One-time adjustments

1. Adjustments to meet licensure standards. a. The department may provide for an increase in the established rate for additional costs incurred to meet licensure standards. The survey conducted by the department's public health division must clearly require that the facility take steps to correct deficiencies dealing with resident care. The plan of correction must identify the salary or other costs increased to correct the deficiencies cited in the survey process. b. The facility shall submit a written request to the department within thirty days of submitting the plan of correction to the department's public health division. The request must: (1) Include a statement that costs or staff numbers have not been reduced for the report year immediately preceding the department's public health division's licensure survey; (2) Identify the number of new staff or additional staff hours and the associated costs required to meet the licensure standards; (3) Provide a detailed list of any other costs necessary to meet licensure standards; (4) Describe how the facility shall meet licensure standards if the adjustment is received, including the number and type of staff to be added to the current staff and the projected salary and fringe benefit cost for the additional staff; and (5) Document that all available resources, including efficiency incentives, if used to increase staffing, are not sufficient to meet licensure standards. c. The department shall review the submitted information and may request additional documentation or conduct onsite visits. d. If an increase in costs is approved, the adjustment must be calculated based on the costs necessary to meet licensure standards less any incentives included when calculating the established rate. The net increase must be divided by resident days and the amount calculated must be added to the established rate. This rate must then be subject to any rate limitations that may apply. e. Any additional funds provided must be used in accordance with the facility's written request to the department and are subject to audit. If the department determines that the funds were not used for the intended purpose, an adjustment must be made in accordance with section 75-02-07.1-23. f. If the actual cost of implementation exceeds the amount included in the adjustment, no retroactive settlement may be made. 2. Adjustments for unforeseeable expenses. a. The department may provide for an increase in the established rate for additional costs incurred to meet major unforeseeable expenses. The expenses must be resident related and beyond the control of those responsible for the management of the facility. b. Within sixty days after first incurring the unforeseeable expense, the facility shall submit to the department a written request containing: (1) An explanation as to why the facility believes the expense was unforeseeable; (2) An explanation as to why the facility believes the expense was beyond the managerial control of the owner or administrator of the facility; and (3) A detailed breakdown of the unforeseeable expenses by expense line item. c. The department shall base its decision on whether the request clearly demonstrates that the economic or other factors that caused the expense were unexpected and arose because of conditions that could not have been anticipated by management based on their background and knowledge of basic care industry and business trends. d. The department shall review the submitted information and may request additional documentation or conduct onsite visits. If an increase in costs is approved, the established rate must be adjusted upward not to exceed the limit rate. e. Any additional funds provided must be used to meet the unforeseeable expenses outlined in the facility's request to the department and are subject to audit. If the department determines that the funds were not used for the intended purpose, an adjustment must be made in accordance with section 75-02-07.1-23. 3. One-time adjustments for cost increases approved by the legislative assembly. a. The department shall increase rates otherwise established by this chapter for supplemental payments or one-time adjustments to historical costs approved by the legislative assembly. b. Any additional funds made available by the supplemental payments or one-time adjustments must be used for the legislatively prescribed purpose and are subject to audit. If the department determines that the funds were not used for the legislatively prescribed purpose, an adjustment must be made in accordance with section 75-02-07.1-23.