reglab/statecodes huggingface dataset:
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 12 - Rate-Setting Criteria for Nonstate-Owned Intermediate Care Facilities for the Mentally Retarded and Community Residential Facilities for the Developmentally Disabled › Section 12-12 - Allowable costs; capital return factor

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 12.
(a)
				Providers, other than extensive support needs residences for adults, shall be
				reimbursed for the use of facilities and equipment, regardless of whether they
				are owned or leased, by means of a capital return factor. The capital return
				factor shall be composed of a use fee to cover the use of facilities, land and
				equipment, and a return on equity. Such reimbursement shall be in lieu of the
				costs of all depreciation, interest, lease, rent, or other consideration paid
				for the use of property. This includes all central office facilities and
				equipment whose patient or resident care-related depreciation, interest, or
				lease expense is allocated to the facility.
(b) The capital return factor portion of the
				established rate during rebasing years is the sum of the allowed use fee,
				return on equity, and rent payments.
(c) Allowable patient or resident
				care-related rent, lease payments, and fair rental value of property used
				through contractual arrangement shall be subjected to limitations of the
				capital return factor as described in this section.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 12 - Rate-Setting Criteria for Nonstate-Owned Intermediate Care Facilities for the Mentally Retarded and Community Residential Facilities for the Developmentally Disabled › Section 12-13 - Allowable costs; capital return factor; computation of use fee component; interest; allocation of loan to facilities and parties

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 13.
(a) The use
				fee limitation is based on the following:
(1)
				The assumption that facilities and equipment are prudently acquired and
				financed.
(2) Providers will obtain
				independent financing in accordance with a sound financial plan.
(3) Owner capital will be used for the
				balance of capital requirements.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 12 - Rate-Setting Criteria for Nonstate-Owned Intermediate Care Facilities for the Mentally Retarded and Community Residential Facilities for the Developmentally Disabled › Section 12-14 - Allowable costs; capital return factor; computation of return on equity component

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 14.
(a) For a
				provider with an initial interim rate resulting from:
(1) a change of provider status; or
(2) a new operation;
before the effective date of this rule, the return on equity
				  shall be computed on the higher of twenty percent (20%) of the allowable
				  historical cost of facilities and equipment or actual equity in allowable
				  facilities and equipment up to sixty percent (60%) of allowable historical cost
				  of facilities and equipment. Allowable historical cost of facilities and
				  equipment is the lesser of the provider's actual historical costs of facilities
				  and equipment, or the maximum allowable property basis at the time of the
				  acquisition plus one-half (½) of the difference between that amount and
				  the maximum allowable property basis per bed on the rate effective date.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 12 - Rate-Setting Criteria for Nonstate-Owned Intermediate Care Facilities for the Mentally Retarded and Community Residential Facilities for the Developmentally Disabled › Section 12-15 - Allowable costs; capital return factor; use fee; depreciable life; property basis

