Indiana Medicaid Rate Update – Reprocessing of Claims Has Begun for 1/1/14 and Forward

Regular updating of Indiana Medicaid NF rates had been held up for all of 2014 due to the pending State Plan Amendment (SPA) that proposed to increase NF rates by 2% effective 1/1/14 (i.e. to decrease the existing 5% cut to 3%).  CMS finally approved the rate increase SPA in late July that has set in motion a number of rate reprocessing activities.  Concurrent with the rate cut SPA being approved, CMS also approved an amended waiver for the Quality Assessment Fee that increases the fee.  This increase was required as it was found that the old fee structure failed the meet the Federal regulatory “B1/B2 test” that is a test to demonstrate Indiana’s QAF as “generally redistributive” when such a tax or fee is neither uniform nor broad based (Indiana’s tax is not uniform or broad based due to certain exemptions from the fee and due to a two-tiered fee structure).  See July’s IHCA Insights article for more detail on the QAF Waiver and the new rates by clicking here.

Indiana Medicaid through its contractor HP has already begun reprocessing rates for the 1/1/14 Rate Effective Date.  Indiana Medicaid released a timeline and reprocessing schedule on the website of Myers & Stauffer.  Click here for the rate plan release and click here for the nursing facility listing indicating what batch a particular nursing facility’s rate will be released.  Note that the release plan includes ICF/IIDs as those facility’s rates were also impacted by this SPA.

If you have any questions, please contact Zach Cattell at 317-616-9001 or zcattell@ihca.org.