NURSING HOMES MEDICAID REIMBURSEMENTS AND MEDICAID ELIGIBLE RESIDENTS

OLR Research Report


November 21, 2002		2002-R-0876
NURSING HOMES' MEDICAID REIMBURSEMENTS AND MEDICAID ELIGIBLE RESIDENTS

By: Robin K. Cohen, Principal Analyst

You asked (1) how often the state re-bases nursing home rates, (2) for the Medicaid per-diem rates for the state's nursing homes, and (3) for a list of homes with high numbers of Medicaid-eligible residents.

SUMMARY

The Department of Social Services (DSS) sets the Medicaid per diem rates for the state's nursing homes each year based primarily on cost reports the homes submit to the department. By law, DSS can use a cost report as a base for per diem rates in alternate years for the next immediate four years. After that, it must rebase the rate using updated reported costs. The current per diem is based on cost reports covering October 1, 1999 to September 30, 2000.

Nursing homes receive the per diem rate for each of their Medicaid eligible residents. DSS sets one rate for a home's "skilled" beds (the chronic and convalescent or CCH rate) and a separate, lower one for its intermediate care beds (called the rest home with nursing supervision or RHNS rate), if it has them.

For the current rate year, which runs from July 1, 2001 to December 30, 2002, the CCH per diem rates for the state's 242 homes range from a high of $ 221 for a facility in Hartford to a low of $ 109. 18 for a Norwichtown home. For the RHNS beds, the daily rates ranged from $ 160. 86 for a home in Stamford to $ 98. 96 for a Cromwell home.

DSS did not have statistics on the actual number of Medicaid recipients living in these homes, but it did provide the percentage of days when there were Medicaid-eligible residents living at each (i. e. , percentage of resident days). For example, of all homes with CCH beds, nearly half (112) reported that Medicaid paid for 70% or more of the total number of resident days in their homes. Of these home, 36 had 80% or more of their beds filled by Medicaid-eligible residents. Six homes reported Medicaid resident day rates of 90% or higher. Over 40 of the homes also had intermediate care beds with established rates for these beds. Of these, 28 had 70% or more of their beds occupied by Medicaid-eligible residents. Most of the remaining resident days were paid with private funds. The top five homes with Medicaid-eligible residents in CCH beds for the most days are located in Putnam, Middletown, Hartford, Norwalk, and West Haven. Those with such residents in RHNS beds for the most days are located in Bridgeport, Southbury, Southington, Granby, and Cromwell.

Attachment 1 lists (1) all of the nursing homes that currently get separate Medicaid rates for their skilled, intermediate, or both types of beds; (2) the daily rate DSS currently reimburses the homes for these beds; and (3) the percentage of resident days that were eligible for Medicaid reimbursement, as reported in the homes' 2000-01 cost reports.

PER DIEM RATES AND RATE RE-BASING

When DSS sets the Medicaid rates it pays nursing homes that care for Medicaid-eligible residents, it uses a complex formula that takes into account each individual facility's reported costs. (Homes must submit cost reports covering a particular year beginning on October 1 and ending September 30 by December 31 of the same year. )

Although homes submit their cost reports every year, DSS may not re-base these costs more frequently than once every two years and less frequently than once every four years (CGS Sec. 17b-340(f)(8)). What this means is that DSS may not use the cost report for the most recent cost year and base a facility's future rate on those costs. Instead, it relies on cost reports from two to four years old and uses them to set the rates for multiple years. DSS uses other parts of the rate setting formula to inflate these cost forward but the effect of less frequent re-basing is that in nearly every case, the state ends up paying a lower rate than it would if it were to re-base the rates each year. (This latter method was the way rates were set before 1991 but the legislature eliminated it per PA 91-8, June Special Session. )

For the current rate year DSS is using the cost report covering the period from October 1, 1999 through September 30, 2000. (Normally, the cost year runs from July 1 to June 30, but PA 02-7, May 9 Special Session continues the current rates through December 31, 2002),

ATTACHMENT 1: NURSING HOMES MEDICAID DAILY RATES (FY 2001-02)

