AGING AND DISABILITY SERVICES ADMINISTRATION

ADSA > Professionals & Providers > Rates > 2008 Administrator Letters > #002

2008 NH "Dear Administrator" Letters

March 25, 2008

ADSA NH RATES #2008-002
SUBJECT: APRIL 1, 2008 ADJUSTED
MEDICAID PAYMENT RATE

Dear Nursing Home Administrator:

The Rate Computation Worksheet for your facility’s April 1, 2008 adjusted Medicaid payment rate is enclosed.

The department calculated your facility’s April 1, 2008 adjusted rate using your facility’s Medicaid Average Case Mix Index (with defaults) from the 4th quarter of 2007 (October through December 2007) final RUG report. The department calculated your facility’s July 1, 2007 rate using your facility’s Medicaid Average Case Mix Index (with defaults) from the 1st quarter of 2007 (January through March 2007) final RUG report.

If a timely appeal of your January 1, 2008 rate is pending, when it is resolved any changes made to adjustments because of this appeal will be brought forward to the facility’s
April 1, 2008 adjusted rate.

If you wish to request an administrative review conference in relation to your April 1, 2008, or any subsequent adjusted rate, please keep in mind WAC 388-96-904, the regulation that controls such requests. The regulation provides in part:

1. The contractor’s request for administrative review shall:
   1. Be signed by the contractor or by a partner, officer, or authorized employee of the contractor;
   2. State the particular issues raised; and
   3. Include all necessary supporting documentation or other information.
2. After receiving a request for administrative review conference that meets the criteria in subsection (1) of this section, the department shall schedule an administrative review conference. The conference may be conducted by telephone.
3. At least fourteen calendar days prior to the scheduled date of the administrative review conference, the contractor must supply any additional or supporting documentation or information upon which the
   contractor intends to rely in presenting its case. In addition, the department may request at any time prior to issuing a determination any documentation or information needed to decide the issues raised, and the contractor must comply with such a request within fourteen calendar days after it is received…The department shall dismiss issues that cannot be decided or resolved due to a contractor’s failure to provide requested documentation or information within the required period.
   

The department will enforce this regulation in responding to requests for administrative review. Requests that do not state the issues with particularity, or that are not supported by the required documentation or information, will be denied or dismissed.

Enclosed you will also find a 4th quarter 2007 final RUG report.

Please call your Medicaid rate analyst or Edward Southon, Nursing Home Rates Section Manager, at (360) 725-2469 if you have any questions about this letter.

Sincerely,

Ken Callaghan, Chief
Office of Rates Management

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Enclosures