Public Notice of Final Action for Non-Emergency Medical Transportation (NEMT) Nursing Facility Add-On
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 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).
Effective for non-emergency medical transportation (NEMT) services provided on and after January 1, 2018, the SCDHHS moved the responsibility of the NEMT transports applicable to SC Medicaid nursing facility residents from the NEMT Broker to the SC Medicaid contracting nursing facilities. To implement this change, the SCDHHS determined a provider specific NEMT add-on to the October 1, 2017, nursing facility specific payment rate based upon calendar year 2016 trip and mileage data provided by the NEMT Broker and the use of mileage and transport rates developed by SCDHHS. Now that the SCDHHS has actual trip and cost data incurred by nursing facilities for the January 1, 2018, thru June 30, 2018, service period, the SCDHHS will update the provider specific NEMT add-on effective for services provided on or after October 1, 2018, based upon the January 1, 2018, thru June 30, 2018, data that will be subject to adjustment due to significant acuity and utilization shifts observed in the type of NEMT transports among some participants.
The SCDHHS is implementing the above action to adjust reimbursement to reflect updated cost data for clinically appropriate NEMT transportation.
As a result of the above action relating to the Medicaid reimbursement methodology change for nursing facilities effective for services provided on or after October 1, 2018, the weighted average rate is projected to be $182.42. The weighted average October 1, 2018, rate prior to the October 1, 2018, NEMT add-on update was $181.77. This represents a weighted average per diem increase of $.65 per patient day, or a .36% increase.
The SCDHHS projects that based upon the above action, annual aggregate Medicaid nursing facility expenditures will increase by approximately $2.5 million total dollars including Medicaid days paid while the resident is under the Hospice benefit.
Copies of this notice are available at each County South Carolina Department of Health and Human Services Office and at www.scdhhs.gov for public review. Additional information concerning this action is available upon request at the address cited below.
Any written comments submitted may be reviewed by the public at the South Carolina Department of Health and Human Services, Reimbursement Methodology and Policy, 1801 Main Street, Room 1219, Columbia, South Carolina, Monday through Friday between the hours of 9:00 A.M. and 5:00 P.M.