Medicaid reimbursement methodology amongst various states has always fascinated me. Here in the Northeast, we find two neighboring states in completely different places. New York has been utilizing case mix reimbursement since 2007 and is trying to make “changes on the fly” amidst another budget crunch. Meanwhile Connecticut, which has utilized a cost-based system for years, is transitioning to case mix in July 2020.
Over 20 Connecticut SNFs have closed in the last 7 years citing poor reimbursement. Officials and operators are optimistic a case mix reimbursement system should provide higher reimbursement to buildings with higher acuity levels. The implementation date is planned for July 1, 2020.
Here in New York, the state has tried to move the target and providers continue to ask themselves “Are we in a case mix window or not?” Additionally, there are issues surrounding the July 2019 Medicaid rates, January 2020 rates, and a 1% surprise rate cut implemented on January 1st.
I am certain that SNF operators from NY have plenty of advice and cautionary tales for their Connecticut colleagues. Rehab and nursing will have many new responsibilities. A great speech therapy department in a skilled nursing facility will provide a positive impact on the case mix reimbursement for long-term care residents.