114 CMR, § 40.09 - New Hospitals

(1) For hospitals which were not licensed and/or operated as non-acute hospitals in FY 1993, or did not report a full year of actual costs in FY 1993, the base year for operating and capital costs shall be the year used in the hospital's first RFR calculation.

(2) If the base year RFR was not based on a full year of actual costs, the Division shall determine whether to utilize base year RFR information, establish a different base year in accordance with Medicare regulations at 42 CFR 413.40(f)(1)(i), or to evaluate the hospital's projected operating and capital costs for reasonableness. Criteria for such review will include, but are not limited to, peer group analysis of costs incurred by comparable facilities.

(3) For new hospitals where base year RFR information is not used, the Division shall make any necessary adjustments to the provisions of 114.1 CMR 40.07 and/or 114.1 CMR 40.08 to reflect the use of a different data source.

(4) For new hospitals, which were not licensed and/or operated as non-acute hospitals in FY 1996, or did not have a base year previously established, the base year for operating and capital cost shall be the first full year of hospital cost pursuant to 114.1 CMR 40.06. If the Division determines that the data source is inadequate or not representative of the hospital's ongoing costs, the Division may consider alternative data sources to determine Base Year costs. Criteria for such review will include but will not be limited to peer group analysis of costs incurred and the determination of approved rates for comparable facilities.

(5) For FY 1997, the PAF shall be based upon projected cost determined by 114.1 CMR 40.09(4) and projected GPSR. The projected inpatient GPSR shall be reviewed by the Division for reasonableness against the Charge per Medicaid Inpatient Day for comparable facilities.

Notes

114 CMR, § 40.09