DHS Final Public Meeting on 2015-16 NH Payment Formula – August 24


DHS will hold the third and likely final public meeting on the 2015-16 Nursing Home Methods of Implementation on Monday, August 24 from 1-4 p.m. The meeting will be in Room 751, 1 West Wilson Street, Madison.

At this meeting DHS will present various options to define the parameters of the 2015-16 payment formula. Given the absence of a Nursing Home funding increase for the current year, the continuing cost of funding the current formula will exceed funds available. DHS will identify the extent of the disparity and offer/solicit recommendations on where reductions should be employed to equate rate payments with funds available for the forthcoming rate year.

Representatives of ForwardHealth’s Third-Party Liability Team will also provide attendees with a briefing on a new claims processing edit that is currently scheduled to be implemented on October 1. Under the new edit, payment on nursing home claims will be denied if it appears the recipient has other insurance is available for payment of the underlying services. The projected effective date of the new edit is October 1, 2015.

Noting that the proposed edit process cannot be reconciled with the operational realities facility confront, WHCA, on July 8th filed three pages of concerns targeting the substance, timing and effect of the proposed new edit. While DHS recently agreed to delay imposing claims denials under the process until January 1, 2016, it has thus far not indicated it will provide clarifications or changes in the edit process that will render it compatible with facilities’ financial and administrative realities.  The meeting on August 24 will afford another opportunity to underscore the gravity of concerns for the impact that the new edit could have for facilities, if it is allowed to go forward without modification.

Anyone interested in attending or participating in the August 24 meeting should RSVP to Mary Jensen. DHS has indicated it will offer an opportunity to participate by teleconference but has not yet identified the process facilities should follow to enable them to participate by phone.