Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.92 - Acute Hospitals › Section 10.09.92.10 - Cost Settlement for Freestanding Acute Rehabilitation Hospitals

Current through Register Vol. 51, No. 14, July 12, 2024
A. Retrospective
				  Cost Reimbursement for Freestanding Acute Rehabilitation Hospitals.
(1) An acute rehabilitation hospital not
				  approved by the Program for reimbursement according to HSCRC rates shall be
				  reimbursed according to Medicare standards and principles for retrospective
				  cost reimbursement described in 42 CFR § 413, or on the basis of charges
				  if less than reasonable cost.
(2)
				  In calculating retrospective cost reimbursement rates, the Department or its
				  designee will deduct from the designated costs or group of costs those
				  restricted contributions which are designated by the donor for paying certain
				  provider operating costs, or groups of costs, or costs of specific groups of
				  participants.
(3) When the cost, or
				  group or groups of costs designated, cover services rendered to all
				  participants, including Medical Assistance participants, operating costs
				  applicable to all participants shall be reduced by the amount of the restricted
				  grants, gifts, or income from endowments, thus resulting in a reduction of
				  allowable costs.
(4) Final
				  settlement for services in the provider's fiscal year shall be determined based
				  on Medicare retrospective cost principles found in 42 CFR § 413, adjusted
				  for Medicaid allowable costs. Allowable costs specific to the Program shall be
				  limited to a base year cost per discharge increased by the applicable federal
				  rate of increase times the number of Program discharges for that fiscal
				  year.
(5) Base Year. For purposes
				  of determining limits on the increase of cost, in accordance with Medicare
				  regulations, the base year shall be:
(a) For
				  an existing provider, the first year of entering into the Program or the first
				  year separate rates for the unit or units of service or services are approved;
				  or
(b) For a new provider, the
				  12-month period immediately before the provider was initially subject to target
				  rate increases.
(6)
				  Initial Interim Rates. In order to establish an initial interim rate, the
				  provider shall submit to the Department or its designee, before the beginning
				  of the first billing period, the following:
(a) A detailed cost build-up, consistent with
				  Medicare principles and cost finding, that supports the requested
				  rate;
(b) A current, projected, and
				  prior year's charge rate schedule;
(c) Finalized prior year's Medicare cost
				  reports and the most current submission;
(d) A detailed revenue schedule;
				  and
(e) Audited financial
				  statements.
(7) The
				  provider shall supply the Department or its designee the assurances necessary
				  to establish that its customary charges to participants liable for payment on a
				  charge basis exceed the allowable cost for these services.
(8) Initial Interim Rates for Newly
				  Established Services or Providers.
(a) The
				  provider shall submit to the Department or its designee, a detailed cost
				  build-up, consistent with Medicare principles and cost finding that supports
				  the requested rate that follows.
(b) The Department will compare the rate with
				  a compatible facility and determine a reasonable rate that does not exceed the
				  projected charges.
(9)
				  Revision of Interim Rates.
(a) The provider
				  may request an interim rate revision if the actual and projected costs exceed
				  the interim rate by 10 percent.
(b)
				  The provider shall furnish the Department or its designee with appropriate
				  documentation showing the reason for the increase and other necessary
				  comparisons.
(c) The Department
				  will lower the provider's interim rate to closely approximate the final
				  allowable reasonable cost based on the results of the prior year's
				  review.
(d) The provider may
				  request no more than one interim rate revision during the provider's fiscal
				  year.
(10) Cost
				  Settlement. The provider shall submit to the Department or its designee:
(a) A Medicaid cost report based on actual
				  data using the cost reporting forms used by Medicare for retrospective cost
				  reimbursement;
(b) A copy of its
				  Maryland Medical Assistance log;
(c) Cost reports that are sufficient in
				  detail to support a separate cost finding for designated Maryland Medical
				  Assistance unique cost centers; and
(d) A finalized Medicare cost report for the
				  cost reporting year.
(11) Final Program costs shall be Maryland
				  Medical Assistance specific.
(12)
				  Tentative cost settlements may not be performed on a routine basis. However,
				  the Program reserves the right to calculate tentative settlements in limited
				  cases, when appropriate, as determined by the Department.
(13) The Department will base final
				  settlement on the results of the finalized Medicare cost reports.