Scope of Study
Nursing Home Medicaid Rate-Setting System
Connecticut's Medicaid program provides significant funding for nursing home services, primarily to the elderly population that meets established income and asset eligibility criteria. Nursing facilities provide a full range of services such as health, rehabilitation, social, nutrition, and housing services for a single per diem Medicaid rate, which varies by facility. Care is provided in facilities licensed as either: (1) chronic and convalescent homes (CCH); or (2) rest homes with nursing services (RHNS). As of February 2001, there were 261 nursing facilities in the state and 30,632 total beds. On average, there were 20,174 nursing home residents receiving Medicaid benefits during FY 00. Medicaid expenditures for nursing home care in FY 00 were $986,677,498, with an average Medicaid reimbursement cost per day of $146.76 per resident.
The Department of Social Services (DSS), Office of Certificate of Need and Rate Setting, is responsible for establishing per diem Medicaid rates for nursing facilities. Under the Medicaid program, payment rates for nursing facilities are set on a cost-based prospective basis in accordance with C.G.S. Section 17b3-40. The annual rate period is July 1 through June 30 and the cost report period is October 1 through September 30. Cost reports are due from facilities by December 31 of each year.
AREA OF FOCUS
The study would evaluate the efficacy and equity of the state's Medicaid rate-setting system for nursing facilities.
AREAS OF ANALYSIS
1. Explanation of other nursing home rate reimbursement systems:
a. Case-mix
b. Medicare
c. Other models
2. Overview of Connecticut's Medicaid reimbursement system:
a. Historical
b. Current
c. Federal law requirements
3. Identify trends in nursing home expenditures by category (direct, indirect, administrative and general, property, and capital related).
4. Describe processes Connecticut has in place to audit facilities' financial records
5. Provide in-depth examination of selected other states' reimbursement systems, including an analysis of costs for states that have recently adopted new systems
6. Conduct case-mix analysis of Connecticut's nursing home resident population
7. Discuss the impact of changing the Medicaid reimbursement system, including administrative consequences.