Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 5 - Reimbursement › Chapter 200 - Reimbursement Methodology › Section II-20011 - New Facilities, Changes of Ownership of Existing Facilities and Existing Facilities with Disclaimer or Non-Filer Status [Formerly LAC 50:VII.1311]

Current through Register Vol. 50, No. 6, June 20, 2024
A. New facilities
				  are those entities whose beds have not previously been certified to
				  participate, or otherwise participated, in the Medicaid program. New facilities
				  will be reimbursed in accordance with this rule using the statewide average
				  case mix index to adjust the statewide direct care component of the statewide
				  price and the statewide direct care component of the floor. The statewide
				  direct care and care related price shall be apportioned between the per diem
				  direct care component and the per diem care related component using the
				  statewide average of the facility-specific percentages determined in §1305.
				  D.1c. After the second full calendar quarter of operation, the statewide direct
				  care and care related price and the statewide direct care and care related
				  floor shall be adjusted by the facility's case mix index calculated in
				  accordance with §1305. D.1.f-g and §1307 of this rule. The capital rate paid to
				  a new facility will be based upon the age and square footage of the new
				  facility. An interim capital rate shall be paid to a new facility at the
				  statewide average capital rate for all facilities until the start of a calendar
				  quarter two months or more after the facility has submitted sufficient age and
				  square footage documentation to the department. Following receipt of the age
				  and square footage documentation, the new facility's capital rate will be
				  calculated using the facility's actual age and square footage and the statewide
				  occupancy from the most recent base year and will be effective at the start of
				  the first calendar quarter two months or more after receipt. New facilities
				  will receive the statewide average property tax and property insurance rate
				  until the facility has a cost report included in a base year rate setting. New
				  facilities will also receive a provider fee that has been determined by the
				  department.
B. A change of
				  ownership exists if the beds of the new owner have previously been certified to
				  participate, or otherwise participated, in the Medicaid program under the
				  previous owner's provider agreement. Rates paid to facilities that have
				  undergone a change in ownership will be based upon the acuity, costs, capital
				  data and pass-through of the prior owner. Thereafter, the new owner's data will
				  be used to determine the facility's rate following the procedures specified in
				  this rule.
C. Existing facilities
				  with disclaimer status includes any facility that receives a qualified audit
				  opinion or disclaimer on the cost report used for rebase under §1305. B.
				  Facilities with a disclaimed cost report status may have adjustments made to
				  their rates based on an evaluation by the secretary of the
				  department.
D. Existing facilities
				  with non-filer status includes any facility that fails to file a complete cost
				  report in accordance with §1303. These facilities will have their case-mix
				  rates adjusted as follows.
1. The statewide
				  direct care and care related price shall be apportioned between the per diem
				  direct care component and the per diem care related component using percentages
				  that result in the lowest overall rate.
2. No property tax and insurance pass-through
				  reimbursement shall be included in the case-mix rate.
3. The fair rental value rate calculated
				  shall be based on 100 percent occupancy.