WSR 13-17-038

[Filed August 13, 2013, 8:52 a.m.]

The purpose of this notice is to advise nursing facilities and the general public of changes that the state of Washington has made to the methodology by which nursing facilities are paid for services they provide to medicaid recipients, as of July 1, 2013.

This notice is furnished in accordance with federal medicaid law, at 42 U.S.C. Sec. 1396a (a)(13)(A) and 42 C.F.R. Sec. 447.205, and state regulations at WAC 388-96-718. Under these provisions, the department of social and health services (DSHS) must publish proposed and final new methodologies for determining the payment rates, and the justification for those new methodologies, when the changes would amount to "material" changes that require DSHS to amend its medicaid state plan under Title XIX of the federal Social Security Act.

The previous rate methodology was calculated to produce a weighted average daily rate of $170.37 in SFY 2012, and $171.43 in SFY 2013. (The state fiscal year runs from July 1 of one year to June 30 of the following calendar year, with the later year used for designation. For example, SFY 2013 runs from July 1, 2012, through June 30, 2013.) The weighted average daily rate designated in the operating budget is commonly known as the "budget dial" amount. DSHS is directed by state law to ensure that the weighted average daily rate actually paid does not exceed that amount; see RCW 74.46.421.

In 2013 the Washington state legislature passed two laws that affect the medicaid nursing facility rate methodology:

1) First, the legislature passed an operating budget for the coming biennium; see 3ESSB 5034, enacted as section 206, chapter 4, Laws of 2013, 2nd sp. sess., of the budget provides for weighted average daily rates not to exceed $171.35 for SFY 2014 and $171.58 for SFY 2015. The weighted average daily rates for SFYs 2012 through 2015 do not include either the "acuity" add-on (described below) or the add-on paid to reimburse facilities for the safety net assessment (SNA) they pay in relation to medicaid residents.

2) Second, HB 2042 was passed and became chapter 3, Laws of 2013, 2nd sp. sess. This law does the following:

a) Postpones the rebase to the 2011 medicaid cost report, which was to have applied to rates beginning July 1, 2013. Instead of a July 1, 2013, rebase of the noncapital rate components to the 2011 medicaid cost report, there will be a July 1, 2015, rebase of the noncapital components to the 2013 medicaid cost report. The 2007 medicaid cost report will continue to be used for rates between July 1, 2013, and June 30, 2015. RCW 74.46.431 is amended to accomplish this.

b) Directs the department to calculate rates for the July 1, 2013, through June 30, 2015, period by using the medicaid average case mix scores effective for January 1, 2013, rates adjusted under RCW 74.46.485 (1)(a), and increasing the scores each six months by one-half of one percent.

c) Continues for fiscal years 2014 and 2015 the "comparative analysis" and "acuity" rate add-ons that have applied to rates during the last biennium. The "comparative analysis" compares a facility's rate on July 1, 2013, with its rate on June 30, 2010. If the July 1, 2013, rate is smaller, the difference between the rates is given to the facility as an add-on to its daily rate. The "acuity" add-on rewards a facility for taking on higher-acuity residents by giving it a ten percent add-on to its direct care component rate if its direct care rate calculated under chapter 74.46 RCW is greater than its direct care rate in effect on June 30, 2010. The "acuity" add-on will continue to be subject to the reconciliation and settlement process provided in RCW 74.46.022(6).

To find and read the full text of acts adopted by the legislature go to http://www.leg.wa.gov.

No comments were received by the department in response to its earlier notice on this subject. That notice appeared at WSR 13-10-56 [13-10-056] in Issue No. 13-10, distributed on May 15, 2013.

The department, in conjunction with the Washington state health care authority, will proceed to file a medicaid state plan amendment reflecting these changes with the federal Centers for Medicare and Medicaid Services.