PURPOSE: This rule implements a supplemental payment program for qualifying public nursing facilities.

1. (1) Effective for dates of service beginning July 1, 2013, Nursing Facility Upper Payment Limit (UPL) payments shall be made as set forth below in subsections (1)(A)-(1)(C). Maximum aggregate payments to all qualifying nursing facilities shall not exceed the UPL defined in 42 CFR 447.272 in each state fiscal year.

   1. (A) An annual UPL payment shall be made after the end of each state fiscal year (SFY) to qualifying nursing facilities.

   2. (B) Qualifying Criteria. Public nursing facilities that have executed an agreement with the department are eligible for a UPL payment and shall be referred to as qualifying nursing facilities. In addition, to qualify for the UPL payment, each nursing facility must be enrolled in the Medicaid program at the time the UPL payments are calculated and made.

      1. 1. A public nursing facility is defined as being owned or

operated by a public entity.

1. (C) Reimbursement Methodology. The annual UPL payment will be made to qualifying nursing facilities based on each facility’s unreimbursed costs determined from the facility’s second prior year Medicaid cost report, subject to the Medicare Upper Payment Limit.

AUTHORITY: sections 208.201 and 660.017, RSMo 2016.* Original rule filed Feb. 15, 2012, effective Aug. 30, 2012. Amended: Filed July 1, 2013, effective Jan. 30, 2014. Amended: Filed Aug. 15, 2014, effective Feb. 28, 2015. Amended: Filed Aug. 28, 2018, effective April 30, 2019. *Original authority: 208.201, RSMo 1987, amended 2007 and 660.017, RSMo 1993, amended 1995.