Icf/Iid: Capped Cost

01. Costs Subject to the Cap. Include all allowable costs except property costs under property reimbursement and exempt excluded costs. (7-1-26) 02. Per Diem Costs. Costs are divided by total resident days for a facility in the cost reporting period to arrive at allowable per diem costs. If costs for services provided any non-Medicaid residents are not included in the total costs submitted, the facility must determine these costs and combine them with submitted costs so a total per diem cost for that facility is determined for both determining the ICF/IID cap and computing final reimbursement. (7-1-26) 03. Cost Data to Determine the Cap. Cost data from the final cost report used for rate setting, per prospective principles, will be used. Cost reports are final when the final audit report is issued, or earlier if the Department informs the facility the report is final for rate setting purposes. However, the final cost reports covering a period of less than twelve (12) months are included in data to determine the cap at the option of the Department. (7-1-26) 04. Payments to Non ICF/IIDs. Payments made by the Department directly to non-ICF/IIDs are excluded from the ICF/IID prospective rates and cap. Services covered under EPSDT or “Medicaid Basic Plan Benefits” are not included in ICF/IID costs. Providers must bill Medicaid directly for these services under their own provider number. (7-1-26) 05. Cost Ranking. Prior to annual rate setting, the Director will determine the percent above the median used in the cap calculation. That percent will apply to the cap and rates set per prospective principles. Per diem capped costs, by facility, as determined in this section will be ranked from the highest to the lowest, with the median being the 50th percentile. The cap for the applicable rate period will not exceed the 75th percentile of these ranked per diems. (7-1-26) a. The median of the range is computed based on the available data points considered the total population of data points. (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 519 Page 115 b. A new cap and rate are set annually for each facility July 1st. (7-1-26) c. The cap and prospective rate are determined and set annually for each facility July 1st and is not changed by any subsequent events or information unless the computations are found to contain mathematical or clerical errors. These errors are then corrected, and the cap is adjusted using corrected figures. (7-1-26) d. Payment of costs subject to the cap are limited to the cap unless the Department determines the exclusions. (7-1-26) 518. (RESERVED)