Medicaid Cost Report: Capital Asset History

Transcription

1 Medicaid Cost Report: Capital Asset History 1

2 Introductions Joseph M. Lubarsky, President, Eljay Todd Bergstrom, Director of Research & Payment, Care Providers of Minnesota Jeff Bostic, Director of Data Analysis, Aging Services of Minnesota Robert Held,Division Director, Minnesota Department of Human Services Nursing Facility Rates & Policy Division Greg Tabelle, Audit Director, Minnesota Department of Human Services Nursing Facility Rates & Policy Division Marilyn Kaufenberg, Minnesota Department of Human Services Nursing Facility Rates & Policy Division 2

3 Background Effective October 1, 2014, property rates shall be rebased in accordance with section 256B.431 and Minnesota Rules, chapter 9549 (i.e. Rule 50). The commissioner shall determine what the property payment rate for a nursing facility would be had the facility not had its property rate determined under section 256B.434 (i.e. APS). Since Fall 2007, the Long-Term Care Imperative Payment Committee has held meetings with Joe Lubarsky to develop a new nursing facility property payment system. Staff from the Minnesota Department of Human Services (DHS) have been guests at these meetings to offer their perspective. The Capital Asset History on the Medicaid Cost Report is to be used to model a Gross Fair Rental Value property payment system for Minnesota s nursing facilities. 3

4 Why a Fair Rental Value System? A well designed fair rental value system will: Differentiate reimbursement based upon age/condition Provide incentives to generate capital resources for renovation, improvement and replacement Encourage investment in physical plant upgrades and renovations Impact the physical environment that can result in improvement of resident quality of life Simplify administration and allow the State to exercise reasonable budget predictability and control Gross fair rental Fair rental value times rental rate Rate not dependent on actual loan terms like interest rate 4

5 'Number of Non-Nursing Facility Beds' is the current beds used by programs such as Assisted Living, apartments, etc. Report only if these beds are in the same physical structure as the nursing facility. No need to reports beds on the same campus but in a separate building. 5

6 'Total Square Footage Applicable to the Nursing Facility', 'Total Square Footage Applicable to Non-Nursing Facility Services', and 'Total Square Footage' are measured using the gross square footage methodology. It is the floor area of the entire building, which includes rooms, common spaces, walls, corridors, conveyances, mechanical and utility rooms, and shafts. Square footage on the gross method is based on the 'footprint' of the building. Report the requested information relative to space used to currently to provide resident care or support functions. 6

7 Enter the month and year the space was available for resident use. For the 'Initial Construction' option in the Type of Construction box, use the date the oldest section of your facility was made available for resident use. Resident care, for this section of the report, includes buildings or portions of buildings formerly used for resident care that are now offices, storage space, etc. For the 'Addition', 'Renovation', and 'Replacement' options in the Type of Construction box, use the date the newly constructed or renovated space was made available for resident use. 7

8 'Initial Construction' refers to the date that the building(s) was place in service to provide nursing facility services for your organization. If your facility was completely replaced at some date, the 'Initial Construction' is the space currently being used for NF services and do not report any information on buildings that were removed from service. 8

9 'Addition' is new space created after the 'Initial Construction' that resulted in a greater number of beds than before the construction began. These projects, for nearly all facilities, will have occurred before the moratorium began about 25 years ago. 9

10 'Renovation' refers to construction projects that modified existing space, and did not create new space. Such a project may have reduced the total number of beds in a facility or the number stayed the same. It includes items capitalized as land improvements, buildings, building improvements, and leasehold improvements. It does not include costs associated with initial construction, additions, replacements already identified, or equipment. Report only 'renovations' that have occurred in the past 15 years and had a total cost equal to or greater than $1,000 per licensed bed at the time of completion. If a 'renovation' project involved construction activities in both the licensed nursing facility and nonnursing facility licensed sections, only those construction cost associated with the licensed nursing facility section of the facility are to be included. Documentation must be available to demonstrate how construction costs were allocated between NF and non-nf space. 10

11 'Replacement' refers to new construction built for resident care that did not result in a greater number of beds. An example is a new wing that did not result in an increase in total beds. All replacement projects since original construction are to be included as replacements. Cost is not needed for replacements, only the date of construction, number of beds and square footage. 11

12 For 'Initial Construction', 'Addition', and 'Replacement' enter the total beds currently in service within the space. For 'Renovation' the number of beds is not required. 12

13 For 'Initial Construction', 'Addition', and 'Replacement' enter the gross square footage currently used for NF services. This can differ from gross square footage when initially constructed because of subsequent bed changes, replacements, or conversions to non- NF space. If a 'Renovation' included new space that did not contain beds (e.g. a new kitchen), enter the gross square footage of the new space and not the entire square footage affected by the project (do not list square footage in a 'Renovation' that has already been reported as 'Initial Construction' or 'Addition', or 'Replacement'). 13

14 The sum of the square feet reported as 'Initial Construction', 'Addition', 'Replacement' and 'Renovation' must equal the amount reported as 'Total Square Footage Applicable to the Nursing Facility'. This requires you to report the net gain/loss of square footage when space is taken out of service as part of a construction project. 14

15 For 'Renovation' the cost of the project, net of equipment, occurring in the past 15 years and with a total cost equal to or greater than $1,000 per licensed bed at the time of completion is to be entered. For 'Initial Construction', 'Addition', and 'Replacement' the cost information is not required. 15

16 16 Questions and Answers

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