Section 86-7.2 - Computation of the rate of payment

86-7.2 Computation of the rate of payment.

(a) For each region, a rate of payment shall be established for each of the sixteen patient classification groups. The rate of payment shall be established for the calendar year 1992. For each subsequent calendar year, the 1992 rate of payment shall be increased by a roll factor as determined pursuant to section 86-7.3.

(b)(1) For purposes of this Subpart, the rate of payment shall be related to an average residential health care facility rate consisting of two components:

(i) Direct component;

(ii) Other than direct component.

(2) Direct component of the rate of payment:

(i) The direct component of the rate of payment shall be composed of costs incurred in providing care directly to patients as set forth in section 86-2.10(c)(1).

(ii) The direct component for each patient classification group shall be equal to the statewide mean direct case mix neutral cost, as determined in section 86-2.10(c)(3), times the case mix index for the patient classification group divided by a regional direct input price adjustment factor for the patient classification group as identified in subparagraph (iii) of this paragraph and trended to 1992 by the applicable weighted average regional roll factor as determined pursuant to section 86-7.3. The case mix index for each patient classification group shall be as identified in Appendix 13-A of this Title, however, the case mix index for reduced physical functioning A shall be .4414 as identified in section 86-2.10(c)(3)(iii)(i).

(iii) The Regional Direct Input Price Adjustment Factor (RDIPAF) shall adjust for differences in wage and fringe benefit costs between and among the regions caused by differences in the wage scale of each level of employee. Within each region, a RDIPAF shall be calculated for each patient classification group.

The RDIPAF shall be based upon the following factors:

(a) Sixteen regions within the state as identified in Appendix 13-A.

(b) Case mix predicted staffing for registered professional nurses, licensed practical nurses and aides, orderlies and assistants for each patient classification group.

(c) The proportion of residential health care facility salaries and fringe benefit costs for the direct care cost centers identified in section 86-2.10(c)(1) to the total costs of the direct care cost centers.

(d) A regional average dollar per hour and proportion of regional direct salaries and fringe benefits to total direct costs as identified in clause (c) of this subparagraph based upon either 1983 or 1987 residential health care facility financial and statistical data in accordance with section 86-2.10(m)(l)(iv).

(3) Other than direct component of the rate of payment:

(i) The other than direct component shall be equal to the mean indirect price per day set forth in section 86-2.10(d)(4) for the freestanding, low intensity, less than 300 beds peer group divided by the regional indirect input price adjustment factor for the patient classification group as identified in subparagraph (ii) of this paragraph and trended to 1992 by the applicable weighted average regional roll factor as determined pursuant to section 86-7.3 plus a 1992 regional weighted average per diem for other than direct and indirect components of the RHCF rate as set forth in sections 86-2.10 (f), (g) and (r), computed using the first January 1, 1992 rate promulgated following the thirty day period established for correcting errors in the initial January 1, 1992 rate issued at least sixty days prior to January 1, 1992.

(ii) The Regional Indirect Input Price Adjustment Factor (RIIPAF) shall adjust for differences in wage and fringe benefit costs between and among the wage equalization factor regions caused by differences in the wage scale of each level of employee. Within each region, a RIIPAF shall be calculated for each patient classification group. The RIIPAF shall be based upon the following factors:

(a) Sixteen regions within the state, as identified in Appendix 13-A.

(b) Case mix predicted staffing for registered professional nurses, licensed practical nurses and aides, orderlies and assistants for each patient classification group.

(c) The proportion of regional RHCF salaries and fringe benefit costs for the indirect cost centers identified in section 86-2.10(d)(1) to the total costs of the indirect care cost centers.

(d) A regional average dollar per hour and proportion of regional indirect salaries and fringe benefits to total indirect costs as identified in clause (c) of this subparagraph based upon either 1983 or 1987 residential health care facility financial and statistical data in accordance with section 86-2.10(m)(l)(iv). (c) For calendar year 1992, for each patient classification group in each region, the direct and other than direct components shall be summed and multiplied by fifty percent. For subsequent calendar years, the 1992 rate of payment shall be increased by the applicable roll factor determined pursuant to section 86-7.3(b).
 

Effective Date: 
Monday, December 20, 1993
Doc Status: 
Complete