Sec.17-312-106. Free-standing chronic disease hospitals with over 50% medicaid patient days

(a) Commission Rate Order. A chronic disease hospital having more than an average of 50% of its inpatient days paid for by the Department may seek to obtain an adjustment of reimbursement from the Department. In order to be considered it shall submit, within thirty (30) days of the issuance of a final uncontested order by the Commission on Hospitals and Health Care (Commission) a copy of such rate order together with a schedule of the hospital's rates and charges as filed with the Commission in compliance with such rate order.

(b) All-Inclusive Rate. The Commissioner may establish, based upon consideration of the Commission rate order and upon documents submitted to the Department by the hospital, and the cost elements set forth in Section 17-312 (c) of the General Statutes, and any other information the Commissioner deems appropriate, an annualized interim all-inclusive per diem rate including routine services and ancillary services, to be paid by the Department to the hospital effective with the date authorized by the Commission.

(c) Year-end Settlement. Each chronic disease hospital reimbursed in accordance with this section shall submit to the Department, within sixty (60) days following the end of the hospital's fiscal year, a verified complete statement of actual utilization of hospital routine and ancillary services by patients paid for by the Department. Services may be paid for based upon consideration of the rates approved by the Commission for said services and the cost elements set forth in Section 17-312 (c) of the General Statutes. Any amount owed to the Department or owing to the provider will be calculated by comparing actual routine and ancillary services utilized during the period to the interim all-inclusive per diem rate. Within sixty (60) days of receipt of the data submitted by the hospital, the Commissioner shall determine, based upon the data and upon such reviews of it as he shall deem necessary, the amount owed either by the Department to the hospital or by the hospital to the Department and shall forward to the hospital a statement reflecting that determination. That amount shall be paid within sixty (60) days of the hospital's receipt of the statement of balance owed.

(Effective April 19, 1988)