N.H. Code Admin. R. He-E 801.09 - Cost Control Methodology
Current through Register Vol. 41, No. 39, September 30, 2021
(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11
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He-E 801.09 Cost Control Methodology.
(a) For each applicant or participant, the department shall conduct a cost comparison between the cost of the individual’s home-based services and the average annual cost of the provision of services to a person in a nursing facility, per RSA 151-E:11.
(b) The cost comparison in (a) above shall be conducted as part of the initial eligibility determination and redetermination, and at any other time when a participant’s comprehensive care plan is adjusted or the services received by the participant change.
(c) The total cost of an individual’s home-based services shall include the costs of all home-based services.
(d) Costs associated with services rendered for acute care needs shall not be included in the calculation in (c) above.
(e) The average annual cost for the provision of services to a person in a nursing facility shall be calculated by adding:
(1) The basic Medicaid cost, determined by dividing the total annual Medicaid cost stated in the nursing facility budget line by the number of paid Medicaid bed days for that budget year; and
(2) The average aggregate payment made under the Medicaid Quality Incentive Program, through the Nursing Facility Trust Fund as described in RSA 151-E:14 and 151-E:15, divided by the number of paid Medicaid bed days.
(f) If the cost of an applicant’s or a participant’s home-based services exceeds 80% of the average annual cost for the provision of services to a person in a nursing facility, participation in the CFI program shall not be approved without the prior approval of the commissioner in accordance with He-E 801.10.
Source. (See Revision Note at part heading for He-E 801) #9969, eff 8-8-11; ss by #12830, INTERIM, eff 8-7-19, EXPIRED: 2-3-20