Division of Rate Setting

Average # of days it takes to issue a special rate memo once external paperwork has been received

14.5SFQ4 2022

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  • Nursing Home Providers
  • DVHA signatories
  • Department of Aging and Independent Living (DAIL)
  • Department of Mental Health (DMH)
  • Department of Corrections (DOC)
Story Behind the Curve

This measure is important because due to the heightened needs of the patients that these special rates serve, it is important that the special rates are set in a timely manner in order to assure that residents are able to be transferred from hospitals to nursing facilities without delay.  These special rates serve as an incentive for nursing facilities to accept residents requiring extraordinarily high levels of care.

Once DRS receives a completed application for a new nursing home special rate from sister Departments, DRS’s target is to set the rate and send the rate memo to Gainwell and the provider within ten business days of the receipt of the completed application.

DRS sets three different types of special rates in accordance with the Division’s rules to compensate nursing facilities for their increased costs and/or risk of taking these three types of exceptional residents close to the time that services are provided.  Without the special rates, any additional costs would be rolled in with the facilities’ other costs and included in the normal rate-setting process.  It may take up to four years for these costs to be reflected in their per diem rate as there is a lag between when costs are incurred in a base year costs and when they are reflected in the per diem rate.  Due to this, many nursing homes will only decide to accept special rate residents once the special rate has been set. 

The recent spike in processing time in SFY2020 is attributed to DRS having multiple staff on leave and other COVID-19 related priorities.  During this time, DRS ensured that special rate applications of individuals whose transfer relied on the setting of the special rates were processed quickly while applications of individuals who were already in nursing facilities took longer than normal.

Narrative last updated 11/04/2020

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