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 15.
(a) The
				following is a schedule of allowable use fee lives by property category:
Property Basis
Use Fee Life
Land
20 years
Land improvements
20 years
Buildings and building components
20 years
Building improvements
20 years
Movable equipment
7 years
Vehicles
7 years
The maximum property basis per bed at the time of
				  acquisition, for all providers, except for providers of extensive support needs
				  residences for adults, shall be in accordance with the following
				  schedule:
Acquisition Date
Maximum Property Basis Per Bed
7/1/76
$12,650
4/1/77
$13,255
10/1/77
$13,695
4/1/78
$14,080
10/1/78
$14,630
4/1/79
$15,290
10/1/79
$16,115
4/1/80
$16,610
10/1/80
$17,490
4/1/81
$18,370
10/1/81
$19,140
4/1/82
$19,690
9/1/82
$20,000
3/1/83
$20,100
9/1/83
$20,600
3/1/84
$20,600
9/1/84
$21,200
3/1/85
$21,200
9/1/85
$21,200
3/1/86
$21,400
9/1/86
$21,500
3/1/87
$21,900
9/1/87
$22,400
3/1/88
$22,600
9/1/88
$23,000
3/1/89
$23,100
9/1/89
$23,300
3/1/90
$23,600
9/1/90
$23,900
3/1/91
$24,500
9/1/91
$24,700
3/1/92
$24,900
9/1/92
$25,300
3/1/93
$25,400
9/1/93
$25,700
The schedule shall be updated semiannually effective on March
				  1 and September 1 by the office and rounded to the nearest one hundred dollars
				  ($100) based on the change in the R.S. Means Construction Index.
(b) The capital return factor
				portion of a rate, for all providers, except for providers of extensive support
				needs residences for adults, that becomes effective after the acquisition date
				of an asset shall be limited to the maximum capital return factor, which shall
				be calculated as follows:
(1) The use fee
				portion of the maximum capital return factor is calculated based on the
				following:
(A) The maximum property basis per
				bed at the time of acquisition of each bed, plus one-half (1/2) of the
				difference between that amount and the maximum property basis per bed at the
				rate effective date.
(B) The term
				is determined per bed at the time of acquisition of each bed and is twenty (20)
				years for beds acquired on or after April 1, 1983, and twelve (12) years for
				beds acquired before April 1, 1983.
(C) The allowable interest rate is the United
				States Treasury bond, ten (10) year amortization, constant maturity rate plus
				three percent (3%), rounded to the nearest one-half percent (0.5%) plus one and
				one-half percent (1.5%) at the earlier of the acquisition date of the beds or
				the commitment date of the attendant permanent financing.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 12 - Rate-Setting Criteria for Nonstate-Owned Intermediate Care Facilities for the Mentally Retarded and Community Residential Facilities for the Developmentally Disabled › Section 12-16 - Capital return factor; basis; historical cost; mandatory record keeping; valuation

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 16.
(a) The
				basis used in computing the capital return factor and the average historical
				cost of property of the median bed shall be the historical cost of all assets
				used to deliver patient or resident-related services, provided they are:
(1) in use;
(2) identifiable to patient or resident
				care;
(3) available for physical
				inspection; and
(4) recorded in
				provider records.
If an asset does not meet all of the requirements prescribed
				  in this section, the cost and any associated property financing or financings
				  or capital lease or leases shall not be included in computing the capital
				  return factor or the average historical cost of property of the median
				  bed.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 12 - Rate-Setting Criteria for Nonstate-Owned Intermediate Care Facilities for the Mentally Retarded and Community Residential Facilities for the Developmentally Disabled › Section 12-17 - Capital return factor; basis; sale or capital lease of facility; valuation; sale or lease among family members

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 17.
(a) If a
				facility is sold or leased within eight (8) years of the seller's or lessor's
				acquisition date and this transaction is recognized as a change of provider
				status, the buyer's or lessee's property basis in facilities and equipment
				shall be the seller's or lessor's historical cost basis plus one percent (1%)
				of the difference between the purchase price, or appraised value if lower, and
				the seller's or lessor's historical cost basis, for each month the seller or
				lessor has owned or leased the property.
(b) Leases shall be subject to the following
				purchase equivalency test based on the maximum capital return factor. The
				provider shall supply sufficient information to the office so as to determine
				the terms and conditions of a purchase that would be equivalent to the lease
				agreement. Such information shall include the following:
(1) Property basis and fair market value on
				the initial lease effective date.
(2) Inception date of the initial agreement
				between lessee and lessor.
(3)
				Imputed or stated interest rate.
(4) Duration of payments.
(5) Renewal options.
Such purchase equivalency terms and conditions shall be
				  utilized to calculate the capital return factor as if it were a purchase. The
				  provisions of section 15(c) through 15(d) of this rule shall apply. The lease
				  payments determined under this section shall be subject to the limitations
				  under section 15(b) of this rule.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 12 - Rate-Setting Criteria for Nonstate-Owned Intermediate Care Facilities for the Mentally Retarded and Community Residential Facilities for the Developmentally Disabled › Section 12-18 - Unallowable costs; cost adjustments; charity and courtesy allowances; discounts; rebates; refunds of expenses

