Medicaid Nursing Home Reimbursement

Overview

Adjusted Nursing Home Rates Effective January 1, 2017

 Please be advised that effective January 1, 2017, nursing home rates will be adjusted to reconcile fair rent asset additions that were fully amortized through cost years ending September 30, 2014.
Nursing Home Fair Rent Analysis

Nursing Facility Providers - Wage Enhancement

Pursuant to Section 377 of Public Act 15-5, June Special Session, the Department of Social Services is authorized to provide Medicaid nursing home rate increases to support wage and benefit enhancements.
State Plan Amendments, Benefit Summary, Forms, and Rate Calculations - Link To

DSS is gathering information to comply with Public Act Number 15-5. The information you provide may be used to calculate your nursing facility's pro-rata share of available monies appropriated for wage and benefit enhancements. Use Nursing Home Rates SPA 15-032 as a guide to completing the form. To be considered in your facility's pro-rata share calculation, the document must be completed and submitted to DSS. If any of the information requests are not applicable to your facility, indicate N/A on the form and return it with your submission. Please note, the attestation (request # 4) must be completed and submitted.
Medicaid Wage Enhancement Form

Nursing Facility Information

The Office of Reimbursement and Certificate of Need (CON) is responsible for establishing Medicaid reimbursement methodologies for Medicaid nursing homes. Reimbursement and CON is responsible for Medicaid State Plan Amendments that are necessary to obtain Federal matching funds for nursing home services provided through Connecticut's Medicaid program. There are currently 218 nursing homes and 26,812 licensed beds in Connecticut. Medicaid is the funding source for approximately 70.0% of nursing home care in Connecticut.

Nursing Facility Rates, Closures, Locations, and Census - Link to Nursing Facility Data

Nursing Home Strike Cost Reimbursement - Link To Nursing Home Strike Data

Connecticut Nursing Facility Payer Mix - 2016

Under the Connecticut Medicaid program, payment rates for nursing homes are set on a cost-based prospective basis in accordance with Section 17b-340 of the Connecticut General Statutes and Section 17-311-52 of the Regulations of Connecticut State Agencies. The federal government provides states discretion in determining the method used to pay for nursing facility services. The state's reimbursement methodology, however, must be approved by the Centers for Medicare and Medicaid Services (CMS) within the federal Department of Health and Human Services. The annual rate period for nursing homes is July 1 through June 30, unless modified by the legislature. The cost reporting period, however, is October 1 through September 30. Every Medicaid nursing home must complete an "Annual Report of Long-Term Care Facility" which is annually due before February 15th.

 Medicaid 71.4%
 Private Pay 10.6%
 Medicare 13.0%
 Other (Veterans/N.Y. Medicaid) 5.0%

Please see below a snapshot of key areas of focus:

• The Annual Report of Long-Term Care Facility template and other supporting information can be found on our rate setting contractor's website Opens in a new window (Myers and Stauffer, LC). The cost report captures detailed cost, statistical (e.g. residents days, therapy service volume, nursing hours) and ownership/related party transaction information.
• For the current rate period, July 1, 2013 through June 30, 2014, the statewide average Medicaid rate is approximately $228.00 per day for all non-specialized facilities. In SFY 2013, Medicaid expenditures for nursing facility services totaled approximately $1.2 billion.
• Medicaid Rate Setting Overview - Link To 
• The Center for Medicare and Medicaid Services (CMS) Nursing Opens in a new window Home Compare Opens in a new window compares Long-Term Care Facilities by location, facility size, ownership type, resident needs, inspection results and nursing home staff.
Medicaid Applications for Long-Term Services and Supports