6502 COMPUTATION OF CEILINGS

6502.1 MAA shall classify each nursing facility operating in the District of Columbia and participating in the Medicaid Program into the following three (3) peer groups:- (a) Peer Group One - All freestanding nursing facilities, with the exception of facilities owned or operated by the District of Columbia government;

- (b) Peer Group Two - All hospital-based nursing facilities; and

- (c) Peer Group Three - All freestanding nursing facilities owned or operated by the District of Columbia government.6502.2 The ceiling for routine and support costs per diem for Peer Groups One and Two shall be the day-weighted median cost per diem for routine and support costs for all facilities in Peer Groups One and Two, which is calculated to be fifty dollars and fifty-three cents (\$50.53).6502.3 The ceiling for routine and support costs per diem for Peer Group Three shall be the day-weighted median cost per diem for routine and support costs for all facilities in Peer Group Three, which is calculated to be sixty- two dollars and twelve cents (\$62.12).6502.4 The ceiling for nursing and resident care costs per diem for Peer Group One shall be the day-weighted median case mix neutralized cost per diem for nursing and resident care costs for all facilities in Peer Group One, which is calculated to be seventy-four dollars and twelve cents (\$74.12).6502.5 The ceiling for nursing and resident care costs per diem for Peer Group Three shall be the day-weighted median case mix neutralized cost per diem for nursing and resident care costs for all facilities in Peer Group Three, which is calculated to be eighty-four dollars and eighty-three cents (\$84.83).6502.6 The ceiling for nursing and resident care costs per diem for Peer Group Two shall be the median case mix neutralized cost per diem for nursing and resident care costs for all facilities in Peer Group Two, which is calculated to be one hundred and fifty-five dollars and seventy-nine cents (\$155.79).6502.7 If a peer group has an even number of nursing facilities or resident days, the median or day-weighted median peer group ceiling shall be the arithmetic mean of the costs of the two nursing facilities or two resident days holding the middle position in the peer group array.6502.8 Once nursing facilities have been classified into peer groups for purposes of establishing the medians and ceilings, the nursing facility costs for those facilities shall remain in that peer group until Medicaid rates are rebased.

6502.9 If a nursing facility changes classification status, the facility shall be reassigned from the peer group used to establish the base year rates to the new peer group based on the revised certification status as of the beginning of the District's subsequent fiscal year.

SOURCE: Final Rulemaking published at 53 DCR 1370 (February 24, 2006).