Indiana Medicaid Rate Update

- January, April and July 2014 Rate Setting
As of June 30, 2014 Indiana Medicaid has been unable to set the 1/1/14 rates, and will not be issuing 4/1/14 or 7/1/14 rates, as CMS has yet to approve the State Plan Amendment (SPA) filed late last year to increase nursing facility reimbursement by 2% effective 1/1/14.  It is not entirely clear why CMS has yet to approved the SPA, but IHCA has become aware that CMS has been asking many rounds of questions to Indiana Medicaid concerning issues that are not related to nursing facility reimbursement rates.  Once the SPA is approved, Indiana Medicaid will work to implement the rate increase as soon as possible, but no definitive timeline is available.  As mentioned above, this delay is impacting issuance of 4/1 and 7/1 rates. 

- Quality Assessment Fee Waiver
As reported in February 2014, Indiana Medicaid was required to re-submit its waiver to CMS for the Indiana Quality Assessment Fee.  IHCA has been informed that the waiver has been approved by CMS, however implementation of the increased QAF rates will not take place until the above mentioned SPA concerning the rate increase is implemented.  Below is the list of QAF rates (imposed on all non-Medicare patient days) under the new waiver:
$4.09 (formerly $4.00) per non-Medicare day if the total patient census is 62,000 days or more (formerly 70,000 days)
$16.37 (formerly $16.00) per non-Medicare day if the total patient census is less than 62,000 days (formerly 70,000 days)
$4.09 (formerly $4.00) per non-Medicare day for non-state government owned or operated (NSGO) nursing facilities that became a NSGO prior to 7/1/03
$16.37 (formerly $16.00) per non-Medicare day for non-state government owned or operated (NSGO) nursing facilities that became a NSGO on or after 7/1/03
Continuing Care Retirement Communities (CCRCs) as defined at IC 16-28-15-7(2), hospital based, or state owned (Indiana Veteran's Home) facilities are exempt from paying the assessment.  In addition, Indiana Medicaid has filed notice to file a new State Plan Amendment to extend the effective date of the QAF until June 30, 2017 as is authorized by State law.

- Value Based Purchasing
Satisfaction surveys for residents, family and staff are now in the field for the second year as part of Indiana Medicaid’s Value Based Purchasing program.  While these surveys are not yet part of the official reimbursement add-on, they are setting the baseline data for possible inclusion in the future.  It has been reported to IHCA that the roll-out of these surveys this year has gone much smoother than last year.  If you have any questions or concerns, please contact Zach Cattell at zcattell@ihca.org or 317-340-6416.

- RUGs IV
As previously reported, Indiana Medicaid has proposed changing the Medicaid reimbursement formula to utilized RUGs IV rather than RUGs III.  No decisions have been made concerning a transition to RUGs IV, specifically in terms of what grouper would be used, and ongoing discussions between Indiana Medicaid, the FSSA Division of Aging, and IHCA are taking place.  IHCA has been assured that no change will occur until July 1, 2016, at the earliest, thereby giving providers ample time to plan for the fiscal and operational impact that the transition will have.