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 18.
(a) Charity,
				courtesy allowances, discounts, refunds, rebates, and other similar items
				granted by a provider shall not be included in allowable costs. Bad debts
				incurred by a provider shall not be an allowable cost.
(b) Payments that must be reported on the
				annual or historical financial report form that are received by a provider, an
				owner, or other official of a provider in any form from a vendor shall be
				considered a reduction of the provider's costs for the goods or services from
				that vendor.
(c) The cost of goods
				or services sold to nonpatients or nonresidents shall be offset against the
				total cost of such service to determine the allowable patient or resident
				related expenses. If the provider has not determined the cost of such items,
				the revenue generated from such sales shall be used to offset the total cost of
				such services.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 12 - Rate-Setting Criteria for Nonstate-Owned Intermediate Care Facilities for the Mentally Retarded and Community Residential Facilities for the Developmentally Disabled › Section 12-19 - Allowable costs; wages; costs of employment; record keeping; owner or related party compensation

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 19.
(a)
				Reasonable compensation of individuals employed by a provider is an allowable
				cost, provided the:
(1) employees are engaged
				in patient or resident care-related functions; and
(2) compensation amounts are reasonable and
				allowable under this section and sections 20 through 22 of this rule.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 12 - Rate-Setting Criteria for Nonstate-Owned Intermediate Care Facilities for the Mentally Retarded and Community Residential Facilities for the Developmentally Disabled › Section 12-20.5 - Extensive support needs residences for adults; fair rental value allowance

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 20.5.
Providers of extensive support needs residences for adults
				  shall be reimbursed for the use of facilities and equipment, regardless of
				  whether they are owned or leased, by means of a fair rental value allowance.
				  The fair rental value allowance shall be in lieu of the costs of all
				  depreciation, interest, lease, rent, or other consideration paid for the use of
				  property. This includes all central office facilities and equipment whose
				  patient care-related depreciation, interest, or lease expense is allocated to
				  the facility. The fair rental value allowance shall be calculated as
				  follows:
(1) The fair rental value
				allowance for extensive support needs residences for adults is calculated
				during rebasing years and base rate reviews by determining, on a per bed basis,
				the historical cost of allowable patient-related property for facilities that
				are not acquired through an operating lease arrangement, including the
				following:
(A) Land.
(B) Building.
(C) Improvements.
(D) Vehicles.
(E) Equipment.
The original historical cost of allowable resident related
				  land, buildings, and improvements as of the provider's date of initial Medicaid
				  certification shall be adjusted for changes in valuation by inflating the
				  reported allowable patient-related historical cost of property from the date of
				  facility acquisition to the present based on the change in the R. S. Means
				  Construction Index.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 12 - Rate-Setting Criteria for Nonstate-Owned Intermediate Care Facilities for the Mentally Retarded and Community Residential Facilities for the Developmentally Disabled › Section 12-21 - Nonstate-operated intermediate care facilities for the mentally retarded; allowable costs; compensation; per diem rate

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 21.
(a) The
				procedures described in this section are applicable to ICFs/IID with nine (9)
				or more beds only, notwithstanding the application of standards and procedures
				set forth in sections 1 through 20 of this rule.
(b) The per diem rate for ICFs/IID is an
				all-inclusive rate. The per diem rate includes all services provided to
				patients by the facility.
(c) Costs
				related to staffing are limited to seven (7) hours worked per patient
				day.
(d) An ICF/IID licensed as a
				CRMNF will be paid at a rate of seven hundred three dollars and ten cents
				($703.10) per resident day. This per diem rate is available only upon
				certification as a Medicaid ICF/IID and licensure by DDRS. ICFs/IID licensed as
				CRMNFs are not subject to other rate adjustments identified in this rule and
				will not receive a base rate nor be subject to the base rate reporting
				requirements set forth in section 5 of this rule.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 12 - Rate-Setting Criteria for Nonstate-Owned Intermediate Care Facilities for the Mentally Retarded and Community Residential Facilities for the Developmentally Disabled › Section 12-22 - Community residential facilities for the developmentally disabled; allowable costs; compensation; per diem rate

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 22.
(a)
				Notwithstanding the application of standards and procedures set forth in
				sections 1 through 20.5 of this rule, the procedures described in this section
				apply to ICFs/IID with eight (8) or fewer beds (CRFs/DD), except for ICFs/IID
				licensed as:
(1) small behavior management
				residences for children for which the procedures described in this section
				apply to facilities with six (6) or fewer beds;
(2) small extensive medical needs residences
				for adults for which the procedures described in this section apply to
				facilities with four (4) beds; and
(3) extensive support needs residences for
				adults for which the procedures described in this section apply to facilities
				with four (4) beds.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 12 - Rate-Setting Criteria for Nonstate-Owned Intermediate Care Facilities for the Mentally Retarded and Community Residential Facilities for the Developmentally Disabled › Section 12-23 - Medical or nonmedical supplies and equipment; personal care items

