*Has your contact information changed? Don’t miss important news about your benefits. Please update your contact info online now! If you’re a HUSKY A, B or D member, go to www.accesshealthct.com and sign in to your Access Health CT User Account. If you’re a HUSKY C member, SNAP or cash assistance client, go to www.connect.ct.gov or www.mydss.ct.gov and sign in to your DSS MyAccount.

*24/7 access to DSS: You can apply for & renew services online through our ConneCT portal (www.connect.ct.gov). Get case/benefit status, view notices, report changes, download budget sheets, upload & send documents & more! Our 24/7 Client Information Line gives you access to many service & eligibility needs (1-855-626-6632). And check out MyDSS--our new mobile-friendly app--access your account anywhere, anytime, on any device (www.ct.gov/mydss).

Medicaid Nursing Home Reimbursement

Overview

Nursing Home Case Mix Implementation Stakeholder Webinar on April 14, 2022 at 1:00pm  Representatives from Myers and Stauffer LLC will present a webinar on the following information:

Notice to Nursing Homes February 2022 - 10% Rate Increase Extended
The Department understands the challenges many nursing homes continue to face with staffing costs. Public Act 21-2 established a temporary 10% rate increase for a 9-month period effective July 1, 2021 to March 31,2022. In support of nursing homes, the Department will extend the 10% rate increase to June 30, 2022 by utilizing the $10 million in ARPA funding for Nursing Home Facility Support under section 306 and 321 of PA 21-2, June special session, and covering the balance under Medicaid. Specifically, the rate increase for April and May 2022 will be covered under Medicaid while the increase for June 2022 will be funded through the utilization of the $10 million in ARPA funding that was allocated for Nursing Home Facility Support. Extending this support through the end of the state fiscal year will provide nursing homes over $29 million to support staffing costs and other expenses related to the public health emergency.

Industry Letter to DSS (January 19, 2022)
DSS Response (February 3, 2022)

Notice to Nursing Homes January 2022 Guidance
On May 13, 2021, the Department of Social Services and the Office of Policy and Management jointly released a financial support package to the nursing home industry that included almost $300 million in support stabilization funds, wage and benefit enhancements, investments in workforce development, and enhanced access to affordable child care, all in support of residents and also nursing home workers, which is recognition of the sacrifice and dedication not only during the pandemic, but year-round.

The COVID-19 pandemic has had significant impacts on the nursing home industry and the frontline workers that served and worked during a difficult time. The Department recognizes the impact that the pandemic has had on workers, residents and on the industry as a whole, and is committed to addressing the long-term viability and stability of the nursing home industry with a goal to maximize the quality of care and the quality of work life for the employees that provide this care for our residents in need. Therefore, the May 13, 2021 letter outlined specifically that:

"Any nursing home that (1) does not reach 85% occupancy by April 1, 2022, (2) has excess beds in their region, or (3) determines the acuity-based payment system will result in substantial deterioration of the home's financial condition that may be expected to adversely affect resident care and the continued operation of the home, will be required to submit a plan to the Department of Social Services on efficiency, quality of care and consolidation of facilities. The review of such plans will include consideration of the need for nursing home beds within a 15-mile radius of the home. Nursing homes must then start acting on the plan within three months of approval."

Plans must be submitted no later than April 1, 2022 to the Office of Reimbursement & CON con-ratesetting.dss@ct.gov

At a minimum, plans must include a description of how the facility will address the criteria above, and submissions may include any and all documents needed to support and describe the facilities intended plan of action. Documents submitted may include, but are not limited to, financial documents such as cost reports, payroll, census data, letters of intent, certificate of need applications, floor plans, and any other document needed to convey to the Department the nursing home’s position and plan of action.

Nursing homes are encouraged to submit plans that support efficiency, quality and, when possible, consolidation. The Department will review the plans and approve or deny the plan. The nursing home must start acting on the plan within three-months of Department approval. The Department will follow-up with each home either approving or denying submissions, and the Department will work with homes to make plan revisions as appropriate. For additional questions please contact the Office of reimbursement & CON con-ratesetting.dss@ct.gov

Letter from OPM & DSS to the Industry (May 13, 2021)
Nursing Home FAQ #1 
Nursing Home FAQ #2 


Enhanced Health Care and Pension Benefits for Nursing Facility Employees
Special Act 21-15 appropriated $15 million to the Department of Social Services, for Medicaid, for the fiscal year ending June 30, 2023 for the purpose of adjusting nursing home rates for facilities that provide enhanced health care and pension benefits for facility employees. Facilities that receive a rate adjustment for the purpose of providing enhanced health care and pension benefits for employees but do not provide such enhanced benefits may be subject to a rate decrease in the same amount as the adjustment by the Commissioner of Social Services. Total funding for the program is $30 million (state and federal).

