective for dates of service occurring on and after
				July 1, 2007, Arkansas State Operated Psychiatric Hospitals are reimbursed
				based on interim per diem rates with year end cost settlements and no per diem
				cost limits. Arkansas Medicaid will use the lesser of cost or charges to
				establish cost settlements. Services to be reimbursed at cost are (1) inpatient
				psychiatric services, (2) residential treatment unit services and (3) sexual
				offender program services.
Cost settlements and interim per diem rates will be
				determined using the same criteria and requirements as are used for Arkansas
				State Operated Teaching Hospitals except GME costs will not be reimbursed
				separately.
Section
			 II
Inpatient Psychiatric Services for Under Age 21
250.120
Arkansas State Operated
			 Psychiatric Hospitals
Effective for dates of service occurring on or after July 1,
				2007, Arkansas State Operated Psychiatric Hospitals are reimbursed based on
				interim per diem rates with year end cost settlements and no per diem cost
				limits. Services to be reimbursed at cost are (1) inpatient psychiatric
				services, (2) residential treatment unit services and (3) sexual offender
				program services.
Arkansas Medicaid will use the lesser of cost or charges to
				establish cost settlements. The interim per diem rates and cost settlements are
				calculated in the same manner as are used for Arkansas State Operated Teaching
				Hospitals, except graduate medical education (GME) costs will not be reimbursed
				separately.