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 23.
(a) Routine
				medical and nonmedical supplies and equipment are included in the provider's
				approved per diem rate, and the provider shall not bill Medicaid for such items
				in addition to the established rate. Under no circumstances shall the routine
				medical and nonmedical supplies and equipment be billed through a pharmacy or
				other provider. Routine supplies and equipment include those items routinely
				required for the care of residents. Nonroutine medical supplies and equipment
				are those items for which the need must be demonstrated by the resident's
				particular condition and identifiable to that resident. The medical records of
				each resident must indicate, by specific written physician's orders, the order
				for the service or supply furnished and the dispensing of the service or supply
				to the resident.
(b) Personal care
				or comfort items include the following:
(1)
				Hairbrushes and combs.
(2) Dental
				adhesives and caps.
(3)
				Toothpaste.
(4) Shower
				caps.
(5) Nail files.
(6) Lemon glycerine swabs.
(7) Mouthwashes.
(8) Toothbrushes.
(9) Deodorants.
(10) Shampoos.
(11) Disposable tissues.
(12) Razor.
(13) Any other items or equipment covered by
				Medicaid and specifically requested by a resident and not routinely provided by
				the provider.
These items may be included in the approved room charge.
				  Under no circumstances shall items included as personal care or comfort be
				  billed through a pharmacy or other provider to Medicaid.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 12 - Rate-Setting Criteria for Nonstate-Owned Intermediate Care Facilities for the Mentally Retarded and Community Residential Facilities for the Developmentally Disabled › Section 12-24 - Assessment methodology

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15-32-11
Sec. 24.
(a) CRF/DD
				and ICF/IID facilities that are not operated by the state will be assessed an
				amount that is based on total annual facility revenue. In determining total
				annual revenue when the financial report period is other than three hundred
				sixty-five (365) days, the total revenue shall be annualized based on the
				number of days in the reporting period. The assessment percentage applied to
				total annual revenue shall be six percent (6%). In no eve
				405 IAC 1-12-20 nt shall the
				assessment percentage exceed the percentage determined to be eligible for
				federal financial participation under federal law.
(b) The assessment on provider total annual
				revenue authorized by IC
				12-15-32-11 shall be an allowable
				cost for cost reporting and audit purposes. Total annual revenue is determined
				as follows:
(1) For an annual rate review,
				from the provider's previous annual financial reporting period as set out in
				section 4(a) of this rule.
(2) For
				a base rate review, from the provider's previous base financial reporting
				period as set out in section 5(c) of this rule.
(3) For an initial interim rate review for a
				new provider that is not the result of a change of ownership, the fiftieth
				percentile provider's assessment for a like level of care shall be used as
				determined in section 5(a) of this rule. The fiftieth percentile provider's
				assessment is divided by their resident days to determine the assessment per
				resident day amount. The assessment per resident day amount is then multiplied
				by the annualized bed days available to determine the new provider's annualized
				assessment.
Providers will submit data to calculate the amount of
				  provider assessment with their annual and base rate reviews as set out in
				  sections 4(a) and 5(c) of this rule, using forms or in a format prescribed by
				  the office. These forms are subject to audit by the office or its
				  designee.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 12 - Rate-Setting Criteria for Nonstate-Owned Intermediate Care Facilities for the Mentally Retarded and Community Residential Facilities for the Developmentally Disabled › Section 12-25 - Reimbursement for day services

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 25.
For ICF/IID and CRF/DD facilities, the all-inclusive per
				  diem rate shall include reimbursement for all day habilitation services. Costs
				  associated with day habilitation services shall be reported to the office on
				  the annual or historical financial report form using forms prescribed by the
				  office. Allowable day habilitation costs shall be included in determining a
				  provider's allowable costs for rate setting purposes in accordance with all
				  sections of this rule.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 12 - Rate-Setting Criteria for Nonstate-Owned Intermediate Care Facilities for the Mentally Retarded and Community Residential Facilities for the Developmentally Disabled › Section 12-27 - Rate reduction (Voided)

