Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.18-020 - Private Duty Nursing (PDN) Rate Calculation SPA #2018-015

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 4.19-B
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES
				OTHER TYPES OF CARE
8. Private
			 Duty Nursing to enhance the effectiveness of treatment for ventilator-dependent
			 beneficiaries, high technology non-ventilator beneficiaries or tracheotomy
			 beneficiaries
Reimbursement is based on the lesser of the amount billed or
				the maximum Title XIX (Medicaid) charge allowed. The State is under a U. S.
				District Court order that sets out the process for rates to be determined. That
				process includes evaluation of rates based upon market forces as they impact on
				access. Payment of the resultant rates is ordered by the court.
The agency's private duty nursing fee schedule rates were set
				as of July 1, 2015 and are effective for fee schedule services on or after that
				date. All fee schedule rates are published on the agency's website
				(https://medicaid.mmis.arkansas.gov/Provider/Docs/fees.aspx). Except as noted
				in the plan, state developed fee schedule rates are calculated using the same
				method for both governmental and private providers of private duty nursing
				services.
Effective for dates of service on or after October 1, 1994,
				reimbursement for private duty nursing medical supplies is based on 100% of the
				Medicare maximum for medical supplies reflected in the 1993 Arkansas Medicare
				Pricing File not to exceed the Title XDC coverage limitations as specified in
				Attachment 3.1 -A, page 3d, and Attachment 3.1-B, page 4a.
Effective for dates of service on or after July 1, 2015
through December 31, 2018,
RN and LPN hourly reimbursement rate
				maximums are set based on market analysis of salaries, fringe benefits and
				administrative/overhead costs. Market analysis included the following
				steps:
* Acquired 2013 wage rates from the Federal Bureau of Labor
				Statistics for Arkansas,
* Determining employee benefit costs by using Skilled Nursing
				Facility cost reports submitted as of July 1,2014,
* Assessing overhead costs by calculating the percent of direct
				to indirect costs reported in the most recent audited Medicare Home Health cost
				reports by the top 70% of Medicaid reimbursed non-hospital home health
				providers during SFY 2007, and
* It was estimated that a private duty nurse will travel
				approximately 8 miles each hour.
Effective for dates of service on or after January 1,
				2019, RN and LPN hourly reimbursement rate maximums are set based on market
				analysis of salaries, fringe benefits and administrative/overhead costs. Market
				analysis included the following steps:
*
Wage rates from the Federal Bureau of Labor Statistics
				for Arkansas do not exceed two calendar years from the establishment of the
				hourly reimbursement rates,
*
Determining employee benefit costs by using Skilled
				Nursing Facility cost reports submitted as of July
				1st of the State Fiscal Year that precedes the
				effective date of the rates,
*
Overhead costs percentage was calculated using Skilled
				Nursing Facility cost reports submitted as of July
				1stof the State Fiscal Year that precedes the
				effective date of the rates, and
*
It was estimated that a private duty nurse will travel
				approximately 8 miles each hour.
The fee schedule will be published on the agency's
				website as referenced above.