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NH Nursing Facility Medicaid Rates and Payments

October 19, 2018

The MQIP payment process has now been captured in the State of NH’s State Plan Amendment (SPA). The SPA now includes a requirement where, on a quarterly basis, the Department shall furnish to the facilities, before supplemental payments are processed, a calculation exhibit which identifies each facility’s calculated rate and supplemental payment for that quarter. This calculation exhibit is available for review.

Please note the following regarding important dates and statements for this MQIP cycle and the higher than usual rates for this quarter only.

MQIP payments shall be in the October 19th MMIS financial cycle with the funds being received by the providers on the following Thursday, October 25th. The NFQA tax funds due will be pulled via ACH by Treasury on the third business day prior to the end of the month; for October this will be the 29th.

MQIP rates for the quarter ending 9/30/2018 are significantly higher than any we have seen in past quarters and will certainly fall back to the normal range in our next quarter payment processing. The reason for these inflated rates is due to a CMS directive where the State is unable to include July 2018 claims in the MMIS MQIP payment process. Therefore, the rates for the 9/30/2018 quarter are based on only 2 months of claims data (August and September 2018). Distributing the full amount of funds available over a smaller amount of paid claims has caused the rates to be significantly higher than usual. For this quarter, there will be two ARS-MQP-002 reports posted to eStudio, one outlining the post payments to be made for previous months’ claim activity processed in July 2018 and the second outlining the payments being made to providers for both previous and current months’ claim activity for August and September 2018. Going forward, the MQIP rate and payment calculations will be back to the usual method of NFQA tax received distributed to facilities for the previous quarter (3 full months) of paid claims activity.

July 19, 2018

MQIP/ProShare/CPE Medicaid State Plan Amendment 18-0006 approved effective January 1, 2018

CMS has reviewed the proposed amendment to Attachment 4.19D of the New Hampshire Medicaid state plan submitted under transmittal number (TN) 18-0006. Effective January 1, 2018, this amendment proposes a Certified Public Expenditure (CPE) Cost Protocol to fund unreimbursed costs for seven counties with eight county government-owned nursing facilities under the state's Proportionate Share Incentive Two (2) supplemental payment program. For the remaining three non-state government owned nursing facilities, the state proposes to fund Proportionate Share Incentive One (1) supplemental payments with Intergovernmental Transfer (IGT). Additionally, New Hampshire proposes a reimbursement methodology for supplemental payments under the Medicaid Quality Incentive Program (MQIP) funded by the state Nursing Facility Quality Assessment Tax (NFQA).

July 24, 2018
Notice is hereby given that the Title XIX State Plan is being amended to reflect the amount of the supplemental pool available for the July 2018 quarterly payment to be allocated among the eligible licensed nursing facilities. The amount of the supplemental pool for the July payment is $22,019,315. Eligible licensed nursing facilities shall receive a one-time supplemental payment from the July quarterly pool amount of $22,019,315. The distribution of the supplemental pool will be weighted based on fourth quarter 2018 utilization data for each facility as compared to total utilization of services for that same time period and paid out based upon services provided on or after July 26, 2018. As noted in the State Plan, eligible facilities will receive a calculation exhibit through e-studio which identifies each facility’s calculated rate and supplemental payment for the July quarter. Notice is also being given that the Title XIX State Plan will also be subsequently amended to reflect the amount of the supplemental pool available for the October 2018 quarterly payment and the January 2019 quarterly payment. The estimated supplemental pool amounts are $19,316,821 for October 2018 and $18,805,295 for January 2019. The distribution of the October 2018 pool will be weighted based on the prior two months of Medicaid paid dates of service. Subsequent quarterly payments will be based on the prior three months of service applicable for the quarter.

Please contact Diane Peterson at (603) 271-4367, or via email at if you would like a copy of the SPA and have any questions or comments on the SPA. The SPA pages my undergo further revisions before and after submittal to CMS based on public input or CMS feedback.

