SOCIAL AND HEALTH SERVICES
MEDICAID PAYMENT RATE METHODOLOGY
Please address any comments or questions concerning the changes to Edward H. Southon, Department of Social and Health Services, Aging and Disability Services Administration, P.O. Box 45600, Olympia, WA 98504-5600, phone (360) 725-2469, fax (360) 493-9484. Comments should be submitted within fourteen days after appearance of this notice.
JUSTIFICATION: In the final operating budget (ESHB 1244 Sec. 1106) and in EHB 2357, the Washington state legislature made changes to the medicaid nursing facility payment system. On May 19, 2009, the governor signed ESHB 1244 (Sec. 206) and EHB 2357 into law.
CHANGES TO THE MEDICAID NURSING FACILITY RATE METHODOLOGY: (1) For purposes of implementing chapter 74.46 RCW, the weighted average nursing facility payment rate shall not exceed $156.37 for state fiscal year (SFY) 2010 and shall not exceed $158.74 for SFY 2011, including the rate add-on described in subsection (12) of this section.
| • | There will be no adjustments for economic trends and conditions in SYF [SFY] 2010 and SFY 2011. |
| • | The economic trends and conditions factor or factors defined in the Biennial Appropriations Act shall not be compounded with the economic trends and conditions factor or factors defined in any other biennial appropriations acts before applying it to the component rate allocations established in accordance with chapter 74.46 RCW. |
| • | When no economic trends and conditions factor for either fiscal year is defined in a Biennial Appropriations Act, no economic trends and conditions factor or factors defined in any earlier Biennial Appropriations Act shall be applied solely or compounded to the component rate allocations established in accordance with chapter 74.46 RCW. |
(3) The long-term care program may develop and pay enhanced rates for exceptional care to nursing homes for persons with traumatic brain injuries who are transitioning from hospital care. The cost per patient day for caring for these clients in a nursing home setting may be equal to or less than the cost of caring for these clients in a hospital setting...
(12) Within the funds provided, the department shall continue to provide an add-on per medicaid resident day per facility not to exceed $1.57. The add-on shall be used to increase wages, benefits, and/or staffing levels for certified nurse aides; or to increase wages and/or benefits for dietary aides, housekeepers, laundry aides, or any other category of worker whose statewide average dollars-per-hour wage was less than $15 in calendar year 2008, according to cost report data.
The add-on may also be used to address resulting wage compression for related job classes immediately affected by wage increases to low-wage workers. Aging and disability services administration (hereafter, department) shall continue reporting requirements and a settlement process to ensure that the funds are spent according to this subsection. The department shall adopt rules to implement the terms of this subsection.
EHB 2357 Sec. 1 affirmed that when setting the direct care, therapy care, support services, and operations component rates the economic trends and conditions factor or factors defined in the Biennial Appropriations Act shall not be compounded with the economic trends and conditions factor or factors defined in any other biennial appropriations acts before applying it to the direct care, therapy care, support services, and operations component rate allocations established in accordance with chapter 74.46 RCW. When no economic trends and conditions factor or factors for either fiscal year are defined in a biennial appropriations act, no economic trends and conditions factor or factors defined in any earlier biennial appropriations act shall be applied solely or compounded to the direct care, therapy care, support services, and operations component rate allocations established in accordance with chapter 74.46 RCW.
[ESHB 2357] Sec. 2 amended RCW 74.46.485 to set the parameters for implementing minimum data set (MDS) 3.0.
(1) The department shall: (a) Employ the resource utilization group III case mix classification methodology. The department shall use the forty-four group index maximizing model for the resource utilization group III grouper version 5.10, but the department may revise or update the classification methodology to reflect advances or refinements in resident assessment or classification, subject to federal requirements; and (b) implement MDS 3.0 under the authority of this section and RCW 74.46.431(3). The department must notify nursing home contractors twenty-eight days in advance of the date of implementation of the MDS 3.0. In the notification, the department must identify for all quarterly rate settings following the date of MDS 3.0 implementation a previously established quarterly case mix adjustment established for the quarterly rate settings that will be used for quarterly case mix calculations in direct care until MDS 3.0 is fully implemented. After the department has fully implemented MDS 3.0, it must adjust any quarter in which it used the previously established quarterly case mix adjustment using the new MDS 3.0 data.
(2) A default case mix group shall be established for cases in which the resident dies or is discharged for any purpose prior to completion of the resident's initial assessment. The default case mix group and case mix weight for these cases shall be designated by the department.
In combination with a variety of other factors, including adjustments to reported costs done in accordance with chapter 74.46 RCW and chapter 388-96 WAC, the methodological changes are estimated to result in a statewide average nursing facility medicaid payment rate of $156.37 per resident day for SFY 2010 running from July 1, 2009, to June 30, 2010, and $158.74 for SFY 2011 running from July 1, 2010, to June 30, 2011.