20 CAR § 579-204 – Rate limitations based on Medicaid rates

(a) The purpose of this provision is to ensure that the Medicaid program is not charged unfairly high rates as compared to other payers.
(b) To that end, Medicaid reimbursement is limited by the weighted average per diem rates charged to other payers.
(c) Specifically, if a long-term care facility charges other long-term care payers less than eighty percent (80%) of the Medicaid rate for long-term care services, except for those public facilities rendering long-term care services free of charge or at a nominal charge, then the weighted average Medicaid reimbursement will be reduced to no more than one hundred twenty-five percent (125%) of the facility’s weighted average reimbursement.
(d) For purposes of applying this rule:
1. (1) Weighted average per diem rates for other payers will be compared to the weighted average Medicaid per diem rates by fiscal year;
2. (2) The sixty (60) consecutive days after a Medicaid rate increase shall not be considered; and
3. (3) No facility shall be required to make a retroactive rate adjustment.