Overview

The District of Columbia’s (District) Department of Health Care Finance (DHCF) is amending to Chapter 65 (Medicaid Reimbursement to Nursing Facilities) to establish a new nursing facility reimbursement methodology effective February 1, 2018.

Major highlights of the revised reimbursement methodology include: 1) continuation of prospective rates that are refined to avoid the continuous cycle of adjusting rates and claims; 2) specific per diem rates for each patient; 3) availability of add-on payments for special needs patients who require ventilator or bariatric care or who are behaviorally complex; and 4) the creation of a new quality improvement program, including mandatory reporting and a performance payment for participating District nursing facilities that demonstrate improvement or maintain a high level of performance across a set of quality improvement measures.

The revised methodology ensures that similar facilities are paid similar reimbursement rates for similar patients, and that facilities receive immediate financial benefit when admitting higher acuity patients. The proposed methodology also eliminates the need for quarterly census and case mix calculation requirements under the prior methodology. Finally, new reporting requirements and the availability of supplemental payments for quality will incent nursing facilities to develop the infrastructure, processes, and reporting mechanisms necessary to implement future quality improvement and payment reform initiatives.

Additionally, DHCF is proposing two new add-on payments to incentivize nursing facilities to develop and maintain the capacity to deliver specialized care to beneficiaries in need of bariatric care or behaviorally complex care.

Additional information regarding the revised methodology can be found below.