AGING AND DISABILITY SERVICES ADMINISTRATION
2009 NH "Dear Administrator" Letters
June 25, 2009
ADSA: NH# 2009-003
RE: JULY 2009 MEDICAID RATES FOR NURSING HOMES AND 2008 EXAMINATION ADJUSTMENTS
Dear Nursing Facility Administrator:
The July 1, 2009 Medicaid payment rate for your facility is enclosed. A copy of the "Description of July 2009 Nursing Facility Medicaid Payment Rate Setting" which explains how your rate was calculated is enclosed for your convenience. In creating the rate computation worksheet, the Department used wording and calculation descriptions as similar as possible to that used in prior rate settings to facilitate your review. Note that the July 1, 2009 non-capital component rates have been rebased using 2007 Cost Report information.
The July 1, 2009 Medicaid payment rate is subject to administrative review in accordance with RCW 74.46.770 and WAC 388-96-901 and 388-96-904. To appeal this rate, you must submit a request in writing within twenty-eight (28) calendar days after receiving this notice of the rate.
The desk examination summary and Reason Codes for the 2008 Medicaid Cost Report are also enclosed and subject to administrative review in accordance with RCW 74.46.770 and WAC 388-96-901 and 388-96-904. To appeal these adjustments, you must submit a request in writing within twenty-eight (28) calendar days after receiving this notice of the adjustments.
The Department calculated your facility’s July 1, 2009 adjusted rate using your facility’s Medicaid Average Case Mix Index (with defaults) from the 1st quarter of 2009 (January through March 2009) final RUG report.
If you wish to request an administrative review conference in relation to your July 1, 2009 rate or to the desk examination of the 2008 Cost Report, 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 are not properly signed, that do not state the issues with particularity, or that are not supported by the required documentation or information, will be denied or dismissed. Mail your appeal to the Office of Rates Management at the address above.
If proof of the date of receipt of the Department's rate notification letter exists, then that date shall be used to determine the timeliness of your request for an administrative review conference. If there is no proof of the date of receipt of the Department's rate notification letter, then you will be deemed to have received notice by July 1, 2009 in accordance with WAC 388-96-904 (1).
The July 1, 2009 rate has been affected by the “budget dial” statute, RCW 74.46.421. The application of the “budget dial” statute to the rate was the subject of a Notice of Adjustment of Medicaid Nursing Facility Rates Pursuant to RCW 74.46.421 dated May 27, 2009 and sent to all Medicaid-contracted nursing facilities. As explained in that notice, and as provided for by the statute, the Department calculated projected rates for all facilities for July 1, 2009, pursuant to Ch. 74.46 RCW and Ch. 388-96 WAC. Those projected rates were then reduced by a percentage reduction factor (PRF) of 7.29% that, when applied to all nursing facilities’ rates, will result in a statewide weighted average payment rate that is equal to or less than the $156.37 weighted average payment rate established by the Legislature for SFY 2010.
The PRF was applied to the rates of all facilities, even those whose rates were below the budget dial amount, as required by the statute.
The PRF was not applied to the low-wage worker add-on of $1.57 per Medicaid patient day, since that was paid as an add-on from a separate appropriation for that specific purpose.
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;…
Also enclosed are an “Addendum for July 2009 Rate Setting”, “Reason Codes for Examination Adjustments”, a list of Department personnel involved with nursing facility Medicaid payment,
listings depicting median cost limits by peer group, case mix weights calculations, and a list of the analysts responsible for specific facilities' Medicaid rates. I encourage you to contact your analyst if you have questions about your rate.
Sincerely,
Ken Callaghan, Chief
Office of Rates Management
Enclosures
cc: Interested Parties
