1. (a) General NF rate setting shall be calculated in accordance with He-E 806, and requests for specialized rate setting shall be conducted pursuant to this section.

2. (b) Each NF presenting a case for consideration, whether for in state or for out of state placement, for a specialized rate, shall complete and submit a “Specialized Service Rate Request Form- Nursing Facility” (September 2020) to the department along with:

   1. (1) The individual’s:

      1. a. History and physical;
      2. b. Therapy notes;
      3. c. Transitional plan; and
      4. d. Plan of care; and
   2. (2) Documentation showing the cost of the individual’s care.
3. (c) The specialized rate request shall be reviewed by a specialized medical professional employed or contracted by the department for clinical appropriateness pursuant to He-E 802.05 above.
4. (d) The approved specialized rate shall be subject to a periodic utilization review, as requested on the “Specialized Service Rate Request Form-Nursing Facility Services”, in 30 days, 6 months, or annual increments.
5. (e) Approved rates shall be communicated to the receiving facility by the department.

Source. (See Revision Note at part heading for He-E 802) #9888-B, eff 3-19-11; ss by #12741, INTERIM, eff 3-20-19, EXPIRED: 9-16-19 New. #13130, eff 10-30-20