405 IAC 1-12-7 Request for rate review; effect of inflation; occupancy level assumptions

Sec. 7. (a) Rate setting during rebasing years shall be based on the provider's annual or historical financial report for the most recent completed year. In determining prospective allowable costs during rebasing years, each provider's costs from the most recent completed year will be adjusted for inflation by the office using the following methodology. All allowable costs of the provider, except for: (1) mortgage interest on facilities and equipment; (2) depreciation on facilities and equipment; (3) rent or lease costs for facilities and equipment; and (4) working capital interest; shall be increased for inflation using the CMS Nursing Home without Capital Market Basket index as published by IHS. The inflation adjustment shall apply from the midpoint of the annual or historical financial report period to the midpoint of the expected rate period. (b) For purposes of determining the average allowable cost of the median patient day as applicable during rebasing years, each provider's costs from their most recent completed year will be adjusted for inflation by the office using the following methodology. Providers whose most recently completed rate is an initial interim rate shall be excluded from the determination of the average allowable cost of the median patient day. All allowable costs of the provider, except for: (1) mortgage interest on facilities and equipment; (2) depreciation on facilities and equipment; (3) rent or lease costs for facilities and equipment; and (4) working capital interest; shall be increased for inflation using the CMS Nursing Home without Capital Market Basket index as published by IHS. The inflation adjustment shall apply from the midpoint of the annual or historical financial report period to the midpoint prescribed as follows: Median Effective Date Midpoint Quarter January 1, Year 1 July 1, Year 1 April 1, Year 1 October 1, Year 1 July 1, Year 1 January 1, Year 2 October 1, Year 1 April 1, Year 2 (c) For ICFs/IID and CRFs/DD, allowable costs per patient or resident day shall be determined based on an occupancy level equal to the greater of actual occupancy, or ninety-five percent (95%) for ICFs/IID and ninety percent (90%) for CRFs/DD, for certain fixed facility costs. The fixed costs subject to this minimum occupancy level standard include the following: (1) Director of nursing wages. (2) Administrator wages. (3) All costs reported in the ownership cost center, except repairs and maintenance. (4) The capital return factor determined in accordance with sections 12 through 17 of this rule for all providers, except for providers of extensive support needs residences for adults. (5) The fair rental value allowance determined in accordance with section 20.5 of this rule for providers of extensive support needs residences for adults.