PDFWAC 388-835-0575

What requirements apply to calculating ICF/ID reimbursement rates?

(1) Medicaid program reimbursement rates established according to this chapter apply only to facilities holding appropriate state licenses and certified to provide ICF/ID services according to state and federal laws and regulations.
(2) All rates must be reasonable and adequate to meet the costs incurred by economically and efficiently operated facilities providing ICF/ID services according to state and federal laws and regulations.
(3) For private facilities:
(a) Final payments must be the lower of the facility's prospective rate or allowable costs.
(b) Prospective rates must be determined according to WAC 388-835-0845, 388-835-0850, 388-835-0860, 388-835-0865, 388-835-0870, 388-835-0875, and 388-835-0880.
(c) Final payments must be determined according to WAC 388-835-0880.
(4) For state facilities:
(a) Final payments must be the facility's allowable costs.
(b) Interim rates must be calculated using the most recent annual reported costs (see WAC 388-835-0845) divided by the total resident days during the reporting period. These costs may be adjusted to incorporate federal, state, or department changes in program standards or services.
(c) Final payments must be determined according to WAC 388-835-0880.
[Statutory Authority: RCW 71A.12.030 and 44.04.280. WSR 15-09-069, § 388-835-0575, filed 4/15/15, effective 5/16/15. Statutory Authority: RCW 71A.16.010, 71A.16.030, 71A.12.030, chapter 71A.20 RCW, RCW 72.01.090, and 72.33.125. WSR 02-16-014, § 388-835-0575, filed 7/25/02, effective 8/25/02. Statutory Authority: RCW 71A.20.140. WSR 01-10-013, § 388-835-0575, filed 4/20/01, effective 5/21/01.]