The Division of Rate Setting (DRS) calculates and certifies Medicaid rates for residential services provided to Vermonters by 34 Vermont nursing homes, out-of-state nursing homes, 14 residential facilities for youth called Private Non-Medical Institutions (PNMIs), the Intermediate Care Facility for the Developmentally Disabled (ICF/DD), and hospital swing bed rates.  The Division’s rules govern the processes for setting the Medicaid rates of each different type of facility.

The Division of Rate Setting serves the providers for which it sets rates as well as the approximately 1,700 nursing home and ICF/DD Medicaid residents and 140 PNMI residents.  DRS is also a resource to DVHA and other departments within the Agency of Human Services, State of Vermont, and external stakeholders, providing census and financial data as well as analysis used to formulate budgets, establish policy and examine trends within the industry.

The Division plays a crucial role in supporting a stable system of long-term care in Vermont by setting cost-based rates, pursuant to the Division’s rules, that allow for a high degree of predictability to providers while ensuring the resources necessary to supply high quality care Vermonters.  The Division’s work removing unallowable cost reimbursements from Medicaid rates has saved the State millions of dollars over the years.  The Division also works with the Attorney General’s Office to recoup fraudulent payments.

SFY24 priorities are:

• Comply with all aspects of the Division’s PNMI and Nursing Home Rate setting rules by completing annual desk reviews for each provider and calculating and setting rates in a timely manner.
• Nursing Home and PNMI rule making, including implementing a lower minimum occupancy for the nursing homes and various changes for the PNMIs. 
• Transition to a new acuity measure using a model such as the Patient-Driven Payment Model (PDPM) from the RUG4 model, which CMS is sunsetting.
• Hire, onboard, and training one nursing home auditor in addition to implementing a staffing plan focused on retention.
• Plan and prepare for a transition away from being paper based.