**DSS Field Offices are now open Monday, Tuesday, Thursday and Friday, from 8:00 a.m. to 4:30 p.m.

**DSS Field Offices and our staffed telephone Benefits Center (1-855-6-CONNECT or 1-855-626-6632) are closed on Wednesdays to allow our staff time to process applications, renewals and related work.

**24/7 access: Customers can access benefit and application information, at www.connect.ct.gov and www.ct.gov/dss/apply; or our automated Client Information Line at 1-855-6-CONNECT (1-855-626-6632). More about 24/7 access options at www.ct.gov/dss/fieldoffices.

Medicaid Nursing Home Reimbursement

Overview

Notice to Nursing Homes 2020 Medicaid Advance Payments
In the spring of 2020, the Department provided $28 million in advance Medicaid payments to nursing homes to issue funds to the homes in an expedited manner in support of the COVID-19 public health emergency. Throughout the pandemic, with low census and financial challenges the nursing homes faced, the Department delayed recovery of the Medicaid advances. While this recovery was postponed through SFY 2021, it was expected to occur in SFY 2022 and was included in the budget as adopted by the General Assembly this past session.

The Department has recently implemented the 10% temporary rate increase (retro to July 1, 2021 through March 31, 2022). The Department will begin the schedule of recoveries over a five-month period from November 2021 to March 2022 to fall within the 10% temporary rate increase time frame. Please send any questions or concerns to Reimbursement & CON at: con-ratesetting.dss@ct.gov

September 29, 2021 Webinar on Case Mix Phase-In

Stakeholder Presentation on Case Mix Three-Year Phase-In

Summary Phase-in Spreadsheet by Nursing Home

Please note, the spreadsheet is for demonstration purposes only, and will not be utilized for Medicaid payment/claim adjudication purposes. It is designed to show the potential provider impact from the transition to a case mix (acuity-based) reimbursement system. Facility rate and fiscal impact information is subject to change from subsequent audit/review findings, CMI updates, additional legislative changes, and/or further system modification. Rate and underlying cost information was established utilizing best data available as of 10/1/2021. Issued rates are as of 10/1/2021. Future rate/wage add-on increases have not been incorporated at this time.

Nursing homes may send questions to the Department directly, or to their Myers & Stauffer representative, or through the associations. Questions will be collected and an FAQ document will be published. Please submit questions by October 15, 2021. Questions to the Department can be sent tocon-ratesetting.dss@ct.gov

Each nursing home has received a rate sheet via their Myers & Stauffer portal account. The rate sheet will feature "shadow rates" and the calculation used to develop the shadow rate. The rate sheet will be published quarterly so each nursing home can understand the quarterly movement of the acuity system. As a reminder, shadow rates are not what the home will receive for reimbursement. The shadow rate is to assist homes in understanding the quarterly movement of an acuity system and to assist homes in preparation for the transition to acuity reimbursement.

 


Letter from OPM & DSS to the Industry (May 2021)

Nursing Home FAQ #1 - responses to questions from the industry regarding the SFY22 and SFY23 financials support for nursing homes provided in the state budget

Nursing Home FAQ #2 - responses to questions from the industry wide town hall held on July 28, 2021


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.

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:
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

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.

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