- (a) Rate setting and payment limitations for NF care shall be determined as specified in (b) through (f) below.
- (b) Each NF's per diem rate shall be reviewed at least annually by the department pursuant to He-E 806 utilizing data submitted on the annual cost report.
(c) The per diem rate shall be calculated by dividing allowable costs by either:
- (1) The actual days of service rendered, including reserved bed days; or
- (2) For the capital component, the greater of the actual days of service rendered or the number of resident days computed at 85% of the certified bed capacity.
- (d) In no case shall payment exceed the NF’s customary charges to the general public for such services, or, where applicable, the Medicare rate of reimbursement, whichever is less.
- (e) When a medicaid per diem rate is established as a condition for a health services planning and review board approval, pursuant to RSA 151-C, and that rate differs from the medicaid rate established by the department, payment shall be made at the lesser of the 2 rates.
- (f) Where a rate limitation is applied as a health services planning and review board condition, an NF may, if aggrieved, appeal such limitation in accordance with He-C 200.
Source. #8547, eff 1-24-06 (formerly He-W 593.37); ss by #10474, 1-24-14; ss by #14020, eff 7-10-24