VHCA-VCAL was copied on an email from DMAS that requests providers fill out a “Survey Monkey” designating the number of Virginia Medicaid Nursing Facility Managed Care days for the 2017 cost reporting period by December 20.  Along with the request, DMAS included its current count of managed care days by facility, which does not match the count in the most recent (or any) version of the rebasing model.  DMAS indicates if a NF does not reply to the survey, then the NF is accepting the count DMAS currently has.

Managed are days are used, along with FFS days, to determine the direct and indirect care peer group prices.   Because the rebasing model contains erroneous data on the managed care days, the current model is flawed.  As we have shared with the Board of Directors, Owners’ Committee and the Payment for Services Committee, the rebasing model has a -2.25% impact on revenue (estimated at -27.4 million for 2020 compared to not rebasing).

VHCA-VCAL has voiced concern with the approach of surveying NFs. In addition to the added administrative burden on the providers, we are concerned with the potential for erroneous reporting from the providers given the significant billing challenges during that time period in both CCC and CCC Plus. In reviewing the rebasing models, VHCA-VCAL has suggested the use of total days (inclusive of both FFS and MCO days, among others) as reported on the audited cost reports from 2017. This approach would require no additional work by the NFs and is audited data. The total days has no bearing on the calculation of cost, only the determination of the peer group prices.

VHCA-VCAL will continue to advocate for use of the total days for the peer group pricing unless we reach a reasonable level of confidence in the managed care day data either reported by DMAS or collected through this process.

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DMAS Medicaid Nursing Facility Managed Care Days Survey
Managed Care Days by Facility