249K.3 - GENERAL PROVISIONS -- INSTANT RELIEF -- NONDIRECT CARE LIMIT EXCEPTION.
249K.3 GENERAL PROVISIONS -- INSTANT RELIEF --
NONDIRECT CARE LIMIT EXCEPTION.
1. A provider that constructs a complete replacement, makes major
renovations to, or newly constructs a nursing facility may be
entitled to the rate relief and exceptions provided under this
chapter. The total period during which a provider may participate in
any relief shall not exceed two years. The total period during which
a provider may participate in any nondirect care limit exception
shall not exceed ten years. A provider seeking assistance under this
chapter may request both instant relief and the nondirect care limit
exception.
2. If the provider requests instant relief, the following
provisions shall apply:
a. The provider shall submit a written request for instant
relief to the Iowa Medicaid enterprise explaining the nature, timing,
and goals of the project and the time period during which the relief
is requested. The written request shall clearly state if the
provider is also requesting the nondirect care limit exception. The
written request for instant relief shall be submitted no earlier than
thirty days prior to the placement of the provider's assets in
service. The written request for relief shall provide adequate
details to calculate the estimated value of relief including but not
limited to the total cost of the project, the estimated annual
depreciation expenses using generally accepted accounting principles,
the estimated useful life based upon existing medical assistance and
Medicare provisions, and a copy of the most current depreciation
schedule. If interest expenses are included, a copy of the general
terms of the debt service and the estimated annual amount of the
interest expenses shall be submitted with the written request for
relief.
b. The following shall apply to the value of relief amount:
(1) If interest expenses are disclosed, the amount of these
expenses shall be added to the value of relief.
(2) The calculation of the estimated value of relief shall take
into consideration the removal of existing assets and debt service.
(3) The calculation of the estimated value of relief shall be
demonstrated as an amount per patient day to be added to the
nondirect care component for the relevant period. The estimated
annual patient days for this calculation shall be determined based
upon budgeted amounts or the most recent annual total as demonstrated
on the provider's Medicaid financial and statistical report. For the
purposes of calculating the per diem relief, total patient days shall
be the greater of the estimated annual patient days or eighty-five
percent of the facility's estimated licensed capacity.
(4) The combination of the nondirect care component and the
estimated value of relief shall not exceed one hundred and ten
percent of the nondirect care median for the relevant period. If a
nondirect care limit exception has been requested and granted, the
combination of the nondirect care component and the estimated value
of relief shall not exceed one hundred twenty percent of the
nondirect care median for the relevant period.
c. Instant relief granted under this subsection shall begin
the first day of the calendar quarter following placement of the
provider's assets in service. If the required information to
calculate the instant relief, as specified in paragraph "a", is
not submitted prior to the first day of the calendar quarter
following placement of the provider's assets in service, instant
relief shall instead begin on the first day of the calendar quarter
following receipt of the required information.
d. Instant relief granted under this subsection shall be
terminated at the time of the provider's subsequent biannual rebasing
when the submission of the annual cost report for the provider
includes the new replacement costs and the annual property costs
reflect the new assets.
e. During the period in which instant relief is granted, the
Iowa Medicaid enterprise shall recalculate the value of the instant
relief based on allowable costs and patient days reported on the
annual financial and statistical report. For purposes of calculating
the per diem relief, total patient days shall be the greater of
actual annual patient days or eighty-five percent of the facility's
licensed capacity. The actual value of relief shall be added to the
nondirect care component for the relevant period, not to exceed one
hundred ten percent of the nondirect care median for the relevant
period or not to exceed one hundred twenty percent of the nondirect
care median for the relevant period if the nondirect care limit
exception is requested and granted. The provider's quarterly rates
for the relevant period shall be retroactively adjusted to reflect
the revised nondirect care rate. All claims with dates of service
from the date that instant relief is granted to the date that the
instant relief is terminated shall be repriced to reflect the actual
value of the instant relief per diem utilizing a mass adjustment.
3. If the provider requests the nondirect care limit exception,
all of the following shall apply:
a. The nondirect care limit for the rate setting period shall
be increased to one hundred and twenty percent of the median for the
relevant period.
b. The exception period shall not exceed a period of two
years. If the provider is requesting only the nondirect care limit
exception, the request shall be submitted within sixty days of the
release of the July 1 rate determination letters following each
biannual rebasing cycle, and shall be effective the first day of the
month following receipt of the request. If applicable, the provider
shall identify any time period in which instant relief was granted
and shall indicate how many times the instant relief or nondirect
care limit exception was granted previously. Section History: Recent Form
2007 Acts, ch 219, §37, 41, 43
Referred to in § 249K.4 Footnotes
Approval received April 17, 2008, from centers for Medicare and
Medicaid services of the United States department of health and human
services for medical assistance state plan amendment effective
October 1, 2007; approval of instant relief or nondirect care limit
exception dependent on extent of available funding; 2007 Acts, ch
219, §41