CABINET FOR HEALTH AND FAMILY SERVICES

Department for Behavioral Health, Developmental and

Intellectual Disabilities

Division of Administration and Financial Management

(Amendment)

 

      908 KAR 3:050. Per diem rates.

 

      RELATES TO: KRS 210.710, 210.720, 210.730

      STATUTORY AUTHORITY: KRS 194A.050(1), 210.720(2), 210.750

      NECESSITY, FUNCTION, AND CONFORMITY: KRS 210.720(2) requires the secretary of the Cabinet for Health and Family Services to establish the patient cost per day for board, maintenance, and treatment for state owned facilities[a facility operated by the cabinet] at frequent intervals which shall be the uniform charge for persons receiving those services. KRS 210.750 authorizes the secretary to promulgate administrative regulations to implement KRS 210.710 to 210.760, the Patient Liability Act of 1978. This administrative regulation establishes the patient cost per day for board, maintenance, and treatment at state owned facilities[operated by the cabinet].

 

      Section 1. Facility Rates. (1) Facilities owned[operated] by the state[cabinet] shall charge a per diem rate for room and board and a separate charge for each treatment service listed in subsection (3) of this section that is provided.

      (2) The per diem rate for room and board for each facility shall be as follows:

Facility

Rate

Central State Hospital

$1,025[$865]

Bingham Gardens

$1,500[$1,590]

Western State Hospital

$740

Western State Nursing Facility

$385[$325]

Outwood ICF/MR

$775[$650]

Oakwood Community Center

Unit 1

$1,225[$1,320]

Unit 2

$1,115[$1,200]

Unit 3

$1,110[$1,200]

Unit 4

$1,115[$1,200]

Hazelwood Center

$1,015[$890]

Glasgow State Nursing Facility

$355

Del Maria

$625[$630]

Meadows

$750[$735]

Windsong

$680[$770]

Eastern State Hospital

$625[$565]

      (3) A separate charge shall be imposed if the following treatment services are provided at a Department for Behavioral Health, Developmental and Intellectual Disabilities facility listed in subsection (2) of this section:

      (a) Physician’s services;

      (b) EEG;

      (c) EKG;

      (d) Occupational therapy;

      (e) Physical therapy;

      (f) X-ray;

      (g) Laboratory;

      (h) Speech therapy;

      (i) Hearing therapy;

      (j) Psychology;

      (k) Pharmacy;

      (l) Respiratory therapy;

      (m) Anesthesia;

      (n) Electroshock therapy;

      (o) Physician assistant; and

      (p) Advanced practice registered nurse.

 

      Section 2. Board, Maintenance, and Treatment Charges. The cost per day for board, maintenance, and treatment charges shall be established using the last available cost report adjusted for inflation. Current rates shall be posted at each facility.

 

MARY REINLE BEGLEY, Commissioner

AUDREY TAYSE HAYNES, Secretary

      APPROVED BY AGENCY: August 7, 2014

      FILED WITH LRC: August 14, 2014 at 1 p.m.

      PUBLIC HEARING AND PUBLIC COMMENT PERIOD: A public hearing on this administrative regulation shall be held on September 22, 2014, at 9:00 a.m. in Conference Suite B, Health Services Building, First Floor, 275 East Main Street, Frankfort, Kentucky 40621.  Individuals interested in attending this hearing shall notify this agency in writing by September 15, 2014, five workdays prior to the hearing, of their intent to attend.  If no notification of intent to attend the hearing is received by that date, the hearing may be canceled.  The hearing is open to the public.  Any person who attends will be given an opportunity to comment on the proposed administrative regulation.  A transcript of the public hearing will not be made unless a written request for a transcript is made.  If you do not wish to attend the public hearing, you may submit written comments regarding this proposed administrative regulation through September 30, 2014.  Send written notification of intent to attend the public hearing or written comments on the proposed administrative regulation to:

      CONTACT PERSON: Tricia Orme, Office of Legal Services, 275 East Main Street - 5W-B, Frankfort, Kentucky  40621, phone (502) 564-7905, fax (502) 564-7573, tricia.orme@ky.gov.

 

REGULATORY IMPACT ANALYSIS And Tiering Statement

 

Contact Person: Paula DeWitt or Susan Walker

      (1) Provide a brief summary of:

      (a) What this administrative regulation does: This administrative regulation establishes the patient cost per day for board, maintenance, and treatment for a facility owned by the state which shall be the uniform charge for persons receiving those services.

      (b) The necessity of this administrative regulation: This administrative regulation is necessary in order to comply with the provisions of KRS 210.720(2).

      (c) How this administrative regulation conforms to the content of the authorizing statutes: KRS 210.720(2) requires the cabinet to establish, at frequent intervals, the patient cost per day for board, maintenance and treatment for a facility owned by the state.

      (d) How this administrative regulation currently assists or will assist in the effective administration of the statutes: This administrative regulation establishes the patient cost per day for board, maintenance and treatment for a facility owned by the state as required by KRS 210.720(2).  The per diem rates are determined by applying a formula that has been in use since the 1980s.  This formula calculates per diem rates by dividing actual costs for a state owned facility (using cost reports from a previous fiscal year) by the total number of a patient's days. 