AND MEDICAID RESIDENT DAYS


*Town*	*Facility*	*CCH*		*RHNS*		*Percentage of Medicaid Resident Days*
*Town*	*Facility*	*FY 2001-02 CCH Rate*	*Rank*	*FY 2001-02 RHNS Rate*	*Rank*	*CCH*	*Rank*	*RHNS*	*Rank*
Ansonia	Mariner HC-Southern CT	197. 51	12	No RHNS beds		55. 9	197	Not applicable (NA)
Avon	Avon Health Center	137. 44	205	No RHNS beds		55. 6	200	NA
Avon	Brightview of Avon	146. 84	180	No RHNS beds		56	196	NA
Bethel	Bethel HCC	200. 44	10	No RHNS beds		25. 1	227	NA
Bloomfield	Alexandria Manor	No rate established	Not applicable (NA)	No RHNS beds		73. 9	81	NA
Bloomfield	Bloomfield HCC	162	121	No RHNS beds		84. 8	19	NA
Bloomfield	Seabury HC	163. 81	118	No RHNS beds		16. 5	228	NA
Bloomfield	Wintonbury CC	185	41	No RHNS beds		65. 4	149	NA
Branford	Branford Hills	167. 26	103	No RHNS beds		74. 3	75	NA
Bridgeport	3030 Park HC	189. 17	31	160. 55	2	60. 7	176	31. 9	37
Bridgeport	Astoria Park	155. 2	150	No RHNS beds		76. 4	64	NA
Bridgeport	Bridgeport HCC	196. 75	13	No RHNS beds		83. 6	22	NA
Bridgeport	Bridgeport Manor	190. 13	30	145. 67	12	87. 8	13	100	1
Bridgeport	Coleman Part Health & Rehab.	169. 13	93	No RHNS beds		89. 7	7	NA
Bridgeport	Northbridge HCC	184. 37	43	No RHNS beds		83. 8	21	NA
Bristol	Countryside Manor	167. 08	105	No RHNS beds		83. 5	23	NA
Bristol	Ingraham Manor	174. 75	76	No RHNS beds		74. 2	78	NA
Bristol	Nursing Care Center	153. 19	156	No RHNS beds		78. 5	45	NA
Bristol	Sheridan Woods	159. 87	131	No RHNS beds		70	111	NA
Brooklyn	Pierce Mem. Baptist Home	180. 92	52	133. 33	23	83. 5	24	78	23
Canaan	Geer Nursing and Rehab.	178. 22	62	No RHNS beds		66. 8	137	NA
Cheshire	Elim Park Baptist Home	191. 3	27	No RHNS beds		60. 4	178	NA
Cheshire	Highlands HCC	133. 05	211	No RHNS beds		67. 8	132	NA
Chester	Aaron Manor Nursing and Rehab.	148. 8	168	No RHNS beds		60	180	NA
Chester	Chesterfields HCC	133. 9	210	No RHNS beds		59. 4	182	NA
Cobalt	Cobalt Lodge HC & Rehab.	139. 4	200	No RHNS beds		78. 1	48	NA
Colchester	Harrington Court	158. 68	136	No RHNS beds		57. 7	192	NA
Colchester	Liberty Specialty	146. 37	184	No RHNS beds		71. 1	98	NA
Collinsville	Cherry Brook HCC	192. 51	22	126. 94	28	70. 9	102	78. 3	21
Cromwell	Cromwell Crest Conv. Home	No rate established	NA	107. 27	39	80. 2	36	81. 5	16
Cromwell	Pilgrim Manor	152. 29	159	126. 27	30	55. 4	201	56. 9	32
Cromwell	Ridgeview HCC	137. 8	203	98. 96	40	66. 1	143	99. 3	3
Danbury	Filosa Conv. Home	191. 39	25	No RHNS beds		39. 8	220	NA
Danbury	Glen Hill Rehab.	144. 29	188	No RHNS beds		66. 6	140	NA
Danbury	Hancock Hall	175. 34	73	155. 41	5	60. 9	175	60. 7	31
Danbury	Heritage Heights	175	75	No RHNS beds		78. 1	49	NA
Danbury	Mediplex-Danbury	148. 8	169	No RHNS beds		77. 5	55	NA
Danbury	Pope John Paul II Ctr. For HC	179. 43	57	154. 04	7	77. 7	52	85	15
Danielson	Roncalli HCC	168	99	No RHNS beds		85. 6	18	NA
Darien	Mediplex-Darien	180. 68	54	No RHNS beds		79. 2	40	NA
Dayville	Westview Nursing Ctr.	155. 45	149	No RHNS beds		55. 8	199	NA
Derby	Birmingham HC	149. 51	165	No RHNS beds		70. 6	104	NA
East Hartford	Riverside Health & Rehab.	180. 69	53	No RHNS beds		77. 5	56	NA
East Hartford	St. Elizabeth HC	143. 51	189	No RHNS beds		73. 6	84	NA
East Hartford	Sterling Manor	141. 68	194	No RHNS beds		86. 5	15	NA
East Haven	Laurel Woods	185. 19	40	No RHNS beds		61. 7	173	NA
