The Division of Rate Setting (Division) is charged with issuing guidelines for utilization percentages to be used in calculating PNMI providers’ per diem rates per V.P.N.M.I.R. §6.6. This practice and procedure issuance details how the Division will use the base year utilization percentages, subject to the minimum occupancy percentages applicable to each program, to set PNMI per diem rates. This Practice and Procedure issuance replaces all prior utilization and minimum occupancy requirement issued by the Placement Authorizing Departments (PADs).
Methodology
In the calculation of PNMI per diem rates, the Division divides the total allowable base year costs from each program’s settled funding application by the total base year resident days for each program, subject to minimum occupancy requirements. V.P.N.M.I.R. §7.4.
It is expected that PNMI programs are utilized as much as possible and that the total licensed capacity accurately reflects the demand for each program. However, programs cannot be expected to be utilized at full capacity all of the time and appropriate minimum occupancy requirements should allow for normal fluctuation in utilization. The minimum occupancy requirements vary based on the total licensed capacity of the program and expected average length of stay of each program. The following table details the minimum occupancy requirements for PNMI programs.
| Category of PNMI Program as Determined by PADs | Total Licensed Capacity | Average Length of Stay | Minimum Occupancy Requirement |
|---|---|---|---|
| Long Term Program | 16 beds and greater | Greater than 90 days | 90% |
| Long Term Program | 11 to 15 beds | Greater than 90 days | 85% |
| Long Term Program | Up to and including 10 beds | Greater than 90 days | 80% |
| Short Term Crisis/Stabilization Program | All programs | 11 to 90 days | 75% |
| Crisis Programs | All programs | 0 to 10 days | No minimum occupancy requirements |
When calculating per diem rates, the Division will use the greater of the actual base year resident days or the minimum required number of resident days. For example, a long term program with a total licensed capacity of 20 beds that has a base year utilization of 88 percent would have a total of 6,424 resident days in the base year:
20 beds * 365 days * 0.88 = 6,424 days
The required minimum occupancy for this program is 90 percent, which is 6,570 days:
20 beds * 365 days * 0.90 = 6,570.
In calculating the per diem rate, the Division will divide the total base year allowable costs by 6,570 days as if the program were utilized at a 90 percent occupancy rate rather than the actual 88 percent occupancy rate.
Providers who are not occupied at or above the applicable minimum occupancy requirement will be penalized in the rate setting process. Providers who consistently run below the minimum required occupancy should consult with the Division and the PADs about what they can do to improve the utilization of their program, including a discussion about the types of services offered, strategies to increase utilization and the possibility of reducing total licensed capacity.
Effective: February 24, 2014
Kathleen Denette, Director of Rate Setting