South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:16 - Covered medical services › Chapter 67:16:04 - Nursing facility rate setting › Section 67:16:04:51 - Ceilings

Current through Register Vol. 51, page 10, July 15, 2024
Ceilings are established using allowable costs as follows:
(1) Case mix adjusted direct care costs --
  The department shall use two ceiling calculations to determine a facility's
  case mix adjusted direct care costs. The first ceiling is established at one
  hundred fifteen percent of the median cost of all nursing facilities that have
  an average case mix score of 1.00 or more for the reporting period. The
  department will recognize one hundred percent of the facility's allowable costs
  up to the one hundred fifteen percent ceiling. The second ceiling is
  established at one hundred twenty-five percent of the median cost of all
  nursing facilities that have an average case mix score of 1.00 or more for the
  reporting period. Payment for the case mix adjusted direct care costs which
  exceed the one hundred fifteen percent ceiling and are up to the one hundred
  twenty-five percent ceiling is calculated according to §
									67:16:04:54.01;
(2) Nondirect care costs of health and
  subsistence, plant, plant operations, and other operating costs-- The
  department shall use two ceiling calculations when determining a facility's
  nondirect care costs of health and subsistence, plant, plant operations, and
  other operating costs. The first ceiling is established at one hundred five
  percent of the median cost of all nursing facilities that have an average case
  mix score of 1.00 or more for the reporting period. The department will
  recognize one hundred percent of the facility's allowable costs up to the one
  hundred five percent ceiling. The second ceiling is established at one hundred
  ten percent of the median cost of all nursing facilities that have an average
  case mix score of 1.00 or more for the reporting period. Payment for these
  nondirect care costs which exceed the one hundred five percent ceiling and are
  up to the one hundred ten percent ceiling is calculated according to §
									67:16:04:54.02;
(3) Nondirect care costs of administration --
  The department shall use two ceiling calculations when determining a facility's
  nondirect care costs of administration. The first ceiling is established at one
  hundred five percent of the median cost of all freestanding nonchain
  organization affiliated nursing facilities. The department will recognize one
  hundred percent of the facility's allowable costs up to the one hundred five
  percent ceiling. The second ceiling is established at- one hundred ten percent
  of the median cost of all freestanding nonchain organization affiliated nursing
  facilities. Payment for the nondirect care costs of administration which exceed
  the-- one hundred five percent ceiling and are up to the one hundred ten
  percent ceiling is calculated according to §
									67:16:04:54.03; and
(4) Capital costs -- Beginning July 1, 2023,
  capital costs are limited to a ceiling of twenty dollars and ninety-five cents
  per resident day. The capital cost limitation will be inflated subject to
  adjustment as appropriated.
General Authority:
SDCL
		28-6-1
Law Implemented:
SDCL
		28-6-1(2).
Method of establishing per diem rates, §
											67:16:04:54.
State fiscal year, SDCL
		4-10-10.