NH Rates Effective 10/1/15


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 actions regarding its methods and standards for setting payment rates for long term care facility services (excluding state owned nursing facilities) under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Effective for services provided on or after October 1, 2015, SCDHHS will amend the South Carolina Title XIX reimbursement methodology for long term care by:

  1. Providing payments to nursing facilities based on the most recent cost report data available (i.e., FYE September 30, 2014);
  2. Updating the cost center standards based upon the FYE September 30, 2014 Medicaid cost reports;
  3. Applying a 3.00% inflation factor in the calculation of the October 1, 2015 payment rates;
  4. Applying an updated deemed asset value and market rate of return factor for October 1, 2015 Medicaid rate setting purposes.

SCDHHS is implementing actions 1 through 4 in order to determine Medicaid reimbursement rates based upon the most recent cost report data available and to ensure that nursing facility expenditures remain within budgeted amounts during state fiscal year 2015/2016.

As a result of the above actions relating to the Medicaid nursing facility reimbursement methodology changes effective for services provided on or after October 1, 2015, the weighted average rate is projected to be $169.01. The weighted average September 30, 2015 rate was $169.40. This represents a weighted average per diem decrease of ($.39) per Medicaid patient day, or a (.23%) decrease.

SCDHHS projects that based upon these actions, annual aggregate expenditures will decrease by approximately ($1,000,000) total dollars including Medicaid days paid while the recipient is under the Hospice benefit.

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 this 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 1209, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9:00 A.M. and 5:00 P.M.

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