§ 10 CCR 2505-10-8.443 - NURSING FACILITY REIMBURSEMENT

  1. § 10 CCR 2505-10-8.443.2 - NURSING FACILITY CLASSIFICATIONS
  2. § 10 CCR 2505-10-8.443.3 - IMPUTED OCCUPANCY FOR CLASS II FACILITIES
  3. § 10 CCR 2505-10-8.443.4 - INFLATION ADJUSTMENT
  4. § 10 CCR 2505-10-8.443.5 - ADMINISTRATIVE COST INCENTIVE ALLOWANCE FOR CLASS II AND CLASS IV FACILITIES
  5. § 10 CCR 2505-10-8.443.6 - CASE MIX ADJUSTMENTS
  6. § 10 CCR 2505-10-8.443.7 - [Effective until 11/27/2021]HEALTH CARE REIMBURSEMENT RATE CALCULATION
  7. § 10 CCR 2505-10-8.443.7 - [Effective 11/27/2021]HEALTH CARE REIMBURSEMENT RATE CALCULATION, version 2
  8. § 10 CCR 2505-10-8.443.8 - REIMBURSEMENT FOR ADMINISTRATIVE AND GENERAL COSTS
  9. § 10 CCR 2505-10-8.443.9 - FAIR RENTAL ALLOWANCE FOR CAPITAL-RELATED ASSETS
  10. § 10 CCR 2505-10-8.443.10 - SUPPLEMENTAL PAYMENTS FOR FACILITIES WITH COGNITIVE IMPAIRED AND PASRR II RESIDENTS, PROVIDER FEE AND QUALITY PERFORMANCE FOR CLASS I NURSING FACILITIES
  11. § 10 CCR 2505-10-8.443.11 - FUNDING SPECIFICATIONS
  12. § 10 CCR 2505-10-8.443.12 - PAY-FOR-PERFORMANCE COMPONENT
  13. § 10 CCR 2505-10-8.443.13 - RATE EFFECTIVE DATE
  14. § 10 CCR 2505-10-8.443.14 - RATES FOR NEW FACILITIES
  15. § 10 CCR 2505-10-8.443.15 - CHANGE OF OWNERSHIP OR WITHDRAWAL FROM MEDICAID
  16. § 10 CCR 2505-10-8.443.16 - STATE-OPERATED ICF/IID (CLASS IV)
  17. § 10 CCR 2505-10-8.443.17 - CLASS I NURSING FACILITY PROVIDER FEES
  18. § 10 CCR 2505-10-8.443.18 - RATES FOR RECEIVERSHIP
  19. § 10 CCR 2505-10-8.443.19 - PAYMENT FOR OUT OF STATE NURSING FACILITY CARE
  20. § 10 CCR 2505-10-8.443.20 - CLASS II AND CLASS IV (ICF/IID) NURSING FACILITY PROVIDER FEE
  21. § 10 CCR 2505-10-8.443.21 - MINIMUM WAGE SUPPLEMENTAL PAYMENT

Current through Register Vol. 44, No. 18, September 25, 2021

8.443.1.A Where no specific Medicaid authority exists, the sources listed below shall be considered in reaching a rate determination:
1. Medicare statutes.
2. Medicare regulations.
3. Medicaid and Medicare guidelines.
4. Generally accepted accounting principles.
8.443.1.B Effective July 1 of each year, a MMIS per diem reimbursement rate for Class I nursing facility providers shall be established for reimbursement of billed claims.
1. The MMIS per diem reimbursement rate shall equal the July 1 Core Component per diem rate multiplied by a percent factor. The percent factor shall be a percentage such that the statewide average MMIS per diem reimbursement rate net of patient payment equals the previous year statewide average MMIS per diem reimbursement rate net of patient payment increased by the statutory limit pursuant to C.R.S 25.5-6-202(9)(b)(VII)(2020) for SFY 2020-21 and SFY 2021-22. The increase for all subsequent years shall be limited pursuant to C.R.S 25.5-6-202(9)(b)(I)(2020).
2. For state fiscal year (SFY) 2019-20, if the MMIS per diem reimbursement rate is less than ninety-five percent (95%) of the SFY 2018-19 MMIS per diem reimbursement rate, the SFY 2019-20 MMIS per diem reimbursement rate shall be the lesser of 95% of the SFY 2018-19 MMIS per diem reimbursement rate or the SFY 2019-20 Core Component per diem rate.
3. In the event that MMIS per diem reimbursement rate is greater than the Core Component per diem rate, the Department shall reduce the rate to no greater than the Core Component per diem rate.

The Core Component per diem rate shall be determined using information on the MED-13, the Minimum Data Set (MDS) resident assessment information and information obtained by the Department or its designee retained for cost auditing purposes.

The Core Component per diem rate shall be the sum of the following per diem rates:

1. Health care per diem rate described in Section 8.443.7.D,
2. Administrative and general per diem rate described in Section 8.443.8.E, and
3. Fair rental allowance per diem rate described in Section 8.443.9.B.

In addition to the MMIS claims reimbursement, a Class 1 nursing facility provider may be reimbursed supplemental payments. Supplemental payments are funded using available provider fee dollars collected as described in Section 8.443.17. Supplemental payments shall be funded in the subsequent order based upon the statutory hierarchy pursuant to C.R.S § 25.5-6-203(2)(b).

1. Medicaid utilization supplemental payment described in Section 8.443.10.C,
2. Acuity Adjusted Core Component supplemental payment described in Section 8.443.11.B,
3. Pay-For-Performance supplemental payment described in Section 8.443.12,
4. Cognitive Performance Scale supplemental payment described in Section 8.443.10.A,
5. Preadmission Screening and Resident Review II Resident supplemental payment described in Section 8.443.10.B,
6. Preadmission Screening and Resident Review II Facility supplemental payment described in Section 8.443.10.B, and
7. Core Component supplemental payment described in Section 8.443.11.A.
8.443.1.C For class II and privately-owned class IV intermediate care Facilities for Individuals with Intellectual Disabilities, a payment rate for each participating facility shall be determined on the basis of the MED-13 and information obtained by the Department or its designee retained for the purpose of cost auditing.

The facility's prospective per diem rate includes the following components:

1. Health Care.
2. Administrative and General.
3. Fair Rental Allowance for Capital-Related Assets.
8.443.1.D For state-operated class IV intermediate care Facilities for Individuals with Intellectual Disabilities, a payment rate for each participating facility shall be determined on the basis of the MED-13 and information obtained by the Department or its designee retained for the purpose of cost auditing.

The facility's retrospective per diem rate includes the following components:

1. Health Care.
2. Administrative and General, which includes capital.
8.443.1.E. For swing-bed facilities, the annual payment rate shall be determined as the state-wide average class I nursing facilities payment rate at January 1 of each year.
8.443.1.F. No nursing facility care shall receive reimbursement unless and until the nursing facility:
1. Has a license from CDPHE, and
2. Is a Medicaid participating provider of nursing care services, and
3. Meets the requirements of the Department's regulations.

Notes

38 CR 07, April 10, 2015, effective 5/1/2015 39 CR 11, June 10, 2016, effective 6/30/2016 39 CR 19, October 10, 2016, effective 10/30/2016 44 CR 01, January 10, 2021, effective 2/15/2021

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