Medicaid Cost Reimbursement

Transcription

1 Medicaid Cost Reimbursement Nursing Home Trends January 16, 2009 (Updated with Trends, February 19, 2009) Workgroup on Nursing Facility Reimbursement Agency for Health Care Administration Tallahassee, Florida

2 Operating. Components of the Reimbursement Per Diem Patient Care. Direct Care. Indirect Care. Property. Cost Based. Fair Rental Value System (FRVS). 1

3 Target and Ceiling Limitations Target Limitations. Provider Target Limitation. New Provider Target Limitation. Ceilings. Cost-Based Class Ceilings. Target Rate Class Ceilings. 2

4 Per Diem $ Nursing Homes Reimbursement Total Costs vs Total Reimbursement $ $ $ $50.00 $- $26.02 $16.46 $15.67 $12.27 $11.59 $10.71 $11.10 $11.34 $13.52 $7.99 $7.78 $8.60 $11.48 $15.74 $18.76 $5.50 $11.20 $10.58 $6.21 $11.12 $12.50 $(2.98) $(5.06) $(50.00) Rate Semester Weighted Average Total Cost Weighted Average Total Reimbursement Total Difference 3

5 Percentage Nursing Homes Reimbursement Occupancy & Medicaid Utilization Percentages Rate Semester Mean Occupancy Mean Medicaid Utilization 4

6 Operating Component

7 Plan Changes to Operating Component by Rate Semester July 1, Interim Rate Request provision for General and Professional Liability Insurance. July 1, Partial Rebase of Target Limits to address General and Professional Liability Insurance issue ($27 million). 6

8 Plan Changes to Operating Component by Rate Semester July 1, Repeal of $27 million for partial rebase of Target Limits due to non-recurring funds. July 1, Full Re-basing of Targets and Ceilings. Floors established for Provider Targets and Target Ceilings. January 1, Provider Specific Target Inflation Multiplier is 2.0. New Targets established based on 7/07 rates. 7

9 Per Diem Nursing Homes Reimbursement Operating Cost vs Reimbursement $50.00 $45.00 $40.00 $35.00 $30.00 $25.00 $20.00 $15.00 $10.00 $5.00 $2.92 $3.46 $4.16 $4.94 $5.60 $5.85 $2.79 $2.82 $3.55 $0.75 $4.76 $7.01 $7.04 $7.17 $7.97 $4.62 $5.69 $5.66 $7.33 $1.91 $2.84 $3.35 $6.06 $ Rate Semester Operating Weighted Average Cost Operating Weighted Average Reimbursement Operating Difference 8

10 Patient Care Component

11 Plan Changes to Patient Care Component By Rate Semester July 1, $.25 Add-on. April 1, Case Mix Add-on. January 1, Partial Rebase of Target Limits. April 1, Direct Care Staffing Add-on (DCSA). 10

12 Plan Changes to Patient Care Component By Rate Semester January 1, Prorate DCSA for cost reports that include periods after April November/December Direct Patient Care Add on. January 1, Eliminated Case Mix Add-on. Patient Care component split into two subcomponents: Direct Patient Care. Indirect Patient Care. 11

13 Per Diem $ Nursing Home Reimbursement Total Patient Care Cost vs Reimbursement $ $ $ $80.00 $60.00 $40.00 $20.00 $- $6.51 $6.75 $5.23 $4.71 $4.51 $4.06 $5.00 $6.04 $(8.54) $(0.37) $(3.84) $(2.85) $0.00 $2.75 $(2.84) $1.20 $0.56 $5.44 $2.66 $4.25 $(1.62) $11.38 $(20.00) $(40.00) $(26.46) Rate Semester Patient Care Weighted Average Reimbursement Patient Care Weighted Average Cost Patient Care Difference 12

14 Direct Patient Care Salaries and benefits of direct care staff providing nursing care directly to the residents. January 1, Elimination of Target Limits. Limited to lower of Cost or Cost-Based Class Ceiling. Increased staffing ratio minimums. CNA from 1.7 hours/ppd to 2.3 hours/ppd. RN/LPN from.6 hours/ppd to 1.0 hours/ppd. Gross-up adjustment. 13

15 Direct Patient Care January 1, Increased staffing ratio minimums. CNA from 2.3 hours /ppd to 2.6 hours/ppd. Gross-up adjustment. July 1, Direct Patient Care Cost receives its own inflation factor. January 1, Increased staffing ratio minimums. CNA from 2.6 hours/ppd to 2.7 hours/ppd min with weekly avg of

16 Per Diem $ Nursing Homes Reimbursement Direct Care Cost vs Reimbursement $80.00 $60.00 $40.00 $20.00 $7.67 $- $(5.38) $(0.62) $(2.84) $(2.25) $(2.51) $(1.17) $(3.53) $(0.58) $(1.30) $1.96 $(0.69) $1.11 $2.20 $(20.00) $(22.02) $(40.00) Rate Semester Direct Care Weighted Average Cost Direct Care Weighted Average Reimbursement Direct Care Difference 15

17 Indirect Patient Care All other patient care costs. January 1, Elimination of Target Limits. Limited to lower of Cost or Cost-Based Class Ceiling. July 1, Target Limits return. 16

18 Indirect Patient Care July 1, Full Re-basing of Targets and Ceilings. Floors established for Provider Targets and Target Ceilings. January 1, Provider Specific Target Inflation Multiplier is 2.0. New Targets based on 7/07 rates. 17

19 Per Diem $60.00 Nursing Homes Reimbursement Indirect Care Costs vs Reimbursement $50.00 $40.00 $30.00 $20.00 $10.00 $- $(4.44) $(3.16) $0.25 $(1.00) $(0.60) $2.51 $3.92 $0.70 $1.78 $1.85 $3.48 $(0.93) $1.55 $2.05 $3.72 $(10.00) Rate Semester Indirect Care Weighted Average Cost Indirect Care Weighted Average Reimbursement Indirect Care Difference 18

20 Property and ROE

21 Per Diem $25.00 Nursing Home Reimbursement Property + ROE Cost vs Reimbursement $20.00 $15.00 $10.00 $7.28 $7.27 $7.55 $5.00 $2.61 $3.15 $3.70 $3.51 $4.16 $2.25 $1.84 $3.62 $4.16 $4.64 $4.62 $5.79 $3.23 $4.22 $4.36 $5.46 $6.22 $ Rate Semester All Property + ROE Costs Not FRVS Property + ROE Reimbursed Not FRVS Property + ROE Cost Not FRVS Property + ROE Difference 20

22 Per Diem $25.00 Nursing Homes Reimbursement Property + ROE vs FRVS $20.00 $15.00 $10.00 $7.66 $5.00 $4.75 $4.71 $5.02 $5.24 $5.29 $2.94 $2.39 $3.58 $3.72 $3.65 $4.27 $4.93 $3.77 $4.32 $4.37 $6.04 $5.16 $5.47 $5.38 $ Rate Semester All Property + ROE Costs FRVS Property + ROE Cost FRVS Rate FRVS Property + ROE vs Rate Difference 21

23 The End!!!!!