37.40.311    RATE ADJUSTMENT FOR COUNTY FUNDED RURAL NURSING FACILITIES

(1) For each state fiscal year, the department will provide a mechanism for a one time, lump sum payment to nonstate government owned or operated facilities for Medicaid services according to the methodology specified in this rule. These payments will be for the purpose of maintaining access and viability for a class of "at risk" county affiliated facilities who are predominately rural and are the only nursing facility in their community or county or who provide a significant share of nursing facility services in their community or county.

(2) A nursing facility is eligible to participate in this lump sum payment distribution if it is a nonstate government owned or operated facility that has provided Medicaid services in the current state fiscal year.

(a) The department will calculate the amount of lump sum distribution that will be allowed for each county affiliated provider so that the total per day amount does not exceed the computed Medicare upper payment limit for these providers. Distribution of these lump sum payments will be based on the Medicaid utilization at each participating facility for the period July 1 of the previous year through June 30 of the current year.

(b) In order to qualify for this lump sum adjustment, each county on behalf of its non-state government owned or operated facility must enter into a written agreement to transfer local county funds to be used as matching funds by the department. This transfer option is voluntary, but those counties that agree to participate must abide by the terms of the written agreement.

(3) On or after July 1 of each year, the department will provide for a one time, lump sum distribution of funding to nursing facilities not participating in the funding for "at risk" facilities for the provision of Medicaid services.

(4) The department will calculate the maximum amount of the lump sum payments that will be allowed for each participating non-state government owned or operated facility, as well as the additional payments for other nursing facilities not participating in the funding for "at risk" facilities for the provision of Medicaid services in accordance with state and federal laws, as well as applicable Medicare upper payment limit thresholds. This payment will be computed as a per day add-on based upon the funding available. Distribution will be in the form of lump sum payments and will be based on the Medicaid utilization at each participating facility for the period July 1 of the preceding year through June 30 of the current year.

(5) There may be no prearranged formal or informal agreements with the nursing facility to return or redirect any portion of the lump sum nursing facility payment to the county in order to fund other Medicaid services or non-Medicaid services.

(a) Payments or credits for normal operating expenses and costs are not considered a return or redirection of a Medicaid payment.

(6) "Normal operating expenses" and "costs" include, but are not limited to:

(a) taxes, including health care provider related taxes;

(b) mill levies;

(c) fees;

(d) payment of facility construction bonds or loans;

(e) health insurance costs, unemployment insurance, workers compensation, and other employee benefits;

(f) payments in lieu of rent based on depreciation cost of county buildings occupied by nursing facility;

(g) mortgage or rent payments;

(h) payment of building insurance;

(i) other business relationships with county governments unrelated to Medicaid in which there is no connection to Medicaid payments; and

(j) legitimate services provided by the county to the nursing facility such as building maintenance, legal services, accounting, and advertising.

(7) Charges for services must be reasonable and the services must be documented.

(a) Documentation supporting charges are subject to the audit and record retention provisions in ARM 37.85.414.

History: 53-6-113, MCA; IMP, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 2000 MAR p. 1754, Eff. 7/14/00; AMD, 2001 MAR p. 1108, Eff. 6/22/01; AMD, 2002 MAR p. 1767, Eff. 6/28/02; AMD, 2003 MAR p. 1294, Eff. 7/1/03; AMD, 2004 MAR p. 1479, Eff. 7/2/04; AMD, 2005 MAR p. 1401, Eff. 7/1/05; AMD, 2006 MAR p. 1638, Eff. 7/1/06; AMD, 2017 MAR p. 1670, Eff. 9/23/17.