222.73 - BILLING OF PATIENT CHARGES -- COMPUTATION OF ACTUAL COSTS -- COST SETTLEMENT.
222.73 BILLING OF PATIENT CHARGES -- COMPUTATION OF
ACTUAL COSTS -- COST SETTLEMENT.
1. The superintendent of each resource center and special unit
shall compute by February 1 the average daily patient charge and
outpatient treatment charges for which each county will be billed for
services provided to patients chargeable to the county during the
fiscal year beginning the following July 1. The department shall
certify the amount of the charges and notify the counties of the
billing charges.
a. The superintendent shall compute the average daily patient
charge for a resource center or special unit for services provided in
the following fiscal year, in accordance with generally accepted
accounting procedures, by totaling the expenditures of the resource
center or special unit for the immediately preceding calendar year,
by adjusting the expenditures by a percentage not to exceed the
percentage increase in the consumer price index for all urban
consumers for the immediately preceding calendar year, and by
dividing the adjusted expenditures by the total inpatient days of
service provided during the immediately preceding calendar year.
b. The department shall compute the outpatient treatment
charges, in accordance with generally accepted accounting procedures,
on the basis of the actual cost of the outpatient treatment provided
during the immediately preceding calendar year.
2. a. The superintendent shall certify to the department the
billings to each county for services provided to patients chargeable
to the county during the preceding calendar quarter. The county
billings shall be based on the average daily patient charge and
outpatient treatment charges computed pursuant to subsection 1, and
the number of inpatient days and outpatient treatment service units
chargeable to the county. The billings to a county of legal
settlement are subject to adjustment for all of the following
circumstances:
(1) The county billing for a patient shall be reduced by the
amount received for the patient's care from a source other than state
appropriated funds.
(2) If more than twenty percent of the cost of a patient's care
is initially paid from a source other than state appropriated funds,
the amount paid shall be subtracted from the average
per-patient-per-day cost of that patient's care and the patient's
county shall be billed for the full balance of the cost so computed.
(3) The county of a patient who is eligible for reimbursement
under the medical assistance program shall be responsible for the
costs which are not reimbursed by the medical assistance program,
regardless of the level of care provided to the patient.
(4) A county shall be responsible for eighty percent of the cost
of care of a patient who is not eligible for reimbursement under the
medical assistance program.
(5) The billings for counties shall be credited with one hundred
percent of the client participation for patients eligible for medical
assistance in the calculation of the per diem rate for patients.
(6) A county shall not be billed for the cost of a patient unless
the patient's admission is authorized through the applicable central
point of coordination process. The state resource center and the
county shall work together to locate appropriate alternative
placements and services, and to educate patients and the family
members of patients regarding such alternatives.
b. The per diem costs billed to each county shall not exceed
the per diem costs billed to the county in the fiscal year beginning
July 1, 1996. However, the per diem costs billed to a county may be
adjusted in a fiscal year to reflect increased costs to the extent of
the percentage increase in the total of county fixed budgets pursuant
to the allowed growth factor adjustment authorized by the general
assembly for that fiscal year in accordance with section 331.439.
3. The superintendent shall compute in January the actual
per-patient-per-day cost for each resource center or special unit for
the immediately preceding calendar year, in accordance with generally
accepted accounting procedures, by totaling the actual expenditures
of the resource center or special unit for the calendar year and by
dividing the total actual expenditures by the total inpatient days of
service provided during the calendar year.
4. The department shall certify to the counties by February 1 the
actual per-patient-per-day costs, as computed pursuant to subsection
3, and the actual costs owed by each county for the immediately
preceding calendar year for patients chargeable to the county. If
the actual costs owed by the county are greater than the charges
billed to the county pursuant to subsection 2, the department shall
bill the county for the difference with the billing for the quarter
ending June 30. If the actual costs owed by the county are less than
the charges billed to the county pursuant to subsection 2, the
department shall credit the county for the difference starting with
the billing for the quarter ending June 30.
5. A superintendent of a resource center or special unit may
request that the director of human services enter into a contract
with a person for the resource center or special unit to provide
consultation or treatment services or for fulfilling other purposes
which are consistent with the purposes stated in section 222.1. The
contract provisions shall include charges which reflect the actual
cost of providing the services. Any income from a contract
authorized under this subsection may be retained by the resource
center or special unit to defray the costs of providing the services
or fulfilling the other purposes. Except for a contract voluntarily
entered into by a county under this subsection, the costs or income
associated with a contract authorized under this subsection shall not
be considered in computing charges and per diem costs in accordance
with the provisions of subsections 1 through 4. Section History: Early Form
[SS15, § 2727-a96; C24, 27, 31, 35, 39, § 3469; C46, 50, 54,
58, 62, § 223.5; C66, 71, 73, 75, 77, 79, 81, § 222.73] Section History: Recent Form
86 Acts, ch 1169, § 1; 88 Acts, ch 1249, § 6; 88 Acts, ch 1276, §
38; 95 Acts, ch 82, §4; 96 Acts, ch 1183, § 6--8; 98 Acts, ch 1155,
§9; 2000 Acts, ch 1112, §51; 2001 Acts, ch 155, §15--17; 2004 Acts,
ch 1090, §33; 2009 Acts, ch 41, §263
Referred to in § 222.74, 222.92, 249A.12, 331.381 Footnotes
For the period beginning October 1, 2008, and ending September 30,
2010, or the period for which funding from the federal American
Recovery and Reinvestment Act of 2009 can be used, per diem amounts
billed to counties may be adjusted downward to comply with the
federal Act; 2009 Acts, ch 182, §58, 59