Icf/Iid: Special Rates

The Department pays special rates for care for residents with long-term medical or behavioral care needs beyond the normal scope of facility services. Payment for specialized care is in addition to any payments made under these rules and based on a per diem rate applicable to the incremental additional costs incurred by a facility. Incremental costs to a facility exceeding the rate for services provided are excluded from the computation of payments. Costs equivalent to payments at the special rate will be removed from the cost components subject to limits and will be reported separately. Special rates are determined on an individual basis, must be prior authorized by the Department, and may be used in one (1) of the following circumstances: (7-1-26) 01. New Admissions to a Community ICF/IID. (7-1-26) 02. Significant Change in Condition. Residents of a community ICF/IID experiencing a significant change in condition not reflected in their current rate. (7-1-26) 03. Altered Services. A facility altered services to achieve or maintain compliance with state or federal requirements resulting in additional costs not reflected in their current rate. (7-1-26) 04. Emergency. An emergency exists when a facility must incur additional behavioral or medical costs to prevent more restrictive placements. (7-1-26) 526. – 529. (RESERVED) SUB AREA: HOME AND COMMUNITY-BASED SERVICES (HCBS) (Sections 530-539)