      (2) If this is an amendment to an existing administrative regulation, provide a brief summary of:

      (a) How the amendment will change this existing administrative regulation: This administrative regulation is being amended to establish the revised patient cost per day for facilities owned by the state as required by KRS 210.270(2).

      (b) The necessity of the amendment to this administrative regulation:  The amendment to this administrative regulation is necessary to assure that the cabinet complies with KRS 210.720(2) by establishing the patient cost per day for board, maintenance, and treatment for each facility owned by the state.

      (c) How the amendment conforms to the content of the authorizing statutes: KRS 210.720(2) requires the cabinet to establish the patient cost per day for board, maintenance and treatment for a facility owned by the state at a frequent interval.

      (d) How the amendment will assist in the effective administration of the statutes: KRS 210.720(1) requires that every patient admitted to a facility owned by the state, except for prisoners transferred in accordance with KRS 202A.201 shall be charged for board, maintenance, and treatment.  This administrative regulation establishes a rate for room, board, and treatment which is based on a formula in use for over twenty (20) years that calculates per diem rates by dividing actual cost for a state owned facility (using cost reports from the previous fiscal year) by the total number of patient days.

      (3) List the type and number of individuals, businesses, organizations, or state and local government affected by this administrative regulation:  There are fifteen (15) state owned facilities affected by this administrative regulation.  In addition, this amendment will affect only a small number of patients (approximately ten (10) on any given day out of an average daily statewide census in excess of 1,000) admitted to these facilities who have the financial resources to be 100 percent self-pay and are uninsured.  Medicare pays at the reimbursement rates it establishes under CMS requirements, not the per diem rates found in this regulation.  Private insurers and MCOs will pay a negotiated rate to state owned facilities – just as they do with other health care providers.

   (4) Provide an analysis of how the entities identified in question (3) will be impacted by either the implementation of this administrative regulation, if new, or by the change, if it is an amendment, including:

      (a) List the actions that each of the regulated entities identified in question (3) will have to take to comply with this administrative regulation or amendment: Each facility will be required to change the charge rates in their billing systems.

      (b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3): There will not be any cost for a state owned facility to comply with this administrative regulation.  For those few patients who are uninsured and have the resources to be 100 percent self-pay, the per diem rate will increase in some state owned facilities.  Thus, they would pay more for services. In other state owned facilities, the per diem rate will decrease resulting in a lower cost for patients who are 100 percent self-pay and uninsured.

      (c) As a result of compliance, what benefits will accrue to the entities identified in question (3): This change will ensure that the facilities are reimbursed for services and treatments they rendered to self-pay patients.

      (5) Provide an estimate of how much it will cost to implement this administrative regulation: 

      (a) Initially: There will be no additional cost to implement this administrative regulation.

      (b) On a continuing basis: There will be no additional cost to implement this administrative regulation.

      (6) What is the source of the funding to be used for the implementation and enforcement of this administrative regulation:  Residential services are funded primarily with restricted agency funds generated from patient charges.

      (7) Provide an assessment of whether an increase in fees or funding will be necessary to implement this administrative regulation, if new or by the change if it is an amendment:  This administrative regulation adjusts the charge rates as required by statute.  Because only a small number of patients (those who have the resourced to be 100 percent self-pay and who are uninsured) will be required to pay the revised rates, it is anticipated that the revenue increase would be approximately $14,000. Medicare, Medicaid and private insurance payors do not base their reimbursement on this billed amount, but on Medicare and Medicaid reimbursement requirements. And private insurers and MCOs are based on negotiated rates.

      (8) State whether or not this administrative regulation establishes any fees or directly or indirectly increases any fees:  The amendment to this administrative regulation establishes, as required by law, charges for room, board, and treatment at state owned facilities.  At some state owned facilities, the per diem rate will increase; at other facilities, the per diem rate will decrease.  Per diem rates are set utilizing the facilities most recently completed cost reports. 

      (9) Tiering: Is tiering applied? Tiering is not appropriate in this administrative regulation because all facility rates are set based on actual cost.

 

FISCAL NOTE ON STATE OR LOCAL GOVERNMENT

 

       (1) What units, parts or divisions of state or local government (including cities, counties, fire departments, or school districts) will be impacted by this administrative regulation? This administrative regulation impacts the fifteen (15) state owned facilities.

      (2) Identify each state or federal statute or federal regulation that requires or authorizes the action taken by the administrative regulation. KRS 210.720 (2)

      (3) Estimate the effect of this administrative regulation on the expenditures and revenues of a state or local government agency (including cities, counties, fire departments, or school districts) for the first full year the administrative regulation is to be in effect.

      (a) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for the first year? This administrative regulation will generate a minimal amount of additional revenue for the Department for Behavioral Health, Developmental and Intellectual Disabilities – approximately $14,000 in the first year.

      (b) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for subsequent years? This administrative regulation will generate a minimal amount of additional revenue for the Department for Behavioral Health, Developmental and Intellectual Disabilities – approximately $14,000 in subsequent years.

      (c) How much will it cost to administer this program for the first year? There will be no additional cost associated administrating this regulation in the first year.

      (d) How much will it cost to administer this program for subsequent years? There will be no additional cost associated with administrating this regulation in subsequent years.

      Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.

      Revenues (+/-): This administrative regulation does not generate any revenue.

      Expenditures (+/-): This administrative regulation sets per diem rate for facilities owned by the state.

      Other Explanation: