Reimbursement and Certificate of Need

Overview

Reimbursement and Certificate of Need

The primary functions of Reimbursement and Certificate of Need (CON) include establishment of payment rates for medical and residential care services, cost report auditing, and performing certificate of need reviews for nursing facilities, residential care homes, and ICF/MR development projects. Cost based rates are issued on an annual basis by the unit for services including hospitals, nursing facilities, home health care, clinics, and community residences for the elderly and disabled; as well as state-operated psychiatric hospitals, ICF/MR and federal Medicaid waiver services. Since rate changes have a significant impact on the Department's budget, Reimbursement and Certificate of Need also conducts special rate projection analysis. Rate appeals and hearings are processed through the unit, while cost report audits are conducted through a contract with a major accounting firm and the Department's Quality Assurance Division. The unit is comprised of sixteen staff including a Director, a Manager, an office position, and thirteen analysts.

Below is detailed information regarding the various programs Reimbursement and Certificate of Need oversee. Please feel free to contact us. You can email your questions to: Reimbursement and Certificate of Need.

What's New...

2/28/2017 - Nursing Facility Census for February 2017

2/28/2017 - 2017 Continuing Care Facility Disclosure Statements

2/16/2017 - February 2017 SBCH Monthly Payment

1/19/2017 - SBCH Administrative Claiming Information and Training Video