Sec.17-311-61a. Rate adjustments for charges in excess of reasonable and necessary costs for other allowable services

Pursuant to Section 17-314 (c):

(a) No facility shall accept payment for other allowable services, as defined in Section 17-311-60a, provided by the facility in excess of the rate set by the Commissioner of the Department of Income Maintenance pursuant to paragraph (c) below.

(b) Any facility which accepts payment over the reasonable and necessary costs as determined in accordance with subsection (c) below for other allowable services from any state, as defined in Section 17-311-60a, shall be subject to recovery actions as defined in Connecticut General Statutes 17-314 (d) and subsection (d) below.

(c) Reasonable and necessary costs per patient day for other allowable services, which services are defined in Section 17-311-60a, shall be calculated by multiplying the statewide average costs for other allowable services for Connecticut Medicaid patients for the cost year October 1 through September 30 preceding the rate year by the implicit price deflator for the gross national product for the current cost year divided by the implicit price deflator for the gross national product for the prior cost year and dividing by the number of Connecticut Medicaid patient days. The Commissioner shall notify the facility of the reasonable and necessary costs, per patient day, for other allowable services annually effective July 1.

(d) Any amount received for other allowable services in excess of the reasonable and necessary costs of the other allowable services provided by the facility shall be deducted from the allowable costs of the facility for routine care, as defined in Section 17-311-50 et seq., of the Regulations of Connecticut State Agencies, as follows:

From the facility's out-of-state Medicaid rates shall be deducted the facility's Connecticut Medicaid per diem rate and the statewide average cost per patient day for other allowable services as determined pursuant to subsection (c) above. The result of the computation shall be multiplied by the out-of-state patient days and the product derived therefrom shall be deducted from the facility's allowable costs as defined in Section 17-311-50 et seq., of the Regulations of Connecticut State Agencies.

(e) The facility shall provide the Department with the following information annually with the Annual Report of Long-Term Care Facility:

(1) The out-of-state Medicaid rate(s) applicable to the cost period and the corresponding out-of-state Medicaid patient days by month; and

(2) The Connecticut Medicaid rate(s) applicable to the cost period and the corresponding Connecticut Medicaid patient days by month.

(f) In the event that any facility fails to provide the information requested in (e) of this section, the Commissioner shall make the computation set forth in (d) of this subsection based upon the revenue and patient day sections of the Annual Report of Long Term Care Facility submitted by the facility for the appropriate cost period.

(Effective December 5, 1986)