AGING AND DISABILITY SERVICES ADMINISTRATION
2009 NH "Dear Administrator" Letters
May 27, 2009
ADSA: NH # 2009-002
SUBJECT: June 1, 2009 ADJUSTED MEDICAID PAYMENT RATE
Dear Nursing Home Administrator:
The Rate Computation Worksheet for your facility’s June 1, 2009 adjusted Medicaid payment rate is enclosed.
This rate will be effective for the month of June only, and is necessitated by the Legislature’s passage of c. 564, Laws of 2009, the state operating budget, in its recently concluded session.
As explained in the “Dear Administrator” letter which accompanied them, your facility’s April 1, 2009 rates were affected by the so-called “budget dial” section, RCW 74.46.421. On February 18, earlier in this legislative session, the Legislature had changed the statewide average payment rate from $165.04 to $163.72. That change triggered the “budget dial” statute, and required the reduction that was shown in the April 1 rates.
In the final operating budget passed at the end of the legislative session, the Legislature restored most of the reduction in the statewide average payment rate it had passed in February. Instead of $163.72, the statewide average payment rate was set at $164.85.
The Department determined that the most appropriate way to implement this restoration was to calculate a new rate for the month of June. In part, this was because the Governor did not sign the operating budget bill until May 19, several weeks after the Legislature adjourned. This was not unusual. The operating budget bill is long and complex, and the Governor traditionally takes as much time as possible in reviewing it, to determine which sections to veto, if any. However, until the Governor signed the bill with the relevant section (Sec. 1106) intact, the Department could not presume that the partial restoration of the statewide average payment rate would actually occur.
The budget bill appropriated a total of $4,409,000 (including the federal matching funds) to fund the restoration of the statewide average payment rate.
A “restoration adjustment” factor of 7.8681% was used to calculate the June 1 rate. In abbreviated form, this was the calculation:
- take the facility’s rate from the April 1 rate setting - before application of the “budget dial’s” percentage reduction factor
- subtract the low-wage worker add-on paid to the facility, since that amount was not subject to the “budget dial”
- multiply the resulting number by the restoration factor of 7.8681%
- add the resulting number to the facility’s rate (which included the low-wage worker add-on) from the April 1 rate setting after application of the “budget dial’s” percentage reduction factor.
The Department calculated your facility’s June 1, 2009 adjusted rate using your facility’s Medicaid Average Case Mix Index (with defaults) from the 4th quarter of 2008 (October through December 2008) final RUG report. The department calculated your facility’s July 1, 2008 rate using your facility’s Medicaid Average Case Mix Index (with defaults) from the 1st quarter of 2008 (January through March 2008) final RUG report.
In accordance with WAC 388-96-901 (1)(b), budget dial actions are not subject to administrative review under WAC 388-96-904:
WAC 388-96-901 (1)(b) Adverse actions taken under the authority of this chapter or chapter 74.46 RCW not subject to administrative review under WAC 388-96-904 include but are not limited to:
- Actions taken under the authority of RCW 74.46.421 and sections of this chapter implementing RCW 74.46.421;…
If you wish to request an administrative review conference in relation to any other actions affecting your June 1, 2009, or any subsequent adjusted rate, please keep in mind WAC 388-96-904, the regulation that controls such requests. The regulation provides in part:
- The contractor’s request for administrative review shall:
- Be signed by the contractor or by a partner, officer, or authorized employee of the contractor;
- State the particular issues raised; and
- Include all necessary supporting documentation or other information.
- 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.
- 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.
(emphasis added)
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.
Further, bear in mind that the entire appropriation for Medicaid payments to nursing facilities in SFY 2009 has now been committed. At present there are no funds to pay any increased rates for any portion of SFY 2009, and the Department will not enter any rate into the system that would result in overspending of the amount set by the Legislature.
The department is no longer mailing the RUG reports. You can access your 4th quarter 2008 final RUG report or any other RUG report on line by using the directions located at http://www.adsa.dshs.wa.gov/Professional/MDS/documents/RUGreportsOnline.doc.
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
ljb
Enclosures
