Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › RULES OF PRACTICE › Article 4 - COST RELATED REIMBURSEMENT SYSTEM › Cost Related Reimbursement System for Long-Term Care Facilities › Section 17-311-61a - Rate adjustments for charges in excess of reasonable and necessary costs for other allowable services

Current through July 10, 2024
Pursuant to Section 17-314(c):
(a) No facility shall accept payment for
					 other allowable services, as defined in Section
					 17-311-60a, provided
					 by the facility in excess of the rate set by the Commissioner of the Department
					 of Income Maintenance pursuant to paragraph (c) below.
(b) Any facility which accepts payment over
					 the reasonable and necessary costs as determined in accordance with subsection
					 (c) below for other allowable services from any state, as defined in Section
					 17-311-60a, shall be
					 subject to recovery actions as defined in Connecticut General Statutes 17-314
					 (d) and subsection (d) below.
(c)
					 Reasonable and necessary costs per patient day for other allowable services,
					 which services are defined in Section
					 17-311-60a, shall be
					 calculated by multiplying the statewide average costs for other allowable
					 services for Connecticut Medicaid patients for the cost year October 1 through
					 September 30 preceding the rate year by the implicit price deflator for the
					 gross national product for the current cost year divided by the implicit price
					 deflator for the gross national product for the prior cost year and dividing by
					 the number of Connecticut Medicaid patient days. The Commissioner shall notify
					 the facility of the reasonable and necessary costs, per patient day, for other
					 allowable services annually effective July 1.
(d) Any amount received for other allowable
					 services in excess of the reasonable and necessary costs of the other allowable
					 services provided by the facility shall be deducted from the allowable costs of
					 the facility for routine care, as defined in Section
					 17-311-50
et seq.,
of the Regulations of Connecticut State Agencies, as
					 follows:
From the facility's out-of-state Medicaid rates shall be
						deducted the facility's Connecticut Medicaid per diem rate and the statewide
						average cost per patient day for other allowable services as determined
						pursuant to subsection (c) above. The result of the computation shall be
						multiplied by the out-of-state patient days and the product derived therefrom
						shall be deducted from the facility's allowable costs as defined in Section
						17-311-50
et seq.,
of the Regulations of Connecticut State
						Agencies.
(e) The facility
					 shall provide the Department with the following information annually with the
					 Annual Report of Long-Term Care Facility:
(1)
					 The out-of-state Medicaid rate(s) applicable to the cost period and the
					 corresponding out-of-state Medicaid patient days by month; and
(2) The Connecticut Medicaid rate(s)
					 applicable to the cost period and the corresponding Connecticut Medicaid
					 patient days by month.