AGING AND DISABILITY SERVICES ADMINISTRATION

December 31, 2003

ADSA: NH #2003-039
JANUARY 1, 2004 ADJUSTED MEDICAID PAYMENT RATE

Dear Nursing Facility/Home Administrator:

The Rate Computation Worksheet for your facility's January 1, 2004 adjusted Medicaid payment rate is enclosed.

Except for the different quarter RUG data, the department calculated your facility's January 1, 2004 adjusted rate using the same data used to calculate your facility's

July 1, 2003 Medicaid payment rate. The department calculated your facility's

January 1, 2004 adjusted rate using your facility's Medicaid Average Case Mix Index (with defaults) from the 3rd Quarter of 2003 (July through September 2003) final RUG report. The department calculated your facility's July 1, 2003 rate using your facility's Medicaid Average Case Mix Index (with defaults) from the 1st Quarter of 2003 (January through March 2003) final RUG report.

If a timely appeal of your July 1, 2003 rate is pending, when it is resolved, any changes made to adjustments because of this appeal will be brought forward to the facility's January 1, 2004 adjusted rate.

Enclosed you will also find a 3rd Quarter 2003 final RUG report.

Under WAC 388-96-901 (2) (f), the quarterly updates of a facility's resident case mix are not subject to review under WAC 388-96-904.

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

Sincerely,

Tom Kearns, Chief
Office of Rates Management

Enclosures (Facility-specific)