East Haven	Talmadge Park	155	151	No RHNS beds		72. 9	87	NA
East Windsor	Kettle Brook CC	170. 42	86	No RHNS beds		76. 6	62	NA
Enfield	Blair Manor	192. 37	23	No RHNS beds		65. 5	146	NA
Enfield	Parkway Pavillion	128. 66	222	No RHNS beds		75. 5	70	NA
Enfield	St. Joseph's Residence	177. 58	64	No RHNS beds		85. 7	17	NA
Fairfield	3030 Park Fairfield HC	$ 160. 65	130	No rate established		64. 7	155	NA (2)
Fairfield	Cambridge Manor	179. 76	56	154. 45	6	71. 2	97	NA
Fairfield	Carolton Chronic & Conv. Hospital	185. 59	39	No RHNS beds		37. 6	222	NA
Fairfield	Jewish Home for the Elderly	192. 01	24	119. 64	33	69. 6	115	74. 2	26
Fairfield	Southport Manor Conv.	165	114	No RHNS beds		64. 2	160	NA
Farmington	Farmington HC	156. 83	141	No RHNS beds		66. 9	136	NA
Farmington	Olympus HC-Farmington	161. 02	125	No RHNS beds		None Reported		NA
Forestville	Subacute Ctr. of Bristol	191	28	No RHNS beds		65. 7	145	NA
Glastonbury	Glastonbury HCC	176. 96	68	No RHNS beds		54. 5	203	NA
Glastonbury	Salmon Brook Ctr.	132. 67	213	No RHNS beds		55. 9	198	NA
Granby	Meadowbrook	202. 28	8	159. 74	3	65. 2	152	99. 8	2
Greenwich	Greenwich Laurelton Nursing and CH	165. 56	110	No RHNS beds		50. 9	209	NA
Greenwich	Greenwich Woods HCC	159. 81	133	No RHNS beds		57	194	NA
Greenwich	Nathaniel Witherell	197. 94	11	No RHNS beds		64. 9	153	NA
Groton	Fairview Inc.	148. 74	170	No RHNS beds		63. 7	162	NA
Groton	Groton Regency Ctr.	141. 75	193	No RHNS beds		73. 2	85	NA
Guilford	Fowler Nursing Ctr.	132. 04	215	No RHNS beds		65. 5	147	NA
Guilford	West Lake Lodge	124. 42	228	No RHNS beds		72. 5	91	NA
Hamden	Hamden HCC	156. 63	143	No RHNS beds		69. 5	117	NA
Hamden	Harborside HC-(A) Arden House	156. 49	144	No RHNS beds		72. 8	88	NA
Hamden	Whitney Ctr.	167. 93	100	No RHNS beds		4. 7	230	NA
Hamden	Whitney Manor	149	166	No RHNS beds		79. 2	41	NA
Hartford	Avery Nursing Home	No rate established	NA	No rate established		51	207	31. 2	38
Hartford	Chelsea Place Care Ctr.	206. 4	5	No RHNS beds		92. 8	3	NA
Hartford	Ellis Manor	165	111	No RHNS beds		88. 1	12	NA
Hartford	Greenwood HC	190. 56	29	No RHNS beds		88. 9	8	NA
Hartford	Trinity Hill CC	221	1	No RHNS beds		88. 8	9	NA
Jewett City	Roncalli HCC	146. 5	182	No RHNS beds		73. 6	83	NA
Kensington	Ledgecrest HCC	140. 53	197	No RHNS beds		80. 4	35	NA
Kent	Kent. , LTD, The	184. 57	42	No RHNS beds		52. 2	206	NA
Madison	Madison House	183. 6	45	No RHNS beds		32. 8	224	NA
Manchester	Crestfield Rehab. Ctr. & Fenwood Manor	177. 53	65	No RHNS beds		75. 3	71	0	39
Manchester	Manchester Manor	145. 69	185	No RHNS beds		48. 3	214	NA
Manchester	Olympus HC-Manchester (Bidwell)	167. 15	104	No RHNS beds		None Reported		NA
Manchester	Olympus HC-Manchester (Victorian Bldg)	166. 54	107	No RHNS beds		None Reported		NA
Manchester	Olympus HC-Manchester (West)	158. 23	137	128. 35	27	None Reported		None Reported
Marlborough	Marlborough HCC	151. 52	161	No RHNS beds		77. 1	58	NA
Meriden	Coccomo Memorial HC	132. 71	212	No RHNS beds		63. 9	161	NA
Meriden	CT Baptist Homes	153. 68	153	117. 1	34	68. 9	124	66. 7	29
Meriden	Curtis Home/St. Elizabeth Ctr.	176. 61	71	No RHNS beds		71. 5	94	NA
Meriden	Meriden Center	116. 74	231	No RHNS beds		64. 6	157	NA
Meriden	Miller Memo. Community	No rate established	NA	137. 75	21	69. 3	121	71. 7	28
