Note: CMS has not yet approved the pre-print application for the PathWays managed care program, which may impact UPL distribution timing and calculation. FSSA provided an update on this during a recent Nursing Home Steering Committee meeting.
As a reminder, the pre-print application outlines the state’s managed care program including policies, procedures, capitation rates, payments rates, etc. including how UPL supplemental payments are computed and paid. While FSSA is hopeful that approval will come in December, there are no guarantees especially given the change in administration in DC. The UPL release process currently takes thirty days from release of data to payments due to a 15-day reconsideration period after release of calculations. This means if FSSA waits for CMS approval sometime in December, payment would not occur until probably January. FSSA wants to try to make payment in December if possible.
As a result, FSSA proposed changing the UPL process to try and get through the reconsideration process by early to mid-December, so funds can be released as soon as the state receives approval. To that end, the steering committee discussed the following changes to the UPL process:
- Myers and Stauffer released a notice with UPL allocations for the 9/30/24 quarter assuming CMS approves the pre-print. The Excel allocations will be posted to the Myers & Stauffer website as in the past.
- The allocation spreadsheets have changed to SCU and Vent add-ons being removed from the base rates and they will separate Fee for Service allocations and Managed Care Pool Allocations.
- The allocations will utilize census from the monthly census forms submitted by providers to Myers & Stauffer. While we believe that the census forms may overstate Fee For Service and overall Medicaid census in the short run, everyone agreed this was the best information available. The annual reconciliation process will utilize claims paid census days, so some providers may have significant recoupments upon annual reconciliation if days have been overstated on their census forms.
- Providers will have 15 days from today to file a reconsideration. Given that FSSA is using nursing facility provided census data and has already released the Medicare CMI data, we are hopeful there should be only a few, if any, reconsiderations filed.
- NSGOs will be required to sign an annual Memorandum of Understanding agreement which has been discussed in prior Steering Committee meetings. A draft of the MOU should be released in the next couple of days for the NSGOs to review.
- The quarterly payment letter has been revised and a draft will also be released in the next couple of days.
- The Fee For Service portion of the UPL payments will be released in mid-December as usual.
We believe the above changes should allow FSSA to make payment in December assuming approval is received and that there are no significant changes proposed by CMS. If CMS approval is not received by mid-December, FSSA and the state budget agency will have to decide if they will make the UPL payments without that approval. The association members of the Steering Committee expressed the need for the payments, given the cash flow disruption from the implementation of PathWays and that there was little risk to the state of recoupment issues with providers. However, FSSA expressed concern that they would be advancing 100% state funds since they could not claim the payments as Medicaid payments eligible for federal financial participation until the pre-print is approved. FSSA will continue to push on CMS for approval given the pre-print was filed in March and due to the imminent payment deadline.