Medicaid Nursing Home Reimbursement


Cost Basis of Rates
The July 1, 2022 rate has been determined pursuant to Public Act 21-2, based upon a rebased rate using the cost report for the period ending September 30, 2019. Rates have been increased by 4.5% provided such rate increases are used for the purpose of employee wage enhancement pursuant to Public Act 21-2.
Categorization of Costs
Desk reviewed reported expenditures are categorized into five cost groups as follows in the rate computation:
  1. Direct - Nursing and nurse aide personnel salaries, related fringe benefits and nursing pool costs.
  2. Indirect - Professional fees, dietary, housekeeping, laundry personnel costs and expenses and supplies related to patient care.
  3. Administrative and General - Maintenance and plant operation expenses, and salaries and related fringe benefits for administrative and maintenance personnel.
  4. Property (Fair Rent) - A fair rental value allowance is calculated to yield a constant amount each year in lieu of interest and depreciation costs. The allowance for the use of real property (non-moveable equipment) other than land is determined by amortizing the base value of property over its remaining useful life, using the Hospital Fixed Asset Guide Book, and applying a rate of return (ROR) on the base value. The ROR is linked to the Medicare borrowing rate and is currently 2.766% for assets placed in service in 2016. Under state statute the maximum ROR is 11%. Non-profit facilities receive the lower of the fair rental value allowance or actual interest and depreciation plus certain other disallowed costs.
  5. Capital Related - Property taxes, insurance expenses, moveable equipment leases and moveable equipment depreciation.

Allowable Cost Maximums
Facility costs, calculated on a per diem basis by category, are limited to maximums established as percentages of median costs in the Direct, Indirect and Administrative/General categories. (Percentage of median, effective July 1, 2001 to current.)

Allowable Cost Maximum Percentages by Category
 Direct  135%
 Indirect  115%
 Admin/General  100%

Cost Component Limit Amounts
Under the statute, there are separate "peer groupings" by licensure type within the Direct category and for facilities in Fairfield County in recognition of higher wages in that area. The following limits are based on the 9/30/2019 Annual Reports:

Fairfield County (CCNH)
 Direct  $211.61
 Indirect  $74.77
 Admin/General  $40.72

Non-Fairfield County (CCNH)
 Direct  $190.78
 Indirect  $74.77
 Admin/General  $40.72

Inflation Update
Reductions to the inflation update have been included in statute for certain rate periods to promote efficiency and to limit the update to meet necessary cost increases. Application of allowable inflation is outlined in Regulations of Connecticut State Agencies §§ 17-311.

Incentives/Efficiency Allowances
The system provides a rate increase adjustment or "efficiency allowance" to facilities having lower costs in the Indirect and Administrative cost categories. The incentive is 25% of the difference between the facility's cost per day and the state-wide median cost per day in the component category.

Minimum Occupancy for Rate Setting
For rate computation purposes, allowable costs are divided by the higher of reported total resident days for the year or facility occupancy at 90% of licensed capacity.

Interim Rates
Under state statute and regulations, the Commissioner may grant an interim rate when a facility changes ownership, has a significant change in licensed bed capacity or faces a financial distress. In reviewing rates for hardship increases, area bed availability is considered. Over the past several years, due to the excess nursing facility beds available in Connecticut, there have been no hardship rate increases granted.

Resident Day User Fee
Public Acts 05-251 and 05-280 established a nursing facility resident day user fee to be imposed effective for calendar quarters commencing on or after July 1, 2005 and calculated by multiplying a nursing home's total non-Medicare resident days during the calendar quarter by the user fee. The current User Fee is $21.02 per non-Medicare resident day. For facilities with over 230 beds or owned by municipality, the User Fees is $16.13.

The resident day user fee is paid to the Department of Revenue Services by electronic funds transfer on or before the last day of October, January, April and July for the calendar quarter ending on the last day of the preceding month. Resident days mean each resident service day and include the day a resident is admitted and any day for which the facility is eligible for payment for reserving a resident's bed due to hospitalization or temporary leave or death. Resident days do not include the day a resident is discharged or days for which a resident is eligible for payment, in full or with a coinsurance requirement, under the Medicare program.

The User Fee legislation required that DSS apply to the Federal government for a waiver of tax uniformity rules to exempt nursing homes owned by entities registered as Continuing Care Retirement Communities (CCRCs) from the resident day user fee. There are 16 nursing homes associated with CCRCs and 13 are exempt from the resident day user fee under the Federal waiver.