Meriden	Olympus HC-Meriden	167. 8	101	126. 42	29	None reported	NA	None reported
Meriden	Westfield Care and Rehab.	131. 69	216	No RHNS beds		65. 9	144	NA
Middlebury	Middlebury Conv. Home	148. 56	173	No RHNS beds		40. 3	219	NA
Middletown	Harbor Hill CC	170. 69	85	No RHNS beds		83. 9	20	NA
Middletown	Highview HCC	125. 81	226	No RHNS beds		77. 1	57	NA
Middletown	Lutheran Home	No rate pending field audit	NA	No RHNS beds		93. 3	2	NA
Middletown	Middlesex HCC	150. 69	162	No RHNS beds		64. 5	158	NA
Middletown	Wadsworth Glen HC & Rehab.	169. 84	90	143. 66	14	69. 4	119	64. 8	30
Milford	Mediplex Rehab. & Skilled Nursing	154. 55	152	No RHNS beds		68. 7	126	NA
Milford	Mediplex-Milford	180. 98	51	No RHNS beds		47. 5	215	NA
Milford	Milford HCC	187. 91	34	No RHNS beds		68. 6	127	NA
Milford	Pond Point HCC	171. 29	84	No RHNS beds		82	27	NA
Moodus	Chestelm HC	157. 83	139	115. 59	35	60. 3	179	78. 7	20
Mystic	Mariner HC-Pendleton	194. 48	20	No RHNS beds		58. 3	190	NA
Mystic	Mary Elizabeth NC	129. 34	218	No RHNS beds		50. 9	210	NA
Mystic	Mystic Manor	145. 52	186	No RHNS beds		71	100	NA
Naugatuck	Beacon Brook HC	176. 65	70	No RHNS beds		59. 1	185	NA
Naugatuck	Glendale Center	129. 03	221	No RHNS beds		60	181	NA
New Britain	Andrew House HC	143. 2	190	No RHNS beds		70. 6	103	NA
New Britain	Brittany Farms HC	165. 66	108	135. 01	22	67. 2	135	86. 9	11
New Britain	Jerome Home	165	113	140. 97	17	50. 7	211	39. 1	36
New Britain	LaCasa Lexington	148. 97	167	No RHNS beds		88. 7	10	NA
New Britain	Monsignor Boinowski Manor	169. 98	88	No RHNS beds		86. 1	16	NA
New Britain	Walnut Hill CC	150	164	No RHNS beds		75	73	NA
New Canaan	Waveny Care Ctr.	195. 07	17	No RHNS beds		34. 5	223	NA
New Haven	Atrium Plaza Health CC	177. 13	66	No RHNS beds		None reported		NA
New Haven	Center for Optimum Care-Elm City	No rate established	NA	No RHNS beds		88. 5	11	NA
New Haven	Clifton House Rehab.	174. 25	79	No RHNS beds		75. 7	67	NA
New Haven	Haven Health-New Haven	177. 09	67	No RHNS beds		72. 9	86	NA
New Haven	Jewish Home for the Aged	196. 39	14	No RHNS beds		86. 8	14	NA
New Haven	Mary Wade Home	167. 35	102	No RHNS beds		73. 7	82	NA
New Haven	St. Regis HC	175. 56	72	No RHNS beds		78. 8	44	NA
New London	Beechwood	178. 83	61	No RHNS beds		40. 6	218	NA
New London	Camelot Nursing & Rehab.	138. 46	201	No RHNS beds		55	202	NA
New London	Nutmeg Pavillion HC	122. 55	230	No RHNS beds		77. 6	53	NA
New Milford	Candlewood Valley Health & Rehab.	161. 95	122	133. 25	24	63. 2	164	55. 7	33
New Milford	New Milford NH	146. 5	181	No RHNS beds		70. 2	108	NA
Newington	Bel-Air Manor	147. 4	176	No RHNS beds		59	186	NA
Newington	Jefferson House	194. 86	19	130. 64	26	51	208	79. 7	19
Newington	Mediplex-Newington	134. 63	208	No RHNS beds		62. 9	165	NA
Newtown	Ashlar of Newtown	176. 95	69	No RHNS beds		67. 8	131	NA
Niantic	Mariner HC-Bride Brook	188. 58	33	No RHNS beds		61. 2	174	NA
North Haven	Montowese Health & Rehab.	186. 29	38	No RHNS beds		12. 7	229	NA
Norwalk	Centennial House	189. 13	32	No RHNS beds		90. 2	4	NA
Norwalk	Honey Hill Care	206. 14	6	148. 14	10	58. 7	188	85. 3	14
Norwalk	Notre Dame Conv. Home	168. 68	97	No RHNS beds		74	80	NA
Norwalk	Strawberry Hill Care Ctr.	169	95	No RHNS beds		None Reported		NA
Norwich	Hamilton Rehab. & HC	123. 16	229	No RHNS beds		79. 6	39	NA