Current through July 10, 2024
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 13 - Disproportionate Share Hospital Payments › Section 13-1 - Eligibility

Current through July 10, 2024
Authority: IC
				  12-15-21-1; IC
				  12-15-21-3
Affected: IC
				  12-15-6
Sec. 1.
(a)
				Eligibility for basic and enhanced disproportionate share hospital payments for
				hospital providers that are not owned or operated by the state will be
				determined using a provider's Medicaid inpatient utilization rate and low
				income utilization rate based on utilization and revenue data from the cost
				reporting period used to determine that provider's eligibility for
				disproportionate share payments as of July 1, 1992.
(b) Hospital providers that are owned or
				operated by the state are eligible for disproportionate share hospital payments
				for a fiscal year if:
(1) for any portion of
				that fiscal year, the provider meets CMS's conditions of participation for the
				Medicare program;
(2) for any
				portion of that fiscal year, the provider is eligible for Medicaid
				payments;
(3) the hospital's low
				income utilization rate for that fiscal year exceeds twenty-five percent (25%);
				and
(4) the hospital's Medicaid
				utilization rate exceeds one percent (1%).
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 13 - Disproportionate Share Hospital Payments › Section 13-2 - Basic disproportionate share payments

Current through July 10, 2024
Authority: IC
				  12-15-21-1; IC
				  12-15-21-3
Affected: IC
				  12-15-6
Sec. 2.
(a) For
				purposes of determining the proportional distribution to be made from the
				disproportionate share pool for basic disproportionate share payments to
				hospital providers eligible under section 1(a) of this rule, the provider's
				utilization and revenue data shall be for the same cost reporting period as in
				section 1(a) of this rule.
(b)
				Basic disproportionate share distributions from the disproportionate share pool
				to hospital providers eligible under section 1(b) of this rule shall be based
				on the hospital's costs during the fiscal year for services furnished to
				individuals who are either of the following:
(1) Eligible for Medicaid under the state
				plan.
(2) Have no health insurance
				or other source of third party coverage for services provided during the fiscal
				year and whose personal resources are inadequate to cover the cost of the
				services furnished. For purposes of this subdivision, payments made to a
				hospital for services provided to indigent patients made by the state or a unit
				of local government within the state shall not be considered a source of third
				party payment.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 14.2 - Rate-Setting Criteria for Nursing Facilities (Voided)

Current through July 10, 2024
Voided by P.L. 130-1998, SECTION 3, retroactively effective
				  July 1, 1997.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 14.6 - Rate-Setting Criteria for Nursing Facilities › Section 14.6-1 - Policy; scope

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  6-8.1-10-1; IC
				  12-13-7-3; IC
				  12-15-13-4; IC
				  24-4.6-1-101
Sec. 1.
(a) This rule
				sets forth payment procedures for services rendered to members who are not in
				managed care and covered by the Indiana health coverage program (IHCP) by
				nursing facilities. All payments referred to within this rule are contingent
				upon the following:
(1) Proper and current
				certification.
(2) Compliance with
				applicable state and federal statutes and regulations.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 14.6 - Rate-Setting Criteria for Nursing Facilities › Section 14.6-2 - Definitions

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 2.
(a) The
				definitions in this section apply throughout this rule.
(b) "Administrative component" means the
				portion of the Medicaid rate that shall reimburse providers for allowable
				administrative services and supplies, including prorated employee benefits
				based on salaries and wages. Administrative services and supplies include the
				following:
(1) Administrator and
				co-administrators, owners' compensation (including director's fees) for
				patient-related services.
(2)
				Services and supplies of a home office that are:
(A) allowable and patient-related;
				and
(B) appropriately allocated to
				the nursing facility.
(3) Office and clerical staff.
(4) Legal and accounting fees.
(5) Advertising.
(6) All staff travel and mileage.
(7) Telephone and Internet.
(8) License dues and subscriptions.
(9) All office supplies used for any purpose,
				including repairs and maintenance charges and service agreements for copiers
				and other office equipment.
(10)
				Working capital interest.
(11)
				State gross receipts taxes.
(12)
				Utilization review costs.
(13)
				Liability insurance.
(14)
				Management and other consultant fees.
(15) Qualified intellectual disability
				professional.
(16) Educational
				seminars for administrative staff.
(17) Support and trouble-shooting,
				maintenance, and license fees for all general and administrative computer
				software and hardware such as accounting or other data processing
				activities.
(18) Court appointed
				guardian, financial institution, or third party trust costs not covered by
				resident personal funds.
(19)
				Preemployment related costs such as background checks, drug testing, and
				employment contingent physicals.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 14.6 - Rate-Setting Criteria for Nursing Facilities › Section 14.6-3 - Accounting records; retention schedule; audit trail; accrual basis; segregation of accounts by nature of business and by location

