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Nursing Facility and Specialized Care Rate Updates Effective July 1, 2020

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Bulletin
Effective Date:

To:
Nursing Facility, Specialized Care, and Hospice Service Providers; Commonwealth Coordinated Care (CCC) Plus Managed Care Plans
From:
Karen Kimsey, Director DMAS

The purpose of this bulletin is to inform you of new nursing facility and specialized care rates effective July 1, 2020. Nursing facility operating rates have been rebased in accordance with 12VAC30-90-44, including an inflation adjustment of 4.1%. Specialized care operating rates will be adjusted 4.1% for inflation effective July 1, 2020 in accordance with Item 313.LLLL of the 2020 Appropriation Act. 

Inflation Adjustment

The inflation for State Fiscal Year (SFY) 2021 is 2.8%. However, after correcting for previous inflation projections as required by regulations, there will be a 4.1% inflation adjustment for both nursing facility and specialized care rates.    

Nursing Facility Rebasing

Nursing facility operating rates have been rebased using cost data from provider fiscal years ending in calendar year (CY) 2017, in accordance with price-based regulations 12VAC30-90-44. During rebasing, each facility is assigned to a peer group according to geographic location or size, and a day-weighted median is calculated for each peer group for direct (nursing and ancillary) and indirect (all other) operating costs. Each day-weighted median is then adjusted to develop the price-based rates: 106.8% of the day weighted median for direct operating rates and 101.3% of the day weighted median for indirect operating rates. 

Nursing facilities are paid these price-based operating rates unless their costs are less than 95% of the pricebased rate. If nursing facility costs are less than 95% of the price-based rate, rates are limited to 5% more than their costs.  

The statewide fiscal impact of rebasing nursing facilities is a 2% reduction prior to the inflation adjustment; however the fiscal impact for each facility will vary.  The table below shows the overall fiscal impact of rebasing by Commonwealth Coordinated Care (CCC) Plus region. 

Nursing Facility and Specialized Care Rate Updates Effective 7/1/2020 

NURSING FACILITY FISCAL IMPACT

CCC PLUS REGION

FISCAL IMPACT

TIDEWATER

-1.3%

CHARLOTTESVILLE WESTERN

-3.5%

ROANOKE AND ALLEGHANY

-0.5%

CENTRAL

-2.5%

NORTHERN AND WINCHESTER

-1.1%

SOUTHWEST

-4.1%

TOTAL

-2.0%

 

Other Nursing Facility Rate Components

Capital rates for freestanding nursing facilities were refreshed using the Fair Rental Value (FRV) methodology set forth in 12VAC30-90-36 and using settled FRV CY 2019 reports. Capital reimbursement for hospital-based nursing facilities is based on depreciation from cost reports with provider fiscal years ending in CY 2018. Rates for Nurse Aid Training and Competency Evaluation Programs (NATCEP) are based on costs per day from cost reports with provider fiscal years ending in CY 2017 and inflated to the current rate year. Rates for Criminal Records Checks (CRC) are based on costs per day from cost reports with provider fiscal years ending in CY 2017 and are not inflated. 

Specialized Care

In accordance with Item 313.LLLL of the 2020 Appropriation Act, specialized care operating rates for the next two years will be adjusted for inflation. Final Specialized care per diem operating rates for SFY 2020 will be inflated by 4.1% to calculate rates for SFY 2021.  Capital rates have been updated for SFY 2021.  

SFY 2021 Rate Notification  

This bulletin serves as the official notification that rates for SFY 2021 are posted on the DMAS website at http://www.dmas.virginia.gov/#/ratesetting. Corrections or revisions after July 1, 2019 will be noted at the bottom of the official rate sheet. 

MDS Assessments

Upcoming Minimum Data Set (MDS) guidelines from the Centers for Medicare and Medicaid Services

(CMS) will not impact Medicaid reimbursement. MDS Section G resident assessment and Omnibus Budget

Reconciliation Act (OBRA) assessments will be available after October 1, 2020 to generate a Medicaid Resource Utilization Group (RUG) code for billing. Medicaid MDS assessment guidance can be found in the nursing facility provider manual and on the DMAS nursing facility website at http://www.dmas.virginia.gov/#/nursingfacilities. Medicaid RUG settings and assessments will remain the same. DMAS will not use the Optional State Assessment (OSA).  

For questions, please contact Sara Benoit by email: Sara.Benoit@dmas.virginia.gov, or by phone: (804)

786-3673.

Nursing Facility and Specialized Care Rate Updates Effective 7/1/2020Image removed.

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Medicaid Expansion Eligibility Verification

Medicaid coverage for the new expansion adult group began January 1, 2019.  Providers may use the Virginia Medicaid Web Portal and the Medicall audio response systems, as shown in the table below, to verify Medicaid eligibility and managed care enrollment, including for the new adult group.  In the Virginia Medicaid Web Portal, individuals enrolled in the new adult group are shown as “MEDICAID EXP.”  If the individual is enrolled in managed care, the “MEDICAID EXP” segment will be shown as well as the “MED4” (Medallion 4.0) or “CCCP” (CCC Plus) managed care enrollment segment.  Eligibility and managed care enrollment information is also available through the DMAS Medicall eligibility verification system. Additional Medicaid expansion resources for providers are available on the DMAS Medicaid Expansion webpage at:  http://www.dmas.virginia.gov/#/medex. 

PROVIDER CONTACT INFORMATION & RESOURCES

Virginia Medicaid Web Portal Automated Response System (ARS)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

www.virginiamedicaid.dmas.virginia.gov

Medicall (Audio Response System)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

1-800-884-9730 or 1-800-772-9996

KEPRO

Service authorization information for fee-forservice members.

https://providerportal.kepro.com

Managed Care Programs

Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), and the Program of All-Inclusive Care for the Elderly (PACE).  In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider.  The managed care plan may utilize different guidelines than those described for Medicaid feefor-service individuals.  

Medallion 4.0 Managed Care Program

http://www.dmas.virginia.gov/#/med4

CCC Plus Managed Care Program

http://www.dmas.virginia.gov/#/cccplus

PACE Program

http://www.dmas.virginia.gov/#/longtermprograms

Magellan Behavioral Health

Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members.

www.MagellanHealth.com/Provider

For credentialing and behavioral health service information, visit:

www.magellanofvirginia.com, email:

VAProviderQuestions@MagellanHealth.com,or   call: 1-800-424-4046

Provider HELPLINE

Monday–Friday 8:00 a.m.-5:00 p.m.  For provider use only, have Medicaid Provider ID Number available.

1-804-786-6273 

1-800-552-8627