Opinion ID: 74877
Heading Depth: 3
Heading Rank: 1

Heading: e., DRI times 1.786;

Text: b. Three year averaging of cost reports shall be used to calculate rate reductions based on decreases in costs; c. The cap on rates for new facilities of six beds or less shall be deleted; d. Settlement of budgeted rates for new providers shall use an average of the relevant rate periods; e. For providers at small facilities, rates shall be set based on an average (or collectively) for all six bed ICF/DDs operated by that provider; f. The Defendants shall develop a definable standard for an efficiently operated provider; 13 g. Increased costs related to increased needs of a client due to changed medical, behavioral or therapeutic needs shall be a basis for an interim rate request; h. Cost allocations between levels of care shall be revised (except where such a revision would reduce reimbursement already paid to a provider); i. The Defendants shall rebase whenever actual costs exceed actual expenditures for 50% or more of providers in any rate period as shown on KM Schedules of cost reports maintained by Defendants. Id. at 1360-61, Conclusion ¶ 2. The district court also ordered that “Defendants shall comply with its published Rate Plan including the immediate rebasing for the 1995 rate setting period where it failed to rebase.” Id. at 1361, Conclusion ¶ 3. Moreover, ordered the Court, “Defendants are enjoined from violation of the Boren Amendment from September 13, 1991 until the State adopts regulations, procedures and standards governing the reimbursement of ICF/DD providers in place of the standards set forth in the Boren Amendment. Defendants shall amend the Rate Plan accordingly.” Id., Conclusion ¶ 4. On April 23, 1999, Defendants moved for reconsideration of the final order. Defendants pointed out that in 1998, they had amended the state Medicaid rate plan and taken it through the notice-and-comment process now required by the Boren Amendment’s successor. The amendments had been approved effective October 1, 1998. Defendants argued that this development mooted Plaintiffs’ claims. 14 Attached to the motion was an affidavit from a state official who described the amendment process in detail and noted that at least one of the Plaintiffs (Sunrise Community, Inc.) had unsuccessfully challenged the new plan in the administrative proceeding. On July 9, 1999, the district court denied Defendants’ motion, finding that Defendants had established no good reason for their failure to present the court evidence of these events prior to its final judgment, and that the new evidence would not warrant a modification of the final judgment anyway. This appeal followed.