Resident Care Cost Quotient

(1) Beginning July 1, 2022, residential care facilities must have a Resident Care Cost Quotient (RCC-Q) that meets or exceeds a threshold of 80%. For the rate year beginning in SFY2024, a residential care facility’s rate may be subject to a downward adjustment if the facility fails to be at or above the specified RCC-Q threshold in the previous state fiscal year. (2) The RCC-Q will be calculated by dividing certain resident care expenses by the facility’s total revenue, excluding the revenue for non-residential care facility lines of business, and excluding endowment income. EOHHS may further identify or clarify these certain resident care expenses by administrative bulletin or other written issuance. A multiplier may be applied to certain resident care expenses related to one or more resident care workforce position types. EOHHS may establish the workforce position types eligible for any multiplier, details related to application of such multiplier, and the magnitude of such multiplier in calculating the RCC-Q, by administrative bulletin or other written issuance. (3) All resident care facilities, excluding facilities described in 101 CMR 204.10(5), will be required to submit an interim compliance report by March 1st of each year and a final compliance report by September 1st of each year. The interim report will be used to inform facilities if they are on track to meet the RCC-Q threshold in the reporting period. The final compliance report will be used for determining whether the facility met that threshold and whether a downward adjustment will be applied to the facility’s rate in the following rate year. (4) The downward adjustment to the rate will be applied in the following rate year to facilities that failed to meet the RCC-Q threshold or failed to submit the final report by the final compliance report due date. Such downward adjustment will be applied as follows. (a) For every 1% below the 80% RCC-Q threshold, a 0.5% downward adjustment will be applied to the facility’s rate. (b) The maximum downward adjustment calculated in accordance with 101 CMR 204.10(4)(a) may be no more than 5% of the facility’s rate. EOHHS may apply the maximum downward adjustment of 5% in the following rate year for facilities that fail to submit the final report by the due date established in 101 CMR 204.10(3). (5) Residential care facilities that have fewer than 1,700 SSI/SSP and EAEDC days (also known as DTA days), based on the most recent cost report data available to CHIA, for a particular state fiscal year, starting the state fiscal year of July 1, 2022, through June 30, 2023, except for the facilities that failed to submit the final compliance report by September 1st in accordance with 101 CMR 204.10(3) immediately following the end of the particular state fiscal year, will be exempt from the downward adjustment established at 101 CMR 204.10(4). Residential care facilities that request and receive approval for a waiver because their capital expenses exceeded 10% of reported revenue will be exempt from the downward adjustment described at 101 CMR 204.10(4). For purposes of 101 CMR 204.10(5), the RCC-Q minimum paid DTA days will be established by EOHHS by administrative bulletin or other written issuance. (6) EOHHS may issue an administrative bulletin or other written issuance to clarify provisions of 101 CMR 204.10, and as otherwise provided at 101 CMR 204.10. (7) EOHHS or the Center may audit facilities or otherwise require the provider to submit data, documentation, or other materials to support or otherwise demonstrate costs as an audit of the RCC-Q reporting that a facility submitted, or failed to submit, in accordance 101 CMR 204.10(3), or to confirm the validity of the RCC-Q determined pursuant to 101 CMR 204.10. In addition, EOHHS may request additional information and data relating to the operations of the facility and any related party concerning the RCC-Q in accordance with 101 CMR 204.10. After this audit, if EOHHS determines that the facility did not meet the RCC-Q threshold established pursuant to 101 CMR 204.10(1), but the full and appropriate downward adjustment was not applied to the applicable facility rates pursuant to 101 CMR 204.10(4), EOHHS, in its sole authority and discretion, may apply one or more of the following actions, as appropriate: (a) apply the downward adjustment for the full or partial period of the rate year to which the downward adjustment should have been applied pursuant to 101 CMR 204.10(4); (b) apply a negative annualization adjustment to one or more prospective payments to account for the period the facility was paid at a rate to which the downward adjustment should have been applied pursuant to 101 CMR 204.10(4); (c) notwithstanding the maximum downward adjustment described in 101 CMR 204.10(4), apply the downward adjustment that should have been applied to the applicable rate year to the rate for the subsequent rate year in accordance with the parameters described at 101 CMR 204.10(4) in addition to any applicable downward adjustment pursuant to 101 CMR 204.10(4) that would otherwise be applicable for the subsequent rate year; (d) require the facility to refund the overpayments that account for the difference between the rate paid and the rate that should have been paid after application of the downward adjustment that should have been applied pursuant to 101 CMR 204.10(4); or (e) take another appropriate action.