Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.10 - Nursing Facility Services › Section 10.09.10.25 - New Nursing Facilities, Replacement Facilities, and Change of Ownership

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Department
				  shall establish rates for new nursing facilities, replacement facilities, and
				  nursing facilities with a change of ownership as outlined in §§B-D of
				  this regulation.
B. New Nursing
				  Facilities.
(1) Until such time as an
				  appraisal for the new facility is available as set forth in Regulation
				  .11B(1)(b) of this chapter, the fair rental value per diem rate shall be based
				  on the lower of the facility's construction costs plus the assessed land value
				  divided by the number of licensed beds, or the maximum appraised value per bed
				  in Regulation .11B(1)(g) of this chapter.
(2) A new nursing facility shall be assigned
				  the Statewide average Medicaid CMI until assessment data submitted by the
				  nursing facility is used in a quarterly rate determination.
(3) The nursing facility shall be assigned to
				  the appropriate geographic region, as specified under Regulation .30 of this
				  chapter, for purposes of assigning the Nursing Service rate, the Other Patient
				  Care price, and the Administrative and Routine price.
(4) The geographic region price for Nursing
				  Service costs shall be multiplied by the new nursing facility's Medicaid CMI
				  until there is a nursing facility cost report used in the rebasing
				  process.
(5) The fair rental value
				  per diem rate shall use days as the greater of total estimated resident days or
				  days at full occupancy times an occupancy standard calculated under Regulation
				  .09B(4) of this chapter and the maximum bed value identified in Regulation
				  .11B(1)(g) of this chapter. For the period of time the facility is operating
				  under a waiver of occupancy granted in accordance with Regulation .26F of this
				  chapter, the fair rental value per diem rate shall be calculated using
				  estimated resident days. At the completion of the waiver period, either the
				  State or the facility may initiate a settlement payment should the estimate
				  vary from the actual by more than 10 percent.
(6) Upon providing the real estate bills to
				  the State which incorporate the new construction at least 15 days before the
				  start of operations or at least 15 days before the beginning of any calendar
				  quarter, the real estate tax per diem rate shall be calculated in accordance
				  with Regulation .11B(1)(l) of this chapter. This amount shall be used for the
				  period from the time of submission until the next facility cost report is
				  filed. For the period of time the facility is operating under a waiver of
				  occupancy granted in accordance with Regulation .26F of this chapter, the real
				  estate tax per diem rate shall be calculated using estimated resident days. At
				  the completion of the waiver period, either the State or the facility may
				  initiate a settlement payment should the estimate vary from the actual by more
				  than 10 percent.
(7) For the first
				  2 State fiscal rate setting years, or portions thereof, new nursing facilities
				  that are required to pay an assessment in accordance with COMAR
				  10.01.20.02 shall receive a
				  Quality Assessment add-on calculated as follows:
(a) Estimate the assessed days to be reported
				  on the Nursing Facility Quality Assessment Payment Reporting Forms for the
				  quarters covering the upcoming State fiscal rate setting year or portion
				  thereof;
(b) Multiply the estimated
				  assessed days by the assessment rate anticipated for the rate quarters;
				  and
(c) Divide the total estimated
				  assessed amount by the sum of the total estimated patient days. At the
				  completion of either of these first two rate setting periods, either the State
				  or the facility may initiate a settlement payment should the estimates vary
				  from the actual by more than 10 percent.