Public Notice of Proposed 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 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).

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 proposes to 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.

The SCDHHS is proposing the above action in order to address the NEMT escort related industry concerns and to provide nursing facilities with adequate 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 October 1, 2018, the weighted average rate is projected to be $182.62. 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 $.85 per patient day, or a .47% increase.

The SCDHHS projects that based upon the proposed action, annual aggregate Medicaid nursing facility expenditures will increase by approximately $3,250,000 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 the proposed action is available upon request at the address cited below.

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 comments@scdhhs.gov. Written and e-mailed comments must be received by close of business September 27, 2018.

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.