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 3.
(a) The basis
				of accounting under this rule is a comprehensive basis of accounting other than
				GAAP. All cost and charges reported on the provider's cost report must also be
				recorded on the provider's financial statements. Costs and charges must be
				reported on the cost report in accordance with the following authorities, in
				the hierarchal order listed:
(1) Costs must be
				reported in accordance with the specific provisions as set forth in this rule,
				any financial report instructions, provider bulletins, and any other policy
				communications.
(2) Costs must be
				reported in conformance with cost finding principles published in the Medicare
				Provider Reimbursement Manual, CMS 15-1.
(3) Costs must be reported in conformance
				with GAAP.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 14.6 - Rate-Setting Criteria for Nursing Facilities › Section 14.6-4 - Financial report to office; annual schedule; prescribed form; extensions; penalty for untimely filing

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 4.
(a) Each
				provider shall submit an annual financial report to the office not later than
				the last day of the fifth calendar month after the close of the provider's
				reporting year. The annual financial report shall coincide with the fiscal year
				used by the provider to report federal income taxes for the operation unless
				the provider requests in writing that a different reporting period be used.
				Such a request shall be submitted within sixty (60) days after the initial
				enrollment of a provider. This option:
(1) may
				be exercised only one (1) time by a provider; and
(2) must coincide with the fiscal year end
				for Medicare cost reporting purposes.
If a reporting period other than the tax year is established,
				  audit trails between the periods are required, including reconciliation
				  statements between the provider's records and the annual financial report.
				  Nursing facilities that are certified to provide Medicare-covered skilled
				  nursing facility services are required to submit a written copy of their
				  Medicare cost report that covers their most recently completed historical
				  reporting period.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 14.6 - Rate-Setting Criteria for Nursing Facilities › Section 14.6-5 - New provider; initial financial report to office; criteria for establishing initial interim rates

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 5.
(a) Rate
				requests to establish an initial interim rate for a new operation shall be
				filed by submitting an initial rate request to the office on or before thirty
				(30) days after notification of the enrollment date. Initial interim rates will
				be set at the sum of the average allowable cost of the median patient day for
				the direct care, therapy, indirect care, administrative, and eighty percent
				(80%) of the capital component. Before the provider's first annual rate review,
				the direct care component of the Medicaid initial interim rate will be adjusted
				retroactively to reflect changes, occurring in the first and second calendar
				quarters of operation, in the provider's CMI for Medicaid residents and
				adjusted prospectively after the second calendar quarter to reflect changes in
				the provider's CMI for Medicaid residents. Initial interim rates shall be
				effective on the:
(1) enrollment date;
				or
(2) date that a service is
				established;
whichever is later. In determining the initial rate,
				  limitations and restrictions otherwise outlined in this rule shall
				  apply.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 14.6 - Rate-Setting Criteria for Nursing Facilities › Section 14.6-6 - Active providers; rate review

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 6.
(a) While
				performing a provider's annual rate review the office shall determine the
				following for each provider:
(1) normalized
				average allowable cost of the median patient day for the direct care component
				as of the July 1st that falls after the first calendar quarter following the
				provider's reporting year-end; and
(2) average allowable cost of the median
				patient day for the indirect, administrative, and capital components as of the
				July 1st that falls after the first calendar quarter following the provider's
				reporting year-end.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 14.6 - Rate-Setting Criteria for Nursing Facilities › Section 14.6-8 - Limitations or qualifications to Medicaid reimbursement; advertising; vehicle basis

