Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 15 - MEDICAID PAYMENT FOR PSYCHIATRIC HOSPITAL INPATIENT SERVICES › Section 309-015-0023 - Interim Rate Setting

Current through Register Vol. 63, No. 7, July 1, 2024
Rate establishment process. At least annually, the Medicaid
				intermediary will establish an interim Medicaid per diem rate for each
				participating psychiatric hospital, separate cost entity or distinct program
				within a hospital:
(1) A hospital may
			 request an interim per diem rate or rates. If a review of the hospital's prior
			 year Medicaid cost report (adjusted for inflation, changes in patient
			 populations and programs and other relevant factors) does not justify the
			 requested rate(s), the Medicaid Intermediary may establish different interim
			 rate(s):
(a) Actual expenditures for the most
			 recent fiscal period available will be used to determine salary and wage and
			 total expense distribution for each cost center included in the total
			 expenditures. Any other directly relevant event, such as facility
			 restructuring, will be considered as well;
(b) The Division will apply the proportions
			 from subsection (a) of this section to total anticipated expenditures for the
			 new period to determine salary and wage expense distribution for each cost
			 center during the new period;
(c)
			 The Division will establish and apply capital allowances and other adjustments
			 to total anticipated expenditures for the new period from subsection (b) of
			 this section;
(d) If the hospital
			 has separate cost entities or distinct programs, the hospital will provide
			 estimates to the Division of a weighted average interim rate. The average will
			 be developed by multiplying each proposed interim rate by estimated Medicaid
			 patient days for that rate, summing all of the products, and dividing that sum
			 by the total annual estimated Medicaid patient days for the hospital;
(e) The interim or weighted average interim
			 per diem rate may not exceed the maximum allowable rate unless the hospital
			 meets the criteria for reimbursement above the maximum allowable rate as a
			 disproportionate share hospital (see OAR
			 309-015-0035(5)).
			 In that case, the interim or average interim Disproportionate Share adjusted
			 Medicaid Rate (DSR) may include estimated costs up to 135 percent of the
			 maximum allowable Medicaid rate except for hospitals meeting criteria set forth
			 in the following paragraph;
(f) If
			 a psychiatric hospital has a low-income rate of 60 percent and also receives 60
			 percent or more of its service revenue from any combination of the following:
(A) Public funds, excluding Medicare and
			 Medicaid;
(B) Bad debts;
			 or
(C) Free care.
(g) The hospital qualifies to
			 receive disproportionate share payment at a rate based on 100 percent of the
			 costs of uncompensated care during the facility's previous fiscal year, subject
			 to a disproportionate share allotment established for Oregon by the Health Care
			 Financing Administration;
(h) The
			 Division will base quarterly disproportionate share reimbursements on the
			 estimated costs for each facility during the current fiscal year and will
			 review and adjust the reimbursements, after conclusion of the fiscal period, to
			 correspond with actual costs encountered during the period. Total reimbursement
			 from disproportionate share and other sources will not exceed actual
			 costs.