Title: Section 86-11.6 - Trend Factor, Increases to Compensation and Other Adjustments

86-11.6 Trend Factor, Increases to Compensation and Other Adjustments.

(a) Trend Factor. For years in which the Department does not update the base year, subject to the approval of the Director of Budget, the Department may use a compounded trend factor to bring base year costs forward to the appropriate rate period. The trend factor shall be taken from applicable years from consumer and producer price indices, including, but not limited to the Medical Care Services Index; U.S. city average, by expenditure category and commodity and service group for the period April to April of each year.

(b) Increases to Compensation.

(1) Applicability. On or after January 1, 2015, rates of reimbursement for providers that operate eligible programs as defined in this section will be revised to incorporate funding for compensation increases to their direct support professional employees. Such rate increases will be effective January 1, 2015. The compensation increase funding will be included in the provider's rate issued for January 1, 2015 or in a subsequent rate with the inclusion of funding in the amount necessary to achieve the same funding impact as if the rate had been issued on January 1, 2015. The compensation increase funding will be inclusive of associated fringe benefits.

(2) Definitions. As used in this section, the following terms shall have the following meanings:

(i) Direct support professionals are those defined as Direct Care and Support per Consolidated Fiscal Report (CFR) Appendix R and reported on the CFR under the Position Title code identifiers of 100 or 200. Contracted staff salary information will not be utilized.

(ii) Clinical staff are those defined as Clinical per CFR Appendix R and reported on the CFR under the Position Title code identifier of 300. Contracted staff salary information will not be utilized.

(iii) Eligible rate based programs shall mean Intermediate Care Facility for Persons with Developmental Disabilities (ICFs/DD).

(3) Increases for Eligible Rate Based Programs.

(i) January 1, 2015 Increase. Rates for eligible rate based programs will be revised to incorporate funding for compensation increases to direct support professional employees. Such rate increases will be effective January  1, 2015. The compensation increase funding will be included in the provider’s rate issued for January  1, 2015, or in a subsequent rate with the inclusion of funding in the amount necessary to achieve the same funding impact as if the rate had been issued on January 1, 2015. The compensation increase funding will be inclusive of associated fringe benefits.

(ii) April 1, 2015 Increase. In addition to the compensation funding effective January 1, 2015, providers that operate ICFs/DD will receive a compensation increase targeted to direct support professional and clinical employees to be effective April 1, 2015. The compensation increase funding will be inclusive of associated fringe benefits. The April 1, 2015 direct support professionals compensation funding will be compounded on the amount which was calculated for the January 1, 2015 compensation increase and will be an augmentation to the January 1, 2015 increase.

(iii) Calculations. The basis for the calculation of provider and regional direct care, support and clinical salary averages and associated fringe benefit percentages will be the data in providers’ CFRs for July 1, 2010 through June 30, 2011 for providers reporting on a fiscal year basis or January 1, 2011 through December 31, 2011 for providers reporting on a calendar year basis.

(a) The January 1, 2015 and April 1, 2015 Direct Support Professionals compensation increase funding formula will be as follows:

(1) The annual impact of a two percent increase to 2010-11 or 2011 salaried direct care dollars, salaried support dollars and associated fringe benefits will be calculated.

(2) The annual impact of the two percent increase for salaried direct care dollars, salaried support dollars and associated fringe will be added to the appropriate operating components in the rate methodology. This will result in a recalculation of provider and regional average direct care wages, provider and regional average employee-related components, provider and regional average program support components, and provider and regional average direct care hourly rates.

(3) The provider direct care hourly rate – adjusted for wage equalization factor will be recalculated to utilize the provider average direct care hourly rate and regional average direct care hourly rate, as calculated in subparagraph (2) of this paragraph.

(4) An identification will be made of the dollar difference between the provider direct care hourly rate – adjusted for wage equalization factor, which is in the rate in effect on December 31, 2014, and the provider direct care hourly rate – adjusted for wage equalization factor, as calculated in subparagraph (3) of this paragraph.

(5) The rate difference identified in subparagraph (4) of this paragraph will be multiplied by the calculated direct care hours in the rate in effect on December 31, 2014 to calculate the additional funding generated by the direct care compensation adjustment.

(6) The rate add-on for the compensation increase shall be determined by dividing the additional funding, as calculated in subparagraph (5) of this paragraph by the rate sheet units in effect on January 1, 2015.

(b) The April 1, 2015 Clinical compensation increase funding formula will be as follows:

(1) The annual impact of a two percent increase to 2010-11 or 2011 salaried clinical dollars and associated fringe benefits will be calculated.

(2) The annual impact of the two percent increase for salaried clinical dollars and associated fringe will be added to the appropriate operating components in the rate methodology. This will result in a recalculation of provider and regional average employee-related components, provider and regional average clinical hourly wages.

(3) The provider clinical hourly wage – adjusted for wage equalization factor will be recalculated to utilize the provider average clinical hourly wage and regional average clinical hourly wage, as calculated in subparagraph (2) of this paragraph.

(4) An identification will be made of the dollar difference between the provider clinical hourly wage – adjusted for wage equalization factor, which is in the rate in effect on December 31, 2014, and the provider clinical hourly wage – adjusted for wage equalization factor, as calculated in subparagraph (3) of this paragraph.

(5) The rate difference identified in subparagraph (4) of this paragraph will be multiplied by the provider salaried clinical hours in the rate in effect on December 31, 2014 to calculate the additional funding generated by the clinical compensation adjustment.

(6) The rate add-on for the compensation increase shall be determined by dividing the additional funding, as calculated in subparagraph (5) of this paragraph by the rate sheet units in effect on January 1, 2015.

(c) Occupancy Adjustment

(1) Definitions.  As used in this section, the following terms shall have the following meanings:

(i) Occupancy Adjustment  – An  adjustment to the calculated daily rate of a Provider operating an ICF/DD to account for days when Medicaid billing cannot occur because an individual has passed away or has moved to another site.

(2) For the initial rate period beginning July 1, 2014 and thereafter, providers will receive an occupancy adjustment to the operating component of their rate for vacancy days.  The occupancy adjustment percentage is calculated by dividing the agency’s rate period service days by one-hundred percent of the agency’s certified capacity.  The certified capacity is calculated taking into account capacity changes throughout the year, multiplied by one-hundred percent of the year’s days.  This adjustment will begin on July 1, 2016 and be recalculated on an annual basis based on the previous year’s experience.  The occupancy adjustment calculation will be agency specific and will be the higher of the agency’s actual occupancy percentage or at 95% occupancy. The occupancy percentage will be used to adjust the operating component of the rate for the rate year.