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 8.
(a)
				Advertising is not an allowable cost under this rule except for those
				advertising costs incurred in the recruitment of facility personnel necessary
				for compliance with facility certification requirements. Advertising costs are
				not allowable in connection with public relations or fundraising or to
				encourage patient utilization.
(b)
				Each facility and home office shall be allowed only one (1) patient
				care-related automobile to be included in the vehicle basis for purposes of
				computing the average historical cost of property of the median bed. As used in
				this subsection, "vehicle basis" means the purchase price of the vehicle used
				for facility or home office operation. If a portion of the use of the vehicle
				is for personal purposes or for purposes other than operation of the facility
				or home office, then such portion of the cost must not be included in the
				vehicle basis. The facility and home office are responsible for maintaining
				records to substantiate operational and personal use for one (1) allowable
				automobile. This limitation does not apply to vehicles with a gross vehicle
				weight of more than six thousand (6,000) pounds.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 14.6 - Rate-Setting Criteria for Nursing Facilities › Section 14.6-9 - Rate components; rate limitations; profit add-on

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC
				  12-15-13-6
Sec. 9.
(a) The
				Medicaid reimbursement system is based on recognition of the provider's
				allowable costs for the direct care, therapy, indirect care, administrative,
				and capital components, plus a potential profit add-on payment as defined
				below. The direct care, therapy, indirect care, administrative, and capital
				rate components are calculated as follows:
(1)
				The direct care component is equal to the provider's normalized allowable per
				patient day direct care costs times the facility-average CMI for Medicaid
				residents, plus the allowed profit add-on payment as determined by the
				methodology in subsection (b).
(2)
				The therapy component is equal to the provider's allowable Medicaid per patient
				day direct therapy costs.
(3) The
				indirect care and capital components are equal to the provider's allowable per
				patient day costs for each component, plus the allowed profit add-on payment as
				determined by the methodology in subsection (b).
(4) The administrative component shall be
				equal to one hundred percent (100%) of the average allowable cost of the median
				patient day.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 14.6 - Rate-Setting Criteria for Nursing Facilities › Section 14.6-10 - Computation of rate; allowable costs; review of cost reasonableness

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 10.
(a) Costs
				and revenues, excluding non-Medicaid routine revenue, shall be reported as
				required on the financial report forms. Allowable patient care costs shall be
				clearly identified.
(b) The
				provider shall report as patient care costs only costs that have been incurred
				in the providing of patient care services. The provider shall certify on all
				financial reports that costs not related to patient care have been separately
				identified on the financial report.
(c) In determining reasonableness of costs,
				the office may compare line items, cost centers, or total costs of providers
				throughout the state. The office may request satisfactory documentation from
				providers whose costs do not appear to be accurate or allowable.
(d) Indiana state taxes, including local
				taxes, shall be considered an allowable cost. Personal or federal income taxes
				are not considered allowable costs.
(e) The following costs are not considered
				allowable costs and shall not be included in the established rate:
(1) All over-the-counter, legend, and
				nonlegend drugs.
(2) Cost of
				replacement hearing aids and eyeglasses.
(3) All costs associated with pastoral
				care.
(4) All costs associated with
				resident and family gifts, including, but not limited to, flowers, Bibles, and
				memory books.
(5) All costs
				associated with collection fees.
(6) All costs, fees, and dues associated with
				lobbying activities.
(7) All costs
				of acquisitions, such as the purchase of corporate stock as an investment or
				purchases of new facilities.
(8)
				All costs associated with barber and beauty shop activities.
(9) All costs associated with
				marketing.
(10) Travel and
				entertainment costs to research investments or business
				opportunities.
(11) Medicare Part D
				covered drugs or supplies.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 14.6 - Rate-Setting Criteria for Nursing Facilities › Section 14.6-11 - Allowable costs; services provided by parties related to the provider

