SECTION 317:30-5-133. Payment methodologies

(a)   Private Nursing Facilities.

(1)   Facilities. Private Nursing Facilities include:

(A)   Nursing Facilities serving adults (NF),

(B)   Nursing Facilities serving Aids Patients,

(C)   Nursing Facilities serving Ventilator Patients,

(D)   Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID),

(E)   Intermediate Care Facilities with 16 beds or less serving severely or profoundly intellectually disabled members, and

(F)   Payment will be made for non-routine nursing facility services identified in an individual treatment plan prepared by the State Intellectual Disabilities (ID) Authority. Services are limited to individuals approved for NF and specialized services as the result of a PASRR/ID Level II screen. The per diem add-on is calculated as the difference in the statewide average standard private ID base rate and the statewide NF base rate. If the standard private ID average base rate falls below the standard NF base rate or equals the standard facility base rate for regular NFs, the payment will not be adjusted for specialized services.

(2)   Reimbursement calculations. Rates for private NFs will be reviewed periodically and adjusted as necessary through a public process. Payment will be made to private NFs pursuant to the methodology described in the Oklahoma Title XIX State Plan.

(b)   Public Nursing Facilities. Reimbursement for public ICFs/IID shall be based on each facility's reasonable cost and shall be paid on an interim basis with an annual retroactive adjustment. Reasonable costs shall be based on Medicare principles of cost reimbursement as set forth in the provider reimbursement manual.

[Source: Added at 12 Ok Reg 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 1321, eff 3-20-95 (emergency); Added at 12 Ok Reg 3131, eff 7-27-95; Amended at 13 Ok Reg 1103, eff 1-10-96 (emergency); Amended at 13 Ok Reg 3469, eff 7-16-96 (emergency); Amended at 14 Ok Reg 1780, eff 5-27-97; Amended at 15 Ok Reg 3784, eff 7-1-98 (emergency); Amended at 15 Ok Reg 4204, eff 7-20-98 (emergency); Amended at 16 Ok Reg 1429, eff 5-27-99; Amended at 17 Ok Reg 3359, eff 9-1-00 (emergency); Amended at 17 Ok Reg 3509, eff 9-1-00 (emergency); Amended at 18 Ok Reg 1130, eff 5-11-01; Amended at 23 Ok Reg 31, eff 7-6-05 (emergency); Amended at 23 Ok Reg 1357, eff 5-25-06; Amended at 24 Ok Reg 2819, eff 7-1-07 (emergency); Amended at 25 Ok Reg 1200, eff 5-25-08; Amended at 30 Ok Reg 1195, eff 7-1-13; Amended at 34 Ok Reg 626, eff 9-1-17]