Date: July 7, 2020
To: Long Term Care Facilities - Nursing Facilities (NF), Supportive Living Program (SLP) Providers, and Specialized Mental Health Rehabilitation Facilities (SMHRF)
Re: Reimbursement Rates effective July 1, 2020
This notice provides updated information on the rate setting process for reimbursement rates effective for services provided between July 1, 2020 and September 30, 2020.
The nursing facility nursing component calculation for the July 1, 2020 rates is dependent upon the submission of Minimum Data Set (MDS) assessments for residents in the quarter ending March 31, 2020. In mid-March, the Centers for Medicare and Medicaid Services, as part of the COVID-19 Emergency Declaration Blanket Waivers, waived the timeframe requirements for MDS assessments and transmission. Due to this waiver, the Department is providing nursing facilities with additional time to submit the MDS assessments for residents in quarter ending March 31, 2020.
The Department is requesting that all MDS assessments for the quarter ending March 31, 2020 be submitted by July 15, 2020. Based upon these submissions, the Department will calculate rates effective for services starting July 1, 2020. It is anticipated that per diem rates will be finalized prior to August 1, 2020 and provided to managed care plans.
To avoid the need to reprice claims, the Department recommends not billing the Department or managed care plans for July 2020 services until the beginning of August 2020. This recommendation also applies to Supportive Living Program (SLP) providers since their regional rates will be dependent on the nursing facility rates being finalized.
MDS Coding for Isolation
CMS requirements for coding isolation have NOT changed. CMS has indicated that providers should continue to code residents for the O0100M isolation item per current MDS-RAI manual instructions.
Code for “single room isolation” only when all of the following conditions are met:
1. The resident has active infection with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission. It also defines this as Symptomatic and/or has a positive test and is in contagious stage. Do not code if history of disease and no active symptoms.
2. Precautions are over and above standard precautions. That is, transmission-based precautions (contact, droplet, and/or airborne) must be in effect.
3. The resident is in a room alone because of active infection and cannot have a roommate. This means that the resident must be in the room alone and not cohorted with a roommate regardless of whether the roommate has a similar active infection that requires isolation.
4. The resident must remain in his/her room. This requires that all services be brought to the resident (e.g. rehabilitation, activities, dining, etc.).
Regional Wage Adjustor Floor
The Department is filing a State Plan Amendment to increase the Regional Wage Adjustor floor used in the nursing component calculation to 1.0, effective for July 1, 2020 services. If approved, this will affect the nursing facility, SLP provider, and Specialized Mental Health Rehabilitation Facility (SMHRF) rates. Additional information will be provided when it becomes available.
Questions regarding this bulletin may be directed to the Bureau of Long Term Care at
Interim Medicaid Administrator