Section 17-1739.2-9 - Application of component rate ceilings(a) Each provider's per diem cost components, as calculated in accordance with section 17-1739.2-8, shall be subject to component rate ceilings in determining a provider's basic PPS rates.(b) For each classification identified in section 17-1739.2-5, component rate ceilings shall be established as follows:(1) For each provider, multiply the provider-specific per diem component cost by the provider's total census days in the base period to determine total cost per component by provider. Any per diem component cost that is greater than two standard deviations above or below the statewide mean of the component cost shall be excluded in calculating the component rate ceilings;(2) For each classification identified in section 17-1739.2-5, sum the providers and totals calculated in paragraph (1) to determine the total cost per component for each classification;(3) Divide the classification component costs calculated in paragraph (2) by the total census days reported in the base year cost reports for all providers in the classification to determine an average cost per component by provider classification; provided, however, that if any per diem costs are excluded because they deviate more than two standard deviations from the statewide mean, then the days associated with those per diem costs shall also be deleted in calculating the average cost per component for the peer group; and(4) Multiply the results of paragraph (3) above by the following factors to determine the cost component rate ceilings by each provider classification: (A) General and Administrative-1.1;(c) Generally, each per diem cost component of a provider's basic PPS rates shall be the lesser of the provider's per diem cost component rate calculated under section 17-1739.2-8 or the per diem ceiling for that component, except as noted in section 17-1739.2-19(f). In the case of the capital component, no provider shall receive less than $1.50 a day regardless of its cost per day.(d) If a provider's rate includes a substitute direct nursing component, then all three of the component ceilings that apply to the acuity level for which the rate is being calculated shall be applied.(e) The component ceilings shall not be applied in the following circumstances: (1) To a grandfathered PPS rate;(2) To a grandfathered capital component if a provider meets the provisions of section 17-1739.2-10;(3) To grandfathered direct nursing and G&A components; and(4) To a new provider or provider with new beds whose basic PPS rates are, in whole or in part, calculated under the special provisions defined in sections 17-1739.2-10 and 17-1739.2-11. That section defines the circumstances in which either the component ceilings or some other ceilings will be applied.(f) For the FY 98 rebasing only, the rate calculation for all providers shall include the higher of the rates calculated under the following two options: (1) Sections 17-1739.2-8 and 17-1739.2-9 and increased by the GET and ROE adjustments and capital and G&A incentives, if applicable; or(2) The grandfathered PPS rate, which excludes OBRA 1987 payments, but includes rate reconsideration;(3) If the grandfathered PPS rate is the lower of the two options, then the provider shall receive the basic PPS rate and all other appropriate adjustments that are defined in this chapter.(4) If the grandfathered PPS rate is the higher of the two options, then the provider shall also receive the following adjustments or increases to that rate: (A) For FY 98, one-half of the inflation adjustment. For all subsequent PPS years, the provider shall receive the same inflation adjustments that are received by all other providers.(B) The GET adjustment, however, shall only be applied to the incremental increase to the total PPS rates that results from the adjustments or increases noted above.Haw. Code R. § 17-1739.2-9
[Eff 09/01/03] (Auth: HRS § 346-59; 42 U.S.C. §1396 a) (Imp: 42 C.F.R. §447.252 )