It looks like you have an older browser that is not supported by this site. Please click here to update.

Article Open to All

MLTSS Update

Posted Jun 3, 20211 min Read

Payment & Reimbursement

New Reimbursement Workstreams

As part of its series of mLTSS Stakeholder Workgroup meetings that have been meeting since January, FSSA held a Medicaid Nursing Facility Reimbursement Kick-off meeting on April 29, 2021.    In the meeting, FSSA announced it has created the three workstreams below to more closely analyze different components of the current rate structure and what changes should occur in a managed care environment.

  • Nursing facility base rates
  • Nursing facility supplemental payment program
  • Nursing facility quality/value-based purchasing

FSSA also reviewed its reimbursement goals and explained the rate setting methods they are developing would comply with CMS rules.  The goals are:

  • Alignment –Bring continuity across rate methodologies and provide a consistent framework.
  • Sustainability– Create a predictable, cost-effective, affordable system with access to quality services and provide long-term workforce growth and provider sustainability.
  • Promote Person–Centeredness and Value-Based Purchasing—Create incentives to achieve access to person-centered services and healthy outcomes.
  • Reduce Disparities—Build payment structures to reduce disparities in access and quality.

FSSA has contracted with Milliman to assist with this reimbursement project.  IHCA members and staff will participate in the workstreams, which will begin to meet later this month.  FSSA presented a project timeline, which showed that finalized rates, methods and simulation results would wrap up in the third quarter of 2021 and that the state and CMS approval process would occur from the fourth quarter through early 2022.  The PPT from the Kick-off meeting is attached here

About the Author

Elizabeth Eichorn