SOCIAL AND HEALTH SERVICES
MEDICAID PAYMENT RATE METHODOLOGY
The proposed change was the subject of WSR 09-12-074 that was published on June 17, 2009, and can be accessed at http://lawfilesext.leg.wa.gov/law/wsr/2009/12/09-12-074.htm.
Having received no comments on the proposed changes, the department of social and health services aging and disability services administration (hereafter, department) is publishing the final notice of the changes used to determine the July 1, 2009 and future medicaid nursing home payment rates.
CHANGES TO THE MEDICAID NURSING FACILITY RATE METHODOLOGY: Under RCW 74.46.421 (2)(b), the department must adjust nursing home component rate allocations to assure that the statewide average payment rate of all nursing component rare [rate] allocations is less than or equal to the statewide average payment rate specified in the Biennial Appropriations Act. The Biennial Appropriations Act (chapter 564, Laws of 2009) specified 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 low wage add-on.
The department will:
| • | Make no adjustments for economic trends and conditions in SYF [SFY] 2010 and SFY 2011; |
| • | Not compound economic trends and conditions factor or factors defined in the Biennial Appropriations Act 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; | |
| • | Issue no additional certificates of capital authorization for SFY 2010 and no new certificates of capital authorization for SFY 2011; |
| • | Within the funds provided, 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. The department shall continue reporting requirements and a settlement process to ensure that the funds are spent according to this subsection; and | |
| • | Implement minimum data set (MDS) 3.0 by notifying 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. |
In combination with other factors, including adjustments to reported costs done in accordance with chapter 74.46 RCW and chapter 388-96 WAC, the changes in methodology are estimated to result in a statewide average nursing facility medicaid payment rate of $156.37 per resident day for SFY 2010 (July 1, 2009, to June 30, 2010) and $158.74 for SFY 2011 (July 1, 2010, to June 30, 2011).
On July 13, 2009, Judge Ronald B. Leighton of the United States District Court for the Western District of Washington in Washington Healthcare Association et. al. vs. Dreyfus (No. CV09-5395-RBL) issued a temporary restraining order (TRO). The department is restrained from applying RCW 74.46.421 using the weighted average nursing facility payment rate of $156.37 for state fiscal year (SFY) 2010 when determining the July 1, 2009 rates for Washington nursing facilities participating in the medicaid program.
This TRO shall remain in force until thirty days following a decision by the Centers for Medicare and Medicaid Services either approving or disapproving a proposed amendment to the Washington medicaid state plan relating to the establishment of a $156.37 budget-dial rate.