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Rhode Island Medicaid Retroactive Rate Adjustment

August 25, 2015

Monica Motta, CPA
Partner

Healthcare AccountingIn a meeting at the Executive Office of Health and Human Services (EOHHS) on August 20, 2015, it was disclosed that the EOHHS had not satisfied all of the technical requirements for making the change from the cost-based to the price-based methodology for nursing home payments until May 3, 2013. As a result, there will be retroactive adjustments to all providers for the period October 1, 2012 through May 3, 2013.

Medicaid rates will be recalculated under the “old” payment system using 2011 Medicaid cost reports as filed. Just to make this more interesting, calendar year 2011 was a base period for determining maximum reimbursement in the direct labor and other operating cost centers. 

Maximum Medicaid per diem ceilings recalculated are as follows:

 

  • (Re-arrayed Medicaid maximums provided by EOHHS)
     
  • Minimum occupancy will be applied to the revised October 1, 2012 Medicaid rates at 90.14%.
     
  • An inflation factor of 2.1% will be applied to the 2011 reported costs for the Medicaid rates effective October 1, 2012.
     
  • Medicaid days incurred for the period October 1, 2012 through April 30, 2013 and paid through December 31, 2013 will be used for settlement purposes. The period May 1, 2013 through May 3, 2013 will be estimated based upon actual Medicaid days from the period October 1, 2012 through April 30, 2013.
     
  • The acuity factor calculated for the period preceding October 1, 2012 will be applied to the Medicaid rate for October 1, 2012 through May 3, 2013.

EOHHS has indicated that this retroactive adjustment will result in payments owed to 59 providers, and 24 providers will owe money back to EOHHS.  For assistance in calculating your settlement, contact Monica Motta at mmotta@blumshapiro.com  or 401.330.2714.
 

Please click here to download an example where the provider is owed $120,882 from Medicaid >>

 

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