Ceilings are established using allowable costs as follows:

1. (1) To determine the case mix adjusted direct care costs of a facility, the department shall use two ceiling calculations. The first ceiling is one hundred and fifteen percent of the median cost of all nursing facilities that have an average case mix score of 1.00 or more for the reporting period. The department shall recognize one hundred percent of the facility's allowable costs up to the one hundred and fifteen percent ceiling. The second ceiling is one hundred and twenty-five percent of the median cost of all nursing facilities that have an average case mix score of 1.00 or more for the reporting period. Payment for the case mix adjusted direct care costs that exceed the one hundred and fifteen percent ceiling and are up to the one hundred and twenty-five percent ceiling is calculated according to § 67:16:04:54.01;
2. (2) To determine the nondirect care costs of health and subsistence, plant, plant operations, and other operating costs of a facility, the department shall use two ceiling calculations. The first ceiling is one hundred and five percent of the median cost of all nursing facilities that have an average case mix score of 1.00 or more for the reporting period. The department shall recognize one hundred percent of the facility’s allowable costs up to the one hundred and five percent ceiling. The second ceiling is established at one hundred and ten percent of the median cost of all nursing facilities that have an average case mix score of 1.00 or more for the reporting period. Payment for these nondirect care costs that exceed the one hundred and five percent ceiling and are up to the one hundred and ten percent ceiling is calculated according to § 67:16:04:54.02;
3. (3) To determine the nondirect care costs of administration of a facility, the department shall use two ceiling calculations. The first ceiling is one hundred and five percent of the median cost of all freestanding nonchain organization affiliated nursing facilities. The department shall recognize one hundred percent of the facility's allowable costs up to the one hundred and five percent ceiling. The second ceiling is one hundred and ten percent of the median cost of all freestanding nonchain organization affiliated nursing facilities. Payment for the nondirect care costs of administration that exceed the one hundred and five percent ceiling and are up to the one hundred and ten percent ceiling is calculated according to § 67:16:04:54.03; and

4. (4) Beginning July 1, 2023, capital costs are limited to a ceiling of twenty dollars and ninety-five cents per resident day.

   Cross-References:

   Method of establishing per diem rates, § 67:16:04:54.

   State fiscal year, SDCL 4-10-10.

Source: 21 SDR 8, effective July 25, 1994; 23 SDR 42, effective September 30, 1996; 24 SDR 185, effective July 6, 1998; 26 SDR 5, effective July 1, 1999; 26 SDR 21, effective August 24, 1999; 29 SDR 177, effective July 1, 2003; 29 SDR 177, adopted July 1, 2003, effective July 1, 2004; 35 SDR 312, effective July 6, 2009 ; 50 SDR 11, effective August 7, 2023 .

General Authority: SDCL 28-6-1 .

Law Implemented: SDCL 28-6-1 .

Prior versions effective: 2009-07-06.