IGT/UPL Calculation Changes

Last Wednesday, August 29th, the IHCA, along with Payment Committee co-chair Rick Mittman of BKD, Jim Leich (Leading Age) and Bob Decker (HOPE) met with representatives of Indiana Medicaid, the Division of Aging, and Myers & Stauffer (collectively, the “State”) on a number of outstanding reimbursement matters.  Just before the meeting took place, the State added to the agenda an item about the IGT/UPL calculation for NSGO nursing facilities.  IHCA learned that morning that that State would be filing notice that same day to amend the State Plan Amendment to provide for a new UPL calculation methodology for NSGO nursing facilities.

The State’s new methodology for UPL calculation will compare the difference of a facility’s Medicaid per diem rate and the reasonable estimate of the Medicare rate.  The State will no longer use the proportional share pool distribution based on the percentage of a facility’s Medicaid days in relation to the total number of Medicaid days in the pool.  There is no fiscal impact to the State, but as to individual facilities there is likely to be a difference in the UPL payments since it will now be based on the facility’s rate.  This change is set to be effective 10/1/12.  The notice may be found at http://www.in.gov/legislative/iac/20120829-IR-405120507ONA.xml.html.

IHCA has informed the IHCA Board of Directors and the IHCA Payment and Reimbursement Committee about the issue and will engage the State at the direction of our members.  In addition, the State confirmed at last week’s meeting that they are having preliminary discussions about establishing quality metrics as conditions to participate in the IGT/UPL nursing facility program.  Neither OMPP or Div. of Aging had any detail to share at that meeting.  IHCA impressed upon them our interest in engaging the State on the concept so that any change is not a surprise and is a reasonable approach to incentivizing quality.

Please contact Zach Cattell at 317-616-9001 or zcattell@ihca.org with any questions.