BKD: Indiana Medicaid Update

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Medicaid Quality Add-On Score - Indiana’s Medicaid Value Based Purchasing is changing.  Effective July 1, 2019, Indiana will utilize a score derived from the existing nine (9) Long-Stay Quality Measures (QM) used in the Five Star Rating program created by CMS (Please see Exhibit 1 for Listing of the Nine Long-Stay Quality Measures).  Although not final, we anticipate this change to phase-in over a two-year period.  Similar to the Five Star QM rating, this Quality portion of the add-on will be calculated over a historical rolling four-quarter average.  MDS data currently being collected will be reflected in future Add-On scoring.
We anticipate the phase-in of the Nursing Facility Quality Add-On Score to calculate as follows:
Current – 75% Report Card Score, 25% Staff Retention / Turnover.
Effective July 1, 2019 – 30% Quality Measures, 55% Report Card Score, 10% Staff Retention & 5% Advance Care Planning Certificate.

Effective July 1, 2020 – 60% Quality Measures, 25% Report Card Score, 10% Staff Retention & 5% Advance Care Planning Certificate.
In preparation for this transition, it is imperative that MDS assessments are accurately coded.  MDS and nursing staff should also understand the existing Long-Stay Measure calculation methodology and apply this knowledge to impact improvements in these quality areas to their clinical practice.   Our MDS consultants are available to assist providers to identify and implement clinical practices to improve performance on these Long-Stay Quality Measures.

End Of Therapy Date Information – Indiana Medicaid will be requiring End of Therapy (EOT) date information for Medicaid rates effective July 1, 2019.  This will be required for all payor types and Myers & Stauffer will use this information to modify Medicaid CMI scores for the end of therapy.  Please see Exhibit 2, which is a schedule for submitting EOT date information.   

Nurse Consulting Expense – Effective October 1, 2017, nurse consulting services will be reimbursed in the Indirect Care component.  The regulation has been modified & reads as follows:
“Nurse consulting services, whether provided by internal facility personnel, central office personnel, or contracted, that are not directly related to the provision of hands-on resident care.  Such nursing consulting services include, but are not limited to:  health survey, quality assurance processes, and MDS consultation (excluding data input and coding).”
These type of expenses have historically been included in the Direct Care component.  However, Myers & Stauffer have recently upon audit been moving these expenses to Administrative, which has a negative impact on the Medicaid rate.  BKD has recently been successful in getting some of these nurse consulting expenses moved back into the Direct Care component.   Please contact us if you would like to discuss this issue.

Proposed Reduction to the Medicaid Fee-For-Service Claims Filing Limit – Medicaid is considering reducing the time allowed to bill Medicaid Fee-for-Service (FFS) claims from 365 days to 90 days.  The healthcare associations are aware of this possible change & are working to prevent it.  Please see Exhibit 3, which provides the percentage of claims billed within 90 days for each Provider.  Although this is still only a proposal, we would recommend reviewing the attachment, comparing it against your records & looking into any Medicaid claims that are taking longer than 90 days to bill.   
Medicaid Statistics
  • Latest Medians (October 1, 2017)
    • Direct Care - $81.77
    • Indirect Care - $43.11
    • Administrative - $23.42
    • Capital - $18.29
  • State-Wide Average Occupancy Percentage – 76.13%
  • State-Wide Average Medicaid Rate – $195.02
  • State-Wide Average Medicaid CMI Score – 1.15

Indiana Upper Payment Limit (UPL) Statistics

  • December 31, 2017 Interim UPL Payment Date – March 7, 2018
  • Number of Indiana Nursing Facilities Participating in UPL Program – 491
  • Total December 31, 2017 State-Wide Average UPL Amount Per Patient Day – $118.79
  • Net December 31, 2017 State-Wide Average UPL Amount Per Patient Day – $77.92  (Net of IGT Payment)



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