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Nursing Facility Supplemental Medicaid Payment (MQIP)

The nursing facility supplemental Medicaid payment (MQIP) is a supplemental Medicaid rate paid to nursing facilities which provide Medicaid services. It is a retrospective payment based on paid dates of service. Payments are made no less frequently than quarterly for the purpose of eliminating or reducing to the maximum extent possible the difference between the allowable Medicaid costs, derived from the nursing facility Medicaid acuity rate setting system, and the amount which the state has budgeted in order to fund nursing facility care to Medicaid residents.

Nursing Facility Reimbursement Methodology - Proportionate Share Incentive Adjustment (ProShare) and Certified Public Expenditures (CPE)

The NH Department of Health and Human Services recognizes that non-State operated governmental (county) nursing facilities provide care to many severely medically involved patients requiring an extraordinarily intensive and costly level of care and have a very high Medicaid proportion of their patient census. The Department will insure continued access to this level of care through proportionate share incentive adjustment (ProShare) payments to county nursing facilities.

The ProShare payments will be separated into two incentive payment groups, ProShare 1 and ProShare 2, and shall be made by the end of each State fiscal year.

The ProShare Incentive Adjustment 1 (ProShare 1) shall be paid only to nursing facilities owned or operated by Belknap County, Hillsborough County or Sullivan County. ProShare 1 shall be the difference between what Medicaid has paid to County facilities for their Medicaid enrollees, including any Medicaid Quality Incentive Program (MQIP) payments and any lump-sum payments related to a year-end budget surplus, and their Medicare equivalent. ProShare 1 will be calculated using a payment-based methodology where the State would not be able to pay, in total, any amounts above the facility’s Medicare equivalent. The variance between the calculated total Medicare costs and the actual Medicaid payments is determined and payment up to the UPL is made to each facility.

The ProShare Incentive Adjustment 2 (ProShare 2) will be paid to nursing facilities owned or operated by Cheshire, Coos, Carroll, Merrimack, Grafton, Rockingham and Strafford counties. ProShare 2 will be calculated using a cost-based methodology of the difference between what Medicaid has paid to County facilities for their Medicaid enrollees, including any Medicaid Quality Incentive Program (MQIP) payments and any lump-sum payments related to a year-end budget surplus, compared to certified Medicaid costs as reflected on the Medicaid cost report submitted by the county facility to the Department for all qualifying nursing facilities for the current fiscal year, including the portion of the Nursing Facility Quality Assessment tax (NFQA) that can be allocated to Medicaid. The total amount of ProShare 2, including both the federal and local shares, shall be no more than the difference between Medicaid costs and Medicaid payments.

The ProShare 1 and 2 incentive payments to the counties shall be made by the end of the State fiscal year. A document outlining the payments to be issued to each County facility can be found at the link below and will be updated yearly, prior to the distribution of the payments.

States may use CPEs to fund the non-federal share of Medicaid expenditures when a local government entity, like a public hospital or school district, incurs expenses delivering services eligible for federal match under the state's approved Medicaid State Plan. The government entity certifies that it used public funds to deliver the service (or perform the Medicaid administrative activity), and the state reports those expenditures as Medicaid expenditures and claims federal matching funds. States generally then transfer the federal matching funds to the local government entity to offset their expenditures, although they are not required to do so.

Nursing Facility Rate Development
New Hampshire nursing facilities are paid a prospective rate which links each facility’s per diem rate to the level of services required by its resident mix. These prospective rates are set every six months to account for changes in the population and its acuity. The nursing facility industry is included throughout the rate setting process and is allowed numerous instances to review the rate setting data and provide feedback prior to the rates being approved and finalized. At the end of each rate setting cycle, a policy release and Appendix A are issued which states the final rates currently in effect for licensed nursing facilities included in the rate setting process, atypical care facilities, hospitals and out of state facilities treating New Hampshire Medicaid residents.

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