1. A. Effective for dates of service on or after September 1, 2007, Medicaid participating nursing facilities that convert a semi-private room to a Medicaid-occupied private room are eligible to receive an additional $5 per diem payment. Facilities that participate will have their fair rental value per diem revised based on the change in licensed beds.

2. B. Qualifying Facilities

   1. 1. In order for a nursing facility's beds to qualify for an additional $5 per diem payment, a revised fair rental value (FRV), a revised property tax pass-through, and revised property insurance pass-through, all of the following conditions must be met.

      1. a. The nursing facility must convert one or more semi-private rooms to private rooms on or after September 1, 2007.
      2. b. The converted private room(s) must be occupied by a Medicaid resident(s) to receive the $5 per diem payment.
      3. c. The nursing facility must surrender their bed licenses equal to the number of converted private rooms.

      4. d. The nursing facility must submit the following information to the department within 30 days of the private room conversion:

         1. i. the number of rooms converted from semi-private to private;
         2. ii. the revised bed license;
         3. iii. a resident listing by payer type for the converted private rooms; and
         4. iv. the date of the conversions.

3. C. The additional $5 per diem payment determination will be as follows.

   1. 1. An additional $5 will be added to the nursing facility's case-mix rate for each Medicaid resident day in a converted private room.
   2. 2. The payment will begin the first day of the following calendar quarter, after the facility meets all of the qualifying criteria in §1310.B.1.
   3. 3. A change in ownership, major renovation, or replacement facility will not impact the $5 additional per diem payment provided that all other provisions of this Section have been met.

4. D. The revised fair rental value per diem will be calculated as follows.

   1. 1. After a qualifying conversion of semi-private rooms to private rooms, the nursing facility's square footage will be divided by the remaining licensed nursing facility beds to calculate a revised square footage per bed.

   2. 2. After a qualifying private room conversion, the allowable square footage per bed used in §1305.D.3.b. will be determined as follows.

      1. a. No Change in Total Square Footage. The total allowable square footage after a qualifying private room conversion will be equal to the total allowable square footage immediately prior to the conversion, provided no other facility renovations or alterations changing total square footage occur concurrently or subsequently to the private room conversion.
      2. b. Square Footage Changes to Existing Buildings. If a change in total nursing square footage occurs in a building existing on the effective date of this rule and that change is concurrent or subsequent to a private room conversion, the allowable square footage will be determined in accordance with §1305.D.3.b.i as if the private room conversion did not occur.
      3. c. Square Footage Changes Due to New Buildings. Replacement buildings constructed or first occupied after the effective date of this rule will have their allowable square footage calculated in accordance with §1305.D.3.b.i.
   3. 3. Resident days used in the fair rental value per diem calculation will be the greater of the annualized actual resident days from the base year cost report or 85 percent of the revised annual bed days available after the change in licensed beds.
   4. 4. A revised fair rental value per diem will be calculated under §1305.D.3.b. using the allowable square footage according to §1310.D.2, remaining licensed beds, and the revised minimum occupancy calculation.
   5. 5. The revised fair rental value per diem will be effective the first of the following calendar quarter, after the facility meets all qualifying criteria in paragraph §1310.B.1.

5. E. Reporting

   1. 1. To remain eligible for the conversion payments and the allowable square footage calculations, facilities must report Medicaid-occupied private rooms with every annual cost report.
   2. 2. The department may also require an alternate billing procedure for providers to receive the additional $5 private room rate.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254, R.S. 46:2742, and Title XIX of the Social Security Act.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 33:1646 (August 2007), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 40:794 (April 2014).