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NH Nursing Facility Medicaid Rates and Payments

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.

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.

The department is in the process of updating its Title XIX State Plan to include a description of the reimbursement methodology for supplemental Medicaid payments. Comments will be due by May 18, 2018.

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.

The department is in the process of updating its state plan to include a description of the reimbursement methodology for ProShare and Certified Public Expenditures. See below for most current public notice information and State Plan Amendment pages relative to ProShare/CPE; for informational purposes only.

 

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