Medicaid Nursing Home Reimbursement

Overview

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 222 nursing homes and 26,445 licensed beds in Connecticut. Medicaid is the funding source for approximately 72.3% of nursing home care in Connecticut.

Nursing Home Fair Rent Analysis

NEW! 2% Wage Increase
The Secretary of the Office of Policy and Management recently approved a 2% increase on nursing home rates effective November 1, 2018. The increase will be implemented by the Department of Social Services (the Department) and is specifically intended to support a permanent increase of no less than 2% to the compensation of employees directly employed by the nursing home. Please visit the 2% Wage Increase page for more information.

NEW! Transition to Acuity-Based Methodology for Medicaid Reimbursement of Nursing Facilities
The Connecticut Department of Social Services will be transitioning Medicaid nursing facility reimbursement from a cost-based methodology to a prospective acuity-based or case mix payment system. This method will aid DSS in its goals of moving toward a system that is data driven, improves transparency, and benefits patient outcomes. View the Acuity Based Methodology web page for additional information and updates.

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 72.3%
Private Pay 10.6%
Medicare 12.7%
Other (Veterans/N.Y. Medicaid) 4.4%

Key Areas of Focus

  • The Annual Report of Long-Term Care Facility template and other supporting information can be found at Myers and Stauffer. 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, 2017 through June 30, 2018, the statewide CCNH average Medicaid rate is approximately $234.09 per day for all non-specialized facilities. In SFY 2017, Medicaid expenditures for nursing facility services totaled approximately $1.2 billion.
  • The Center for Medicare and Medicaid Services (CMS) Nursing 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