WSR 23-14-053
HEALTH CARE AUTHORITY
[Filed June 27, 2023, 2:30 p.m.]
NOTICE
Subject: Medicaid State Plan Amendment (SPA) 23-0042 Nursing Facility Budget Dial, Swing Bed Rate, Ventilator, Tracheotomy, Enhanced Behavioral Services, Enhanced Behavioral Services Respite, and Enhanced Behavioral Services Specialty Services Rates and Minimum Occupancy Assumptions for Rate Calculation.
Effective Date: July 1, 2023.
Description: The health care authority (HCA) and the aging and long-term support administration (ALTSA) of the department of social and health services (DSHS) intends to submit SPA 23-0042 in order to increase the nursing facility budget dial, swing bed rate, and the nursing facility specialty rates for ventilator and tracheotomy rates; convert the enhanced behavioral services (EBS), enhanced behavioral services and respite (EBS + respite), and enhanced behavioral services and specialized services (EBS + specialized services) from flat rates to add-ons; and adjust the minimum occupancy percentages for indirect care calculations. SPA 23-0042 is expected to:
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| • | Increase the budget dial by six percent, an increase of $21.59 per day. |
| • | Increase the swing bed rate by 12 percent, an increase of $31.94 per day. |
| • | Increase the ventilator rate to a flat add-on of $192. Previously varied by provider, no provider will see a decrease. |
| • | Increase the tracheotomy rate to a flat add-on of $123. Previously varied by provider, no provider will see a decrease. |
| • | Convert EBS from a flat rate inclusive of daily rate of $435 to an add-on of $175. The previous flat rate did not allow for recognition of the varying base costs experienced by nursing facilities across the state and reflected in the regular daily rate. This new add-on will be in addition to the daily rate calculated through the regular nursing facility methodology. |
| • | Convert EBS + respite from a flat rate inclusive of daily rate of $435 to an add-on of $175. The previous flat rate did not allow for recognition of the varying base costs experienced by nursing facilities across the state and reflected in the regular daily rate. This new add-on will be in addition to the daily rate calculated through the regular nursing facility methodology. |
| • | Convert EBS + specialized services from a flat rate inclusive of daily rate of $475 to an add-on of $235. The previous flat rate did not allow for recognition of the varying base costs experienced by nursing facilities across the state and reflected in the regular daily rate. This new add-on will be in addition to the daily rate calculated through the regular nursing facility methodology. |
| • | Set the minimum occupancy for the indirect care calculation at 80 percent for state fiscal years 2024 and 2025 (July 1, 2023, through June 30, 2025). |
SPA 23-0042 is under development. HCA and DSHS would appreciate any input or concerns regarding this SPA. To request a copy when it becomes available or submit comments, please contact the person named below.
Interested parties may submit comments and concerns about the rates or the effects the changes may have on beneficiary access to care or continued service access. Please submit comments and concerns to Elizabeth Pashley, regulatory advisor, at Elizabeth.pashley@dshs.wa.gov with a courtesy copy to Ann Myers, state plan coordinator, at ann.myers@hca.wa.gov by July 31, 2023. Please note that all comments are subject to public review and disclosure, as are the names of those who comment.
CONTACT: Elizabeth Pashley, Office of Rates Management, ALTSA, DSHS, P.O. Box 45600, phone 360-995-2807, TRS 711, fax 360-725-2641, email Elizabeth.Pashley@gmail.com, website https://www.dshs.wa.gov/altsa/management-services-division/office-rates-management.