(1) Nursing
facility medicaid payment rate allocations shall be
facility-specific and shall have six components: Direct care,
therapy care, support services, operations, property, and
financing allowance. The department shall establish and adjust
each of these components, as provided in this section and
elsewhere in this chapter, for each medicaid nursing facility in
this state.
(2) Component rate allocations in therapy care and support
services for all facilities shall be based upon a minimum
facility occupancy of eighty-five percent of licensed beds,
regardless of how many beds are set up or in use. Component rate
allocations in operations, property, and financing allowance for
essential community providers shall be based upon a minimum
facility occupancy of eighty-seven percent of licensed beds,
regardless of how many beds are set up or in use. Component rate
allocations in operations, property, and financing allowance for
small nonessential community providers shall be based upon a
minimum facility occupancy of ninety-two percent of licensed
beds, regardless of how many beds are set up or in use.
Component rate allocations in operations, property, and financing
allowance for large nonessential community providers shall be
based upon a minimum facility occupancy of ninety-five percent of
licensed beds, regardless of how many beds are set up or in use.
For all facilities, the component rate allocation in direct care
shall be based upon actual facility occupancy. The median cost
limits used to set component rate allocations shall be based on
the applicable minimum occupancy percentage. In determining each
facility's therapy care component rate allocation under RCW 74.46.511, the department shall apply the applicable minimum
facility occupancy adjustment before creating the array of
facilities' adjusted therapy costs per adjusted resident day. In
determining each facility's support services component rate
allocation under RCW 74.46.515(3), the department shall apply the
applicable minimum facility occupancy adjustment before creating
the array of facilities' adjusted support services costs per
adjusted resident day. In determining each facility's operations
component rate allocation under RCW 74.46.521(3), the department
shall apply the minimum facility occupancy adjustment before
creating the array of facilities' adjusted general operations
costs per adjusted resident day.
(3) Information and data sources used in determining
medicaid payment rate allocations, including formulas,
procedures, cost report periods, resident assessment instrument
formats, resident assessment methodologies, and resident
classification and case mix weighting methodologies, may be
substituted or altered from time to time as determined by the
department.
(4)(a) Direct care component rate allocations shall be
established using adjusted cost report data covering at least six
months. Effective July 1, 2009, the direct care component rate
allocation shall be rebased, so that adjusted cost report data
for calendar year 2007 is used for July 1, 2009, through June 30,
2013. Beginning July 1, 2013, the direct care component rate
allocation shall be rebased biennially during every odd-numbered
year thereafter using adjusted cost report data from two years
prior to the rebase period, so adjusted cost report data for
calendar year 2011 is used for July 1, 2013, through June 30,
2015, and so forth.
(b) Direct care component rate allocations established in
accordance with this chapter shall be adjusted annually for
economic trends and conditions by a factor or factors defined in
the biennial appropriations act. The economic trends and
conditions factor or factors defined in the biennial
appropriations act shall not be compounded with the economic
trends and conditions factor or factors defined in any other
biennial appropriations acts before applying it to the direct
care component rate allocation established in accordance with
this chapter. When no economic trends and conditions factor or
factors for either fiscal year are defined in a biennial
appropriations act, no economic trends and conditions factor or
factors defined in any earlier biennial appropriations act shall
be applied solely or compounded to the direct care component rate
allocation established in accordance with this chapter.
(5)(a) Therapy care component rate allocations shall be
established using adjusted cost report data covering at least six
months. Effective July 1, 2009, the therapy care component rate
allocation shall be cost rebased, so that adjusted cost report
data for calendar year 2007 is used for July 1, 2009, through
June 30, 2013. Beginning July 1, 2013, the therapy care
component rate allocation shall be rebased biennially during
every odd-numbered year thereafter using adjusted cost report
data from two years prior to the rebase period, so adjusted cost
report data for calendar year 2011 is used for July 1, 2013,
through June 30, 2015, and so forth.
(b) Therapy care component rate allocations established in
accordance with this chapter shall be adjusted annually for
economic trends and conditions by a factor or factors defined in
the biennial appropriations act. The economic trends and
conditions factor or factors defined in the biennial
appropriations act shall not be compounded with the economic
trends and conditions factor or factors defined in any other
biennial appropriations acts before applying it to the therapy
care component rate allocation established in accordance with
this chapter. When no economic trends and conditions factor or
factors for either fiscal year are defined in a biennial
appropriations act, no economic trends and conditions factor or
factors defined in any earlier biennial appropriations act shall
be applied solely or compounded to the therapy care component
rate allocation established in accordance with this chapter.
(6)(a) Support services component rate allocations shall be
established using adjusted cost report data covering at least six
months. Effective July 1, 2009, the support services component
rate allocation shall be cost rebased, so that adjusted cost
report data for calendar year 2007 is used for July 1, 2009,
through June 30, 2013. Beginning July 1, 2013, the support
services component rate allocation shall be rebased biennially
during every odd-numbered year thereafter using adjusted cost
report data from two years prior to the rebase period, so
adjusted cost report data for calendar year 2011 is used for July
1, 2013, through June 30, 2015, and so forth.
(b) Support services component rate allocations established
in accordance with this chapter shall be adjusted annually for
economic trends and conditions by a factor or factors defined in
the biennial appropriations act. The economic trends and
conditions factor or factors defined in the biennial
appropriations act shall not be compounded with the economic
trends and conditions factor or factors defined in any other
biennial appropriations acts before applying it to the support
services component rate allocation established in accordance with
this chapter. When no economic trends and conditions factor or
factors for either fiscal year are defined in a biennial
appropriations act, no economic trends and conditions factor or
factors defined in any earlier biennial appropriations act shall
be applied solely or compounded to the support services component
rate allocation established in accordance with this chapter.
