(a)
Reimbursement rate ceilings for the administrative cost center, the patient
transportation cost center and for comparable patient care cost centers shall
be established for facilities. Comparable patient care cost centers shall
include, but not be limited to, the following:
(1) ancillary services cost center (clinical
laboratory, pharmacy and diagnostic radiology services);
(2) medical services cost center;
(3) dental services cost center;
and
(4) therapy services cost
centers.
For a facility which provides limited primary medical
care services as defined in section
86-4.13(b)(2)
of this Subpart, the administrative and patient care costs incurred by the
facility to provide such limited primary medical care services shall be
excluded from the costs used to determine the ceilings for the facility's peer
group. Reimbursement specific to limited primary medical care services will be
established for the facility. The ceilings on costs related to limited primary
medical care services will be determined based on the cost experience of
facilities which provide limited primary medical care services.
(b) The ceilings shall
be established prior to the addition of the trend factor and after the
exclusion of desk-audit disallowances and capital costs from total reported
costs. The costs of facilities with costs less than 75 percent or over 125
percent of the group average will be raised or lowered to fall within the
75-percent to 125-percent limits.
(c) Ceilings for each cost center shall be
computed at 105 percent of the adjusted weighted average base year costs of the
facilities in the cost center group.
(d) For the purpose of grouping facilities to
establish cost center group ceilings, comprehensive primary medical care
facilities will be grouped taking into consideration geographical differences
such as upstate/downstate regions and urban/rural locations; family planning
facilities will be grouped taking into consideration upstate/downstate regions;
all other facilities will be grouped on a statewide basis. If upstate/downstate
regions and/or urban/rural locations have not already been taken into account,
the ceilings for facilities grouped in accordance with Subpart 86-4.13(b) will
be adjusted by wage adjustment factors to recognize differences due to regional
economic factors.
(e) The wage
adjustment factors will be established by the commissioner based on examination
of the salary and employee health and welfare cost experience of the facilities
grouped in accordance with section
86-4.13(b)
and the methodology described section
86-1.54(j)(2).
The wage adjustment factors will be updated on an annual basis based upon then
current and available data.
(f)
Ceilings for operating costs of ungrouped facilities shall be established at
the lower of reported base-year operating costs trended to the rate period or
the operating cost component of the existing published rate trended forward by
a one-year trend factor.
(g) A
change in a facility's group or a revision in cost after ceilings have been
established shall not cause a recalculation of ceilings for other facilities in
the original or new groups, unless the change was occasioned by an error by the
department.