DAR File No. 27852

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-401-3

Assessment

NOTICE OF PROPOSED RULE

DAR File No.: 27852
Filed: 05/02/2005, 11:28
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The 2005 Utah Legislature passed H.B. 62 that requires an assessment on Medicaid beds in Intermediate Care Facilities for the Mentally Retarded (ICF/MRs) and on swing beds in hospitals that can be used for Medicaid nursing care patients. This rule implements that assessment. (DAR NOTE: H.B. 62 is found at UT L 2005 Ch 31, and will be effective 07/01/2005.)

Summary of the rule or change:

In Subsection R414-401-3(2), ICF/MRS are assessed at the uniform rate of $5.52 per patient day and swing bed facilities are assessed the uniform rate for nursing facilities effective January 1, 2006.

State statutory or constitutional authorization for this rule:

Section 26-18-3

Anticipated cost or savings to:

the state budget:

This change is budget neutral due to collection of $1,100,000 from ICF/MRs and a draw down of federal matching funds in the amount of approximately $2,800,000. The change also allows collection of $270,000 annually from hospitals with swing beds with a draw down of federal funds amounting to $670,000.

local governments:

There will be a positive impact on some local hospitals with swing beds due to the net additional federal funding being applied to the swing bed reimbursement rates.

other persons:

There is an enhanced revenue of approximately $3,900,000 for nursing facility providers as a result of federal matching funds.

Compliance costs for affected persons:

Compliance costs include a collection of $5.52 per non-Medicare patient day from each nursing facility or a total of $1,100,000. This collection will be used as state funds to draw down about $2,800,000 in federal funds. All ICF/MRs will gain from this process. The amount of gain depends on the number of Medicaid patients in the facility.

Comments by the department head on the fiscal impact the rule may have on businesses:

At the request of these regulated businesses, a statutory assessment was imposed which will allow for an increase in Medicaid reimbursement. This will have a positive fiscal impact on providers. David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Direct questions regarding this rule to:

Ross Martin at the above address, by phone at 801-538-6592, by FAX at 801-538-6099, or by Internet E-mail at rmartin@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

06/14/2005

This rule may become effective on:

06/15/2005

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-401. Nursing Care Facility Assessment.

R414-401-3. Assessment.

(1) The collection agent for the nursing care facility assessment shall be the Department, which is vested with the administration and enforcement of the assessment.

(2) The uniform rate of assessment for every facility is $6.18 per non-Medicare patient day provided by the facility, except that intermediate care facilities for the mentally retarded shall be assessed at the uniform rate of $5.52 per patient day. Swing bed facilities shall be assessed the uniform rate for nursing facilities effective January 1, 2006. The Utah State Veteran's Home is exempted from this assessment and this rule.

(3) Each nursing care facility must pay its assessment monthly on or before the last day of the next succeeding month.

(4) The Department shall extend the time for paying the assessment to the next month succeeding the federal approval of a Medicaid State Plan Amendment allowing for the assessment, and consequent reimbursement rate adjustments.

KEY: Medicaid, nursing facility

[July 2, 2004]2005

26-1-30

26-35a

ADDITIONAL INFORMATION

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For questions regarding the content or application of this rule, please contact Ross Martin at the above address, by phone at 801-538-6592, by FAX at 801-538-6099, or by Internet E-mail at rmartin@utah.gov

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.