Proposed Actions for Non-Emergency Medical Transportation (NEMT) Services Provided for Nursing Facility Residents
The South Carolina Department of Health and Human Services (SCDHHS), pursuant to the requirements of Section 1902(a)(13)(A) of the Social Security Act, gives notice of the following proposed action regarding its methods and standards for setting payment rates for long term care facility services under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
The SCDHHS has decided to move the responsibility of the non-emergency medical transports applicable to SC Medicaid nursing facility residents from the NEMT Broker to the SC Medicaid contracting nursing facilities. Therefore, effective for services provided on or after January 1, 2018, the SCDHHS proposes to amend the South Carolina Title XIX reimbursement methodology for long term care by reimbursing nursing facilities for non-emergency medical transports. To accomplish this task, the SCDHHS proposes to calculate an individual NEMT per patient day add-on to add to each nursing facility’s October 1, 2017 Medicaid reimbursement rate using calendar year 2016 transport data and SCDHHS determined NEMT transport rates.
The SCDHHS is proposing the above action in order to address the NEMT escort related industry concerns and provide nursing facilities with funding to cover the cost of the new NEMT transport requirement.
As a result of the proposed action relating to the Medicaid reimbursement methodology change for nursing facilities effective for services provided on or after January 1, 2018, the weighted average rate is projected to be $177.25. The weighted average October 1, 2017 rate was $176.29. This represents a weighted average per diem increase of $.96 per patient day, or a .54% increase.
The SCDHHS projects that based upon the proposed action, annual aggregate Medicaid nursing facility expenditures will increase by approximately $3,761,000 total dollars including Medicaid days paid while the resident is under the Hospice benefit. However, due to the savings to be realized from the NEMT Broker’s inability to provide NEMT services to nursing facility residents, the net increase in SCDHHS annual Medicaid expenditures is projected to be approximately $505,000 total dollars.
Written comments may be sent to the Division of Long Term Care Reimbursements, South Carolina Department of Health and Human Services, Post Office Box 8206, Columbia, South Carolina 29202-8206. Comments may also be submitted to firstname.lastname@example.org. Written and e-mailed comments must be received by close of business December 28, 2017.
Copies of this notice are available at each County Department of Health and Human Services Office and at www.scdhhs.gov for public review. Additional information concerning the proposed action is available upon request at the address cited below. Any written comments submitted may be reviewed by the public at the SCDHHS, Division of Long Term Care Reimbursements, Room 1219, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9:00 A.M. and 5:00 P.M.