Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 45 - RATES FOR NURSING FACILITY SERVICES › Section 471-45-007 - RATE DETERMINATION

Current through June 17, 2024
The Department determines rates for facilities under the following
	 cost-based prospective methodology.
007.01
RATE PERIODS.
The Rate Periods are defined as July 1 through December 31, and January 1
  through June 30. Rates paid during the rate periods are determined from base
  year cost reports. For purposes of this section, base year cost reports means
  full and part-year cost reports filed with a base year report period ending
  date of June 30.
007.02
REPORT PERIOD.
Each facility must file a cost report
  each year for the reporting period of July 1 through June 30 or part-year cost
  reports, when applicable.
007.03
CARE CLASSIFICATIONS.
A portion of each individual
  facility's rate may be based on the urban or rural location of the
  facility.
007.04
PROSPECTIVE RATES.
Subject to the allowable,
  unallowable, and limitation provisions of this chapter, the Department
  determines facility-specific prospective per diem rates, one rate corresponding
  to each level of care, based on the facility's allowable costs incurred and
  documented during the base year report period. The rates are based on
  financial, acuity, and statistical data submitted by facilities, and are
  subject to the component maximums and minimums. Component maximums and minimums
  are computed using audited data following the initial desk audits and are not
  revised based on subsequent changes to the data. Only cost reports with a full
  year's data are used in the computations. Cost reports from providers entering
  or leaving Medicaid during the immediately preceding report period are not used
  in the computations. Each facility's prospective rates are the sum of the
  following components; the direct nursing component adjusted by the inflation
  factor and weighted for level of care; the support services component adjusted
  by the inflation factor; the fixed cost component; the nursing facility quality
  assessment component; and the quality measures component. The direct nursing
  component and the support services component are subject to maximum and minimum
  per diem payments based on Median or Maximum computations. For each care
  classification, the median for the direct nursing component is computed using
  nursing facilities within that care classification with an average occupancy of
  40 or more residents, excluding waivered, or facilities with partial or initial
  or final full year cost reports. For each care classification, the median for
  the support services component is computed using nursing facilities within that
  care classification with an average occupancy of 40 or more residents,
  excluding hospital based, waivered, or facilities with partial or initial or
  final full year cost reports. The Department will reduce the direct nursing
  component median by 2% for facilities that are waivered from the 24-hour
  nursing requirement to take into account those facilities' lowered nursing care
  costs. The maximum per diem is computed as 105% of the median direct nursing
  component, and 100% of the median support services component. The Department
  will reduce the direct nursing component maximum by 2% for facilities that are
  waivered from the 24-hour nursing requirement to take into account those
  facilities' lowered nursing care costs. The minimum per diem is computed as 77%
  of the median direct nursing component, and 72% of the median support services
  component. The fixed cost component is subject to a maximum Per Diem of $27.00,
  excluding personal property and real estate taxes.
007.04(A)
DIRECT NURSING
  COMPONENT.
This component of the prospective rate is computed by
  dividing the base year allowable direct nursing costs, lines 94 through 103 of
  Form FA-66, Long Term Care Cost Report, by the base year weighted resident days
  for each facility. The resulting quotient is the facility's computed base year
  per diem. The computed base year per diem is subject to the component maximum
  per diem and minimum per diem for rate determination purposes.
007.04(B)
SUPPORT SERVICES
  COMPONENT.
This component of the prospective rate is computed by
  dividing the base year allowable costs for support services, lines 34, 63, 78,
  93, 104 through 127, 163, 184, and 185 from the FA-66; Resident Transportation
  -Medical from the Ancillary Cost Center, line 219 from the FA-66; and
  respiratory therapy from the Ancillary Cost Center, line 210 from the FA-66, by
  the total base year inpatient days for each facility. The computed base year
  per diem is subject to the component maximum per diem and minimum per diem for
  rate determination purposes.
007.04(C)
FIXED COST
  COMPONENT.
This component of the prospective rate is computed by
  dividing the facility's base year allowable interest, depreciation,
  amortization, long-term rent or lease payments, personal property tax, real
  estate tax, and other fixed costs by the facility's total base year inpatient
  days. Rate determination for the Fixed Cost Component for an individual
  facility is computed using the lower of its own per diem as computed above,
  plus any prior approved increase under 471 NAC 45-007.05, or a maximum per diem
  of $27.00 excluding personal property and real estate taxes.
007.04(D)
NURSING FACILITY
  QUALITY ASSESSMENT COMPONENT.
The Nursing Facility Quality
  Assessment component shall not be subject to any cost limitation or revenue
  offset. For purposes of this section, facilities exempt from the quality
  assurance assessment are state-operated veterans' homes; nursing facilities and
  skilled nursing facilities with twenty-six or fewer licensed beds; and
  continuing care retirement communities. the quality assessment component rate
  will be determined by calculating the anticipated tax payment' during the rate
  year and then dividing the total anticipated tax payments by total anticipated
  nursing facility or skilled nursing facility patient days, including bed hold
  days and Medicare patient days. for each rate year, July 1 through the
  following June 30, total facility patient days, including bed hold days, less
  Medicare days, for the four most recent calendar quarters available at the time
  rates are determined will be used to calculate the anticipated tax payments.
  Total facility patient days, including bed hold days and Medicare days, for the
  same four calendar quarters will be used to calculate the anticipated nursing
  facility or skilled nursing facility patient days. For new providers entering
  the Medicaid program to operate a nursing facility not previously enrolled in
  Medicaid, for the rate period beginning on the Medicaid certification date
  through the following June 30, the quality assessment rate component is
  computed as the quality assurance assessment amount due from the provider's
  first quality assurance assessment form covering a full calendar quarter,
  divided by total resident days in licensed beds from the same quality assurance
  assessment form. for existing providers changing from exempt to non-exempt
  status, for the rate period beginning on the first day of the first full month
  the provider is subject to the quality assurance assessment through the
  following June 30, the quality assessment rate component is computed as the
  quality assurance assessment amount due from the provider's first quality
  assurance assessment form covering a full calendar quarter, divided by total
  resident days in licensed beds from the same quality assurance assessment form.
  For existing providers changing from non-exempt to exempt status, for rate
  periods beginning with the first day of the first full month the provider is
  exempt from the quality assurance assessment, the quality assessment rate
  component will be $0.00 (zero dollars).
007.04(E)
BASE YEAR REPORT PERIOD
  AND INFLATION FACTOR.
For the Rate Periods July 1 through December
  31 and January 1 through June 30, the base year is updated no less frequently
  than every 5 years. The inflation factor is updated annually.
007.04(F)
QUALITY MEASURES
  COMPONENT.
This component of the prospective rate is based on the
  quality measures component of the Centers for Medicare & Medicaid nursing
  facility star rating system. The published rating as of May 1 is used to
  determine the rate component for the following July 1 through December 31 rate
  period. The published rating as of November 1 is used to determine the rate
  component for the following January 1 through June 30 rate period. Per Diem
  amounts corresponding to the quality measures rating are: 5 star rating =
  $10.00 a day; 4 star rating = $6.75 a day; 3 star rating = $3.50 a day; 1 star,
  2 star, or NR (no rating) = $0.00 (zero dollars). This component applies to all
  nursing facility care levels (101-180).