AGING AND DISABILITY SERVICES ADMINISTRATION
2009 NH "Dear Administrator" Letters
September 24, 2009
AASA: NH # 2009-005
SUBJECT: OCTOBER 1, 2009 ADJUSTED MEDICAID PAYMENT RATE
Dear Nursing Home Administrator:
The Rate Computation Worksheet for your facility’s October 1, 2009 adjusted Medicaid payment rate is enclosed.
The department calculated your facility’s October 1, 2009 adjusted rate using your facility’s Medicaid Average Case Mix Index (with defaults) from the 2nd quarter of 2009 (April through June 2009) final RUG report. The department calculated your facility’s July 1, 2009 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.
The department is no longer mailing the RUG reports. You can access your 2nd quarter 2009 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.
Your rate reflects the effects of 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 and subsequent rates.
According to its terms, the court’s order “shall remain in force” until 30 days after the Federal Centers for Medicare and Medicaid Services (CMS) takes action on the amendment to Washington’s Medicaid State Plan which the Department filed to reflect the “budget dial” amount of $156.37 for SFY 2010 set by the Legislature. The department filed the State Plan amendment on July 21, 1009; CMS has yet to act on it.
The State has filed a Motion to Dissolve the temporary restraining order, and oral argument on that motion has been scheduled for September 30. Because of that, and because of the continued pendency of the case, at present it is not possible to say with certainty what will ultimately happen with the rates.
If a timely appeal of your July 1, 2009 rate is pending, when it is resolved any changes made to adjustments because of this appeal will be brought forward to the facility’s October 1, 2009 adjusted rate.
If you wish to request an administrative review conference in relation to your October 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. Mail your appeal to the Office of Rates Management at the address above.
I encourage you to contact your analyst if you have questions about your rate.
Sincerely,
Ken Callaghan, Chief
Office of Rates Management
Enclosures
