Interim Rate Setting
(1)A hospital may request an interim per diem rate or rates. If a review of the hospital’s prior year Medicaid cost report (adjusted for inflation, changes in patient populations and programs and other relevant factors) does not justify the requested rate(s), the Medicaid Intermediary may establish different interim rate(s):
(a)Actual expenditures for the most recent fiscal period available will be used to determine salary and wage and total expense distribution for each cost center included in the total expenditures. Any other directly relevant event, such as facility restructuring, will be considered as well;
(b)The Division will apply the proportions from subsection (a) of this section to total anticipated expenditures for the new period to determine salary and wage expense distribution for each cost center during the new period;
(c)The Division will establish and apply capital allowances and other adjustments to total anticipated expenditures for the new period from subsection (b) of this section;
(d)If the hospital has separate cost entities or distinct programs, the hospital will provide estimates to the Division of a weighted average interim rate. The average will be developed by multiplying each proposed interim rate by estimated Medicaid patient days for that rate, summing all of the products, and dividing that sum by the total annual estimated Medicaid patient days for the hospital;
(e)The interim or weighted average interim per diem rate may not exceed the maximum allowable rate unless the hospital meets the criteria for reimbursement above the maximum allowable rate as a disproportionate share hospital (see OAR 309-015-0035 (Payments)(5)). In that case, the interim or average interim Disproportionate Share adjusted Medicaid Rate (DSR) may include estimated costs up to 135 percent of the maximum allowable Medicaid rate except for hospitals meeting criteria set forth in the following paragraph;
(f)If a psychiatric hospital has a low-income rate of 60 percent and also receives 60 percent or more of its service revenue from any combination of the following:
(A)Public funds, excluding Medicare and Medicaid;
(B)Bad debts; or
(g)The hospital qualifies to receive disproportionate share payment at a rate based on 100 percent of the costs of uncompensated care during the facility’s previous fiscal year, subject to a disproportionate share allotment established for Oregon by the Health Care Financing Administration;
(h)The Division will base quarterly disproportionate share reimbursements on the estimated costs for each facility during the current fiscal year and will review and adjust the reimbursements, after conclusion of the fiscal period, to correspond with actual costs encountered during the period. Total reimbursement from disproportionate share and other sources will not exceed actual costs.
(2)If a hospital does not request an interim rate, the Medicaid Intermediary will establish an interim rate based on the hospital’s prior year cost report using the same factors listed in section (1) of this rule.
Rule 309-015-0023 — Interim Rate Setting,