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 11.
(a) For
				facilities other than nonstate government owned nursing facilities, costs
				applicable to services, facilities, and supplies furnished to the provider by
				organizations related to the provider by common ownership or control must be
				reported in the rate component(s) most descriptive of the related
				organization's cost at the cost to the related organization. However, such cost
				must not exceed the price of comparable services, facilities, or supplies that
				could be purchased as an arm's-length transaction in an open competitive
				market.
(b) For nonstate government
				owned (NSGO) nursing facilities, costs applicable to services, facilities, and
				supplies furnished to the provider by organizations related by common ownership
				or control to either the current NSGO provider, or any former provider or
				related entity that currently serves as the management company or entity in a
				similar decision making capacity for the NSGO provider, must be reported in the
				rate component(s) most descriptive of the related organization's cost at the
				cost to the related organization. However, such cost must not exceed the price
				of comparable services, facilities, or supplies that could be purchased as an
				arm's-length transaction in an open competitive market.
(c) Common ownership exists when an
				individual, individuals, or any legal entity possesses ownership or equity of
				at least five percent (5%) in the provider as well as the institution or
				organization serving the provider. An individual is considered to own the
				interest of immediate family for the determination of percentage of ownership.
				The following persons are considered immediate family:
(1) Husband and wife.
(2) Natural parent, child, and
				sibling.
(3) Adopted child and
				adoptive parent.
(4) Stepparent,
				stepchild, stepsister, and stepbrother.
(5) Father-in-law, mother-in-law,
				sister-in-law, brother-in-law, son-in-law, daughter-in-law, stepson-in-law, and
				stepdaughter-in-law.
(6)
				Grandparent and grandchild.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 14.6 - Rate-Setting Criteria for Nursing Facilities › Section 14.6-12 - Allowable costs; fair rental value allowance

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 12.
(a)
				Providers shall be reimbursed for the use of allowable patient-related
				facilities and equipment, regardless of whether they are owned or leased, by
				means of a fair rental value allowance. The fair rental value allowance shall
				be in lieu of the costs of all depreciation, interest, letter of credit fees,
				lease, rent, amortization expense, deferred loan fees, or other consideration
				paid for the use of property, except that rental costs for low air loss
				mattresses, pressure support surfaces, and oxygen concentrators shall be
				reimbursed in the direct care component. The fair rental value allowance
				includes all central office facilities and equipment whose patient care-related
				depreciation, interest, or lease expense is appropriately allocated to the
				facility.
(b) The fair rental value
				allowance is calculated as follows:
(1)
				Determine, on a per bed basis, the historical cost of allowable patient-related
				property for facilities that are not acquired through an operating lease
				arrangement, including:
(A) land, building,
				improvements, vehicles, and equipment; and
(B) costs;
required to be capitalized in accordance with generally
				  accepted accounting principles. Land, buildings, and improvements shall be
				  adjusted for changes in valuation by inflating the reported allowable
				  patient-related historical cost of property from the later of July 1, 1976, or
				  the date of facility acquisition to the present based on the change in the R.
				  S. Means Construction Index.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 14.6 - Rate-Setting Criteria for Nursing Facilities › Section 14.6-13 - Reporting of financing arrangements; working capital; interest; allocation of loans

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 13.
(a) All
				patient-related property financing arrangements shall be fully and completely
				disclosed on the forms prescribed by the office.
(b) Interest costs on borrowed funds used to
				construct facilities or enlarge existing facilities that are incurred during
				the period of construction shall be capitalized as part of the cost of the
				facility or addition.
(c) Interest
				on working capital loans shall only be recognized if the provider can
				demonstrate that such loans were reasonable and necessary in providing
				patient-related services. Working capital interest must be reduced by
				investment income from any related party. Working capital loans from a related
				party must be identified and reported separately on the annual financial
				report. Interest costs on related party working capital loans shall be
				allowable if they meet all other requirements, the interest does not exceed the
				rate available in the open market, and such loans are repaid at least annually
				for a minimum of thirty (30) days. Failure to document the existence of, or
				adhere to such repayment schedule, shall result in the related party working
				capital interest costs being disallowed.
(d) Loans covering more than one (1) facility
				or asset shall apply to the several facilities or assets acquired in proportion
				to the cost that each item bears to the total cost.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 1 - MEDICAID PROVIDERS AND SERVICES › Rule 14.6 - Rate-Setting Criteria for Nursing Facilities › Section 14.6-14 - Property; basis; historical cost; mandatory record keeping; valuation

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 14.
(a) The
				basis used in computing the average historical cost of property of the median
				bed shall be the historical cost of all assets used to deliver patient-related
				services that meet the following conditions:
(1) The assets are in use.
(2) The assets are identifiable to patient
				care.
(3) The assets are available
				for physical inspection.
(4) The
				assets are recorded in provider records.
If an asset does not meet all of the requirements prescribed
				  in this section, the cost shall not be included in computing the average
				  historical cost of property of the median bed.