Nursing homes that wish to receive funding for this purpose are ask to complete the application and submit to Reimbursement & CON at: con-ratesetting.dss@ct.gov no later than March 25, 2022. Applications received after this date will not be considered. The total allocation is limited to $30 million (state and federal share) and therefore, the available funding will be distributed pro-rata based on the cost of each facility’s enhancements. The Department cannot determine each facility’s pro-rata share of available funding until all applications have been received. Facilities are advised to submit applications as soon as possible before the March 25, 2022 deadline. Please see the FAQ document below for additional information. 

Health Care and Pension Application
FAQ (Revised March 2022)

Applications must be submitted no later than March 25, 2022 to the Office of Reimbursement & CON via emailcon-ratesetting.dss@ct.gov

Please send questions to con-ratesetting.dss@ct.gov 


Social Worker Rate Increase
Per Public Act 21-2, June special session, up to $2,500,000 in state funding has been allocated to the Department of Social Services, for Medicaid, for each of the fiscal years ending June 30, 2022 and June 30, 2023, for Social Worker staffing at nursing homes to meet the Department of Public Health (DPH) requirement. The DPH minimum staffing requirements for Social Workers in nursing facilities has been mandated to a minimum of one full time Social Worker per sixty beds. Nursing homes that are not currently providing such staffing may complete an application to be considered for a Medicaid rate increase to support a staffing increase up to the minimum. The form along with supporting documentation should be completed and returned to con-ratesetting.dss@ct.gov.

Please note: any supporting documentation containing Protected Health Information (PHI) must be submitted in a HIPAA compliant, secure manner. Please include the following documentation with your submission:
Direct Care Rate Increase
Public Act 21-185, established a nursing home minimum staffing level of three hours of direct care per resident per day. Public Act 21-2, June special session allocated up to $500,000 in state funding to the Department of Social Services, for Medicaid, for each of the fiscal years ending June 30, 2022 and June 30, 2023, to support the minimum nursing home staffing requirement. Nursing homes that are not currently providing such staffing may complete an application to be considered for a Medicaid rate increase to support a staffing increase up to the minimum. The form along with supporting documentation should be completed and returned to con-ratesetting.dss@ct.gov.

Please note: any supporting documentation containing Protected Health Information (PHI) must be submitted in a HIPAA compliant, secure manner. Please include the following documentation with your submission:
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 209 nursing homes and 24,522 licensed beds in Connecticut. Medicaid is the funding source for approximately 74% of nursing home care in Connecticut.
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 webpage for additional information and updates.

Nursing Home Bed Reduction Process
The Department is responsible for the Certificate of Need (CON) process for nursing homes. A Nursing Home, or Applicant, may request a decrease in total bed capacity by submitting a letter of Intent for a Certificate of Need (CON) to the Commissioner of the Department of Social Services. Bed Reduction Information

Wage Increase
Rate increases will be implemented by the Department of Social Services (the Department) and is specifically intended to support a permanent increase to the compensation of employees directly employed by the nursing home. Wage Increase Information

Connecticut Nursing Facility Payer Mix
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.

Payor Mix  2018  2019  2020
Medicaid  73.91% 74.09%  72.60%
Medicare  11.5% 10.25%  12.08%
Private Pay  9.99% 9.94% 9.97% 
Other (Veterans/Medicaid Other States)  4.6% 5.72%  5.35%

Medicaid State Plan Amendments
The state plan is an agreement between a state and the Federal government describing how that state administers its Medicaid and CHIP programs. It gives an assurance that a state will abide by Federal rules and may claim Federal matching funds for its program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities. When a state is planning to make a change to its state plan, the state must send state plan amendments (SPAs) to the Centers for Medicare & Medicaid Services (CMS) for review and approval. States also submit SPAs to request permissible program changes, make corrections, change reimbursement methods, or update their Medicaid or CHIP state plan with new information. Connecticut Medicaid State Plan Amendments submitted to the Centers for Medicare & Medicaid Services (CMS) within the U.S. Department of Health and Human Services (HHS) are available through the Department website.

Additional Information