(7)(a) Operations component rate allocations shall be
established using adjusted cost report data covering at least six
months. Effective July 1, 2009, the operations component rate
allocation shall be cost rebased, so that adjusted cost report
data for calendar year 2007 is used for July 1, 2009, through
June 30, 2013. Beginning July 1, 2013, the operations care
component rate allocation shall be rebased biennially during
every odd-numbered year thereafter using adjusted cost report
data from two years prior to the rebase period, so adjusted cost
report data for calendar year 2011 is used for July 1, 2013,
through June 30, 2015, and so forth.
(b) Operations component rate allocations established in
accordance with this chapter shall be adjusted annually for
economic trends and conditions by a factor or factors defined in
the biennial appropriations act. The economic trends and
conditions factor or factors defined in the biennial
appropriations act shall not be compounded with the economic
trends and conditions factor or factors defined in any other
biennial appropriations acts before applying it to the operations
component rate allocation established in accordance with this
chapter. When no economic trends and conditions factor or
factors for either fiscal year are defined in a biennial
appropriations act, no economic trends and conditions factor or
factors defined in any earlier biennial appropriations act shall
be applied solely or compounded to the operations component rate
allocation established in accordance with this chapter.
(8) Total payment rates under the nursing facility medicaid
payment system shall not exceed facility rates charged to the
general public for comparable services.
(9) The department shall establish in rule procedures,
principles, and conditions for determining component rate
allocations for facilities in circumstances not directly
addressed by this chapter, including but not limited to:
Inflation adjustments for partial-period cost report data, newly
constructed facilities, existing facilities entering the medicaid
program for the first time or after a period of absence from the
program, existing facilities with expanded new bed capacity,
existing medicaid facilities following a change of ownership of
the nursing facility business, facilities temporarily reducing
the number of set-up beds during a remodel, facilities having
less than six months of either resident assessment, cost report
data, or both, under the current contractor prior to rate
setting, and other circumstances.
(10) The department shall establish in rule procedures,
principles, and conditions, including necessary threshold costs,
for adjusting rates to reflect capital improvements or new
requirements imposed by the department or the federal government.
Any such rate adjustments are subject to the provisions of RCW 74.46.421.
(11) Effective July 1, 2010, there shall be no rate
adjustment for facilities with banked beds. For purposes of
calculating minimum occupancy, licensed beds include any beds
banked under chapter 70.38 RCW.
(12) Facilities obtaining a certificate of need or a
certificate of need exemption under chapter 70.38 RCW after June
30, 2001, must have a certificate of capital authorization in
order for (a) the depreciation resulting from the capitalized
addition to be included in calculation of the facility's property
component rate allocation; and (b) the net invested funds
associated with the capitalized addition to be included in
calculation of the facility's financing allowance rate
allocation.
[2011 1st sp.s. c 7 § 1; 2010 1st sp.s. c 34 § 3; 2009 c 570 § 1; 2008 c 263 § 2; 2007 c 508 § 2; 2006 c 258 § 2; 2005 c 518 § 944; 2004 c 276 § 913; 2001 1st sp.s. c 8 § 5; 1999 c 353 § 4; 1998 c 322 § 19.]
NOTES:
Analysis -- 2011 1st sp.s. c 7: "(1) For fiscal years 2012
and 2013 and subject to appropriation, the department of social
and health services shall do a comparative analysis of the
facility-based payment rates calculated on July 1, 2011, using
the payment methodology defined in chapter 74.46 RCW as modified
by RCW 74.46.431, 74.46.435, 74.46.437, 74.46.485, 74.46.496,
74.46.501, 74.46.506, 74.46.515, and 74.46.521, to the
facility-based payment rates in effect June 30, 2010. If the
facility-based payment rate calculated on July 1, 2011, is
smaller than the facility-based payment rate on June 30, 2011,
the difference shall be provided to the individual nursing
facilities as an add-on payment per medicaid resident day.
(2) During the comparative analysis performed in subsection
(1) of this section, if it is found that the direct care rate for
any facility calculated under RCW 74.46.431, 74.46.435,
74.46.437, 74.46.485, 74.46.496, 74.46.501, 74.46.506, 74.46.515,
and 74.46.521 is greater than the direct care rate in effect on
June 30, 2010, then the facility shall receive a ten percent
direct care rate add-on to compensate that facility for taking on
more acute clients than they have in the past.
(3) The rate add-ons provided in subsection (2) of this
section are subject to the reconciliation and settlement process
provided in RCW 74.46.022(6)." [2011 1st sp.s. c 7 § 11.]
Purpose -- Findings -- Intent -- Severability -- Effective date -- 2011 1st sp.s. c 7: See RCW 74.48.005, 74.48.900, and 74.48.901.
Effective date -- 2010 1st sp.s. c 34: See note following RCW 74.46.010.
Effective date -- 2009 c 570: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect immediately [May 19, 2009]." [2009 c 570 § 3.]
Effective date -- 2007 c 508: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect July 1, 2007." [2007 c 508 § 8.]
Effective date -- 2006 c 258: See note following RCW 74.46.020.
Severability -- Effective date -- 2005 c 518: See notes following RCW 28A.500.030.
Severability -- Effective date -- 2004 c 276: See notes following RCW 43.330.167.
Severability -- Effective dates -- 2001 1st sp.s. c 8: See notes following RCW 74.46.020.
Effective dates -- 1999 c 353: See note following RCW 74.46.020.