AGING AND DISABILITY SERVICES ADMINISTRATION
2009 NH "Dear Administrator" Letters
July 14, 2009
ADSA: NH# 2009-004
RE: AMENDED JULY 2009 MEDICAID RATES FOR NURSING HOMES
Dear Nursing Facility Administrator:
A revised July 1, 2009 Medicaid payment rate for your facility is enclosed.
This rate reflects a temporary restraining order entered on July 13, 2009 by the U.S. District Court for the Western District of Washington at Tacoma in the matter of Washington Health Care Association, et al. v. Dreyfus, No. C09-5395 RBL. Essentially, the order temporarily enjoins the Department of Social and Health Services from applying the “budget dial” provision of RCW 74.46.421 to Medicaid nursing facility rates for July 1, 2009.
This revision of 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 revised rate, you must submit a request in writing within twenty-eight (28) calendar days after receiving this notice of the rate.
If you wish to request an administrative review conference in relation to your July 1, 2009 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 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 20, 2009 in accordance with WAC 388-96-904 (1).
Simply put, your facility’s revised July 1, 2009 is the projected rate the Department had previously calculated for your facility’s July 1 rate, before application of the 7.29% “percentage reduction factor.” Everything else in the rates packet that was sent to all facilities on June 25, 2009 remains unchanged.
Please note that this revised rate is itself subject to change. By its own terms, the court’s order “shall remain in force” until 30 days after the Federal Centers for Medicare and Medicaid Services takes action on the amendment to Washington’s Medicaid State Plan which the Department will file to reflect the “budget dial” amount of $156.37 for SFY 2010 set by the Legislature. The court may simply allow the order to terminate under its own terms, or it may enter an additional order(s) at the request of one or both of the parties. At present, it is not possible to say with certainty what such additional order(s) might provide, and so it is therefore not possible to say with certainty what will ultimately happen with the 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
