PURPOSE: This rule creates enhancement pools to increase reimbursement to government-owned nursing facilities and all nursing facilities, in an amount not to exceed the Medicare upper limit payment for the Medicaid program.

1. (1) Medicaid Enhancement Pools. Subject to federal approval, the Division of Medical Services shall administer two (2) enhancement payment pools to pay for services covered by the Missouri Medicaid program. The total payment from the pools shall not exceed the difference between the Medicare Upper Limit and the per diem reimbursement for all Medicaid nursing facilities for services covered by the Missouri Medicaid program. The Medicaid enhancement pools shall be calculated and distributed in the manner described below.

   1. (A) Government-owned nursing facilities may elect to participate in the funding and distribution of the first enhancement payment pool in accordance with an intergovernmental funds transfer agreement executed with the Department of Social Services.

      1. 1. The distribution from the first pool

shall be calculated as a percentage, to be determined by the Department of Social Services, of the aggregate difference between the Medicare Upper Limit and per diem reimbursement for all Medicaid nursing facilities through September 30, 2002, and for nonstate government-owned nursing facilities only after September 30, 2002, as follows:

1. A. For State Fiscal Year 2001 the

aggregate difference shall be calculated for the period August 1, 2000–June 30, 2001.

1. B. For State Fiscal Year 2002 the

aggregate difference shall be calculated for the period July 1, 2001–June 30, 2002.

1. C. For the period July 1, 2002–

September 30, 2002 the aggregate difference between the Medicare Upper Limit and per diem reimbursement shall be calculated using data for all Medicaid nursing facilities.

1. D. For the period October 1, 2002–

June 30, 2003 the aggregate difference between the Medicare Upper Limit and per diem reimbursement shall be calculated using data for nonstate governmental owned nursing facilities only.

1. 2. The pool shall be distributed to par-

ticipating government-owned nursing facilities based on a quarterly amount, based on their pro rata share of Medicaid patient days.

1. (B) All Medicaid enrolled nursing facilities may participate in distributions from the second enhancement payment pool, for State Fiscal Year 2003 after September 30, 2002, if there are state funds available.

   1. 1. The distributions from the second

pool may be calculated as a percentage, to be determined by the Department of Social Services, of the aggregate difference between the Medicare Upper Limit and per diem reimbursement for all Medicaid enrolled nursing facilities, for the period July 1, 2002–June 30, 2003.

1. 2. The second pool may be distributed

based on a monthly or quarterly amount, made in addition to per diem payments, to all Medicaid enrolled nursing facilities, applicable to services provided in State Fiscal Year 2003, based on their pro rata share of Medicaid days. A distribution will not be made based on more than a quarterly amount. A distribution will be pro rated if enrollment in the Medicaid program is not maintained by the nursing facility for the full quarter.

1. 3. For State Fiscal Year 2003, an add-on

payment, if state funds are available, may be distributed based on a monthly or quarterly amount to all Medicaid enrolled nursing facilities applicable to services provided in State Fiscal Year 2003, based on their pro rata share of Medicaid days as defined in subsection (1)(C). If a nursing facility is eligible to receive an add-on payment and does not have any paid Medicaid patient days in State Fiscal Year 2002, that facility’s Medicaid days will be determined from the previous quarter of the quarter in which the add-on payment is made.

1. (C) The aggregate difference between the Medicare Upper Limit and the per diem reimbursement for Medicaid nursing facilities will be calculated on an annual basis. The per diem Medicaid rates used in the calculation will be those being paid at the time of the calculation and the Medicare Upper Limit will based on the current Research Utilization Groups (RUGS) system of Medicare nursing facility reimbursement with appropriate adjustments to assure comparability with the Medicaid rate. The difference will be calculated on a facility basis and multiplied by the reported Medicaid days at the particular nursing facility for the most recent cost report year. The product of all calculations will be added together to obtain the aggregate difference. Medicaid days will be determined from the paid day report from Missouri’s fiscal agent for pay cycles during the State’s Fiscal Year 2002.

AUTHORITY: sections 208.153, 208.159 and 208.201, RSMo 2000.* Emergency rule filed Nov. 3, 2000, effective Nov. 13, 2000, expired May 11, 2001. Original rule filed Nov. 13, 2000, effective May 30, 2001. Emergency amendment filed July 9, 2001, effective July 19, 2001, expired Feb. 28, 2002. Amended: Filed July 9, 2001, effective Dec. 30, 2001. Emergency amendment filed Oct. 29, 2002, effective Nov. 8, 2002, expired May 6, 2003. Amended: Filed Oct. 29, 2002, effective April 30, 2002. *Original authority: 208.153, RSMo 1967, amended 1967, 1973, 1989, 1990, 1991; 208.159, RSMo 1979; 208.201, RSMo 1987. Rule Action Notice: 13 CSR 70-10.150(1)(B) Rule Suspension. The Missouri Constitution authorizes the governor to control the rate at which appropriations are expended or reduce expenditures below the appropriated amount when actual revenues are less than estimated. The State Fiscal Year (SFY) 2002 revenue projection is expected to be $750 million less than the original consensus revenue forecast, which was established in December, 2000. This original forecast was the basis upon which the SFY 2002 budget was established by the General Assembly and the governor. The current revenue projection is $230 mil- 13 CSR 70-10 lion less than the revised consensus revenue forecast, which was established in December, 2001. Attempts to access the Rainy Day Fund were not supported by a super majority in the House, even though accessing the fund was proposed by the governor and supported by the Senate. Subsequently, the Department of Social Services was notified by the governor that monies appropriated in SFY 2002 for nursing facility efficiency grants in the approximate amount of $20 million would not be available for expenditure. These monies were contained in House Bill 11, Section 11.445. At this time, the Department of Social Services must suspend the rule authorizing the payment of these monies, effective immediately. Action Taken: Rule 13 CSR 70-10.150(1)(B) is suspended. Authority: Missouri Constitution Article IV, Section 27, and sections 536.022 and 208.201, RSMo 2000. Rule suspension filed May 22, 2002. Attention: Pursuant to the Temporary Restraining Order of Circuit Judge Thomas J. Brown, of the 19th Judicial Circuit, Division I, entered on the 21st day of June 2002, this “Notice of Rule Suspension” is hereby temporarily enjoined from taking effect, until further action by said Court. Cole County Circuit Court, Case No. 02CV324451. (see July 1, 2002, Missouri Register (27 MoReg 1126– 1128).