DMAS has informed VHCA-VCAL that the agency will be changing the way the Medicaid $20 per day add-on is distributed. The now published 2021 operating rates  will reflect the $20 per day added to the Indirect Care rate (so it is unadjusted by the RUG weight). For dates of service beginning July 1, the extra $20 will be distributed through the normal claims process within the 2021 rates. DMAS indicates this will be true for both Fee-for-Service (FFS) and CCC Plus. 

VHCA-VCAL continues to advocate for funding that covers the cost of care for residents and the added expenses related to COVID-19. We know providers have been very grateful for the $20 per day add-on. While there has been no guarantee of how long the $20 add-on will continue, it appears DMAS believes it will continue for a substantially long enough time to justify the new approach.

The last roster billing will occur for the June dates of service with a due date of July 10. We are seeking clarification on FFS responsibility for hospice and PACE residents under the new approach.  It appears that you would simply bill those entities as you normally would for FFS individuals and their reimbursement to you would include the extra $20 per day. You may need to verify that your current contract ties the payment to the “prevailing” or “published” RUG rate, as it will be inclusive of the $20 per day beginning July 1. This hospice and PACE clarification is irrelevant on the CCC Plus side. We will share any updates on this and other details we receive on the reconciliation process when we know more.