592008 This Rule establishes the per diem rate which the Department of Mental Health will charge for inpatient services at Saint Elizabeths Hospital.
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DEPARTMENT OF MENTAL HEALTH
NOTICE OF PROPOSED RULEMAKING
The Director of the Department of Mental Health (Department), pursuant to the authority set forth in sections 104 and 105 of the Department of Mental Health Establishment Amendment Act of 2001, effective December 18, 2001 (D.C. Law 14-56; D.C. Official Code §§ 7-1131.04 and 7-1131.05), hereby gives notice of his intent to adopt a new Chapter 55, entitled “Per Diem Charges for Inpatient Services at Saint Elizabeths Hospital”, to Title 22-A, Mental Health of the District of Columbia Municipal Regulations.
The Department provides inpatient psychiatric services to the residents of the District of Columbia at Saint Elizabeths Hospital. The per diem charge for an inpatient is determined based on the cost of care as reported in the annual Medicare cost report file by Saint Elizabeths Hospital. Recent Medicare and Medicaid cost report settlements have made it clear that St. Elizabeths current rate of $650 is below the actual cost of a patient day. St. Elizabeths must adjust its standard charge to accurately reflect the cost of care.
The Director gives notice of his intent to take final rulemaking action to adopt the proposed rules in not less than thirty (30) days after the date of publication of this notice in the D.C. Register.
Title 22-A, MENTAL HEALTH, of the District of Columbia Municipal Regulations is amended by adding a new chapter 55 to read as follows:
CHAPTER 55 PER DIEM CHARGES FOR INPATIENT SERVICES AT SAINT ELIZABETHS HOSPITAL
5500 PURPOSE
5500.1 This chapter establishes the standard per diem charge at Saint Elizabeths Hospital and the process for determining adjustments to this charge. The per diem charge established by this chapter and the process proscribed for determining adjustments to this charge are intended to establish a per diem charge that reflects the fully loaded actual cost of care for an inpatient.
5501 CURRENT RATE
5501.1 Beginning on the effective date of this section, the per diem charge for an inpatient at Saint Elizabeths Hospital shall be seven hundred eighty-three dollars ($783) per day. This charge is based on the fully loaded cost of care as reflected in the most recently filed Medicare cost report.
5501.2 For the purposes of the per diem charge, a consumer shall be considered an inpatient for a day if he or she appears on the census for that day. A patient shall appear on the census form if he or she is a patient in the hospital at 11:59 p.m.
5502 ANNUAL ADJUSTMENT
5502.1 The per diem charge shall be adjusted when a new annual Medicare cost report is filed with the Centers for Medicare and Medicaid Services’ (CMS) Fiscal Intermediary (FI) Highmark to reflect changes in cost of care.
5502.2 The adjusted per diem charge shall be based on the most recently filed Medicare cost report.
5599 DEFINITIONS
5599.1 When used in this chapter, the following terms shall have the meaning ascribed:
Fully loaded cost of care – the average cost per day to provide inpatient hospital services to a patient. This rate includes direct medical service costs and administrative and overhead costs.
Medicare cost report – a report that calculates the cost to provide inpatient and outpatient hospital services, as required by the Centers for Medicare and Medicaid Services (CMS).
Per diem charge – the cost per day that is to be charged by Saint Elizabeths Hospital for inpatients.
All persons desiring to comment on the subject matter of this proposed rulemaking should file comments in writing not later than thirty (30) days after the date of publication of this notice in the D.C. Register. Comments should be filed with the Office of General Counsel for the Department of Mental Health at 64 New York Avenue, N.E., 4th Floor, Washington, D.C. 20002, or e-mailed to Suzanne Fenzel, Assistant Attorney General, at Suzanne.Fenzel@dc.gov. Copies of the proposed rules may be obtained from dmh.dc.gov or from the Department of Mental Health at the address above.
