Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 90 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES FOR LONG-TERM CARE › Part II - Nursing Home Payment System › Subpart XVII - Specialized Care Services › Section 12VAC30-90-264 - Specialized care services

Current through Register Vol. 40, No. 24, July 15, 2024
Specialized care services provided in conformance with
						12VAC30-60-40
						E and H,
						12VAC30-60-320,
						and
						12VAC30-60-340
						shall be reimbursed under the following methodology. The nursing facilities
						that provide adult specialized care for the categories of Ventilator Dependent
						Care, will be placed in one group for rate determination. The nursing
						facilities that provide pediatric specialized care in a dedicated pediatric
						unit of eight beds or more will be placed in a second group for rate
						determination.
1. Routine operating
					 cost. Routine operating cost shall be defined as in
					 12VAC30-90-271
					 and
					 12VAC30-90-272.
					 To calculate the routine operating cost reimbursement rate, routine operating
					 cost shall be converted to a per diem amount by dividing it by actual patient
					 days. Effective July 1, 2016, the base year for routine operating cost shall be
					 the most recently settled cost reports with a fiscal year ending in a calendar
					 year for all specialized care facilities as of the end of the calendar year
					 prior to the prospective rate year.
2. Allowable cost identification and cost
					 reimbursement limitations. The provisions of Article 5 (12VAC30-90-50 et
					 seq.) of Subpart II of Part II of this chapter and of Appendix III
					 (12VAC30-90-290
					 ) of Part III of this chapter shall apply to specialized care cost and
					 reimbursement.
3. Routine
					 operating cost rates. Each facility shall be reimbursed a prospective rate for
					 routine operating costs. This rate will be the lesser of the facility-specific
					 prospective routine operating ceiling, or the facility-specific prospective
					 routine operating cost per day plus an efficiency incentive. This efficiency
					 incentive shall be calculated by the same method as in
					 12VAC30-90-41.
4. Facility-specific prospective
					 routine operating ceiling. Each nursing facility's prospective routine
					 operating ceiling shall be calculated as:
a.
					 Statewide ceiling. The statewide routine operating ceiling shall be $415 as of
					 July 1, 2002. This routine operating ceiling amount shall be adjusted for
					 inflation based on
					 12VAC30-90-41.
					 Effective July 1, 2016, the routine operating ceiling shall be $573.09 as of
					 state fiscal year 2015 and shall be adjusted for inflation based on 12VAC-30-90
					 -44 to the upcoming state fiscal year, the prospective rate year.
b. The portion of the statewide routine
					 operating ceiling relating to nursing salaries (as determined by the 1994
					 audited cost report data, or 67.22%) will be wage adjusted using a normalized
					 wage index. The normalized wage index shall be the wage index applicable to the
					 individual provider's geographic location under Medicare rules of reimbursement
					 for skilled nursing facilities, divided by the statewide average of such wage
					 indices across the state. This normalization of wage indices shall be updated
					 January 1, after each time the CMS publishes wage indices for skilled nursing
					 facilities. Updated normalization shall be effective for fiscal years starting
					 on and after the January 1 for which the normalization is calculated. Effective
					 July 1, 2016, the normalized wage index for the federal fiscal year following
					 the base year shall be applied to the state fiscal year ceiling.