Sec. 10.02.01.05. Setting of Charges for State-Operated Inpatient Facilities

A. Inpatient Charge.

(1) For each fiscal year, a daily per capita inpatient cost of care for a State-operated inpatient facility shall be determined by:

(a) Utilizing the legislatively approved budget for the inpatient facility;

(b) Adding the federal indirect cost and Statewide and departmental overhead, less shared cost, for the applicable fiscal year; and

(c) Dividing the amount determined in §A(1)(b), of this regulation, by the average daily population of the facility for the applicable fiscal year to arrive at the daily per capita inpatient cost of care for the facility.

(2) The per diem inpatient charge shall equal the daily per capita inpatient cost of care as determined in §A(1)(c) of this regulation.

(3) The per diem inpatient charge shall be set forth in the Schedule of Charges.

B. Medicare-Eligible Patient Charge.

(1) For each fiscal year, a Medicare daily per capita inpatient cost of care for a State-operated inpatient facility shall be determined by:

(a) Utilizing the legislatively approved budget for the inpatient facility, minus the cost of physician and ancillary services for the inpatient facility;

(b) Adding the federal indirect cost and Statewide and departmental overhead, less shared cost, for the applicable fiscal year; and

(c) Dividing the amount determined in §B(1)(b), of this regulation, by the average daily population of the facility for the applicable fiscal year to arrive at the Medicare daily per capita inpatient cost of care for the facility.

(2) The per diem Medicare-eligible inpatient charge shall equal the Medicare daily per capita inpatient cost of care as determined in §B(1)(c) of this regulation.

(3) The per diem Medicare-eligible inpatient charge shall be set forth in the Schedule of Charges.

C. Physician Charge.

(1) For each fiscal year, a charge of physician services provided at a Medicare-eligible State-operated inpatient facility shall be determined by utilizing the most recent Facility Medicare Physicians fee schedule for Maryland or Washington, D.C., suburbs as appropriate, which is updated annually in the Federal Register by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services, pursuant to 42 U.S.C §1395w-4.

(2) The physician charge shall be set forth in the Schedule of Charges.

D. Ancillary Charge.

(1) For each fiscal year, a charge for ancillary services provided at a Medicare-eligible State-operated inpatient facility shall be determined by utilizing the most recent Facility Medicare Physicians fee schedule for Maryland or Washington, D.C., suburbs as appropriate, which is updated annually in the Federal Register by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services, pursuant to 42 U.S.C §1395w-4.

(2) The ancillary charge shall be set forth in the Schedule of Charges.

E. Charges for State-operated inpatient facilities shall be based on the best estimate of costs, including all appropriate indirect costs, according to generally accepted cost accounting practice. State-operated inpatient facilities, in support of the proposed Schedule of Charges, shall report the estimate of costs in the form required by the Secretary. When the dollar amount is set by statute, the Schedule of Charges shall specify that amount.

F. Revisions and modifications to the approved Schedule of Charges to reflect changes in charges or the addition of new services shall be made when recommended by the Division and approved by the Secretary.

G. The approved Schedule of Charges, with all revisions and modifications, shall be retained in the Office of the Secretary and also be available for public inspection in the Superintendent's office of the State-operated inpatient facility.