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Library: Policy

317:30-5-133. Payment methodologies

Revised 9-1-17

(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.

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