Reimbursement Alert: July 1 Medicaid Rate Changes

Effective July 1, all Medicaid rates will change for Florida Skilled Nursing Facility providers reimbursed under the Prospective Payment System (PPS). As part of the 2020 Florida Legislative Session, $74.8 million of recurring funds were approved to provide all PPS providers a rate increase of 1.36% effective July 1, 2020. This unit cost increase was made across the board, even to providers that are reimbursed at their hold harmless rate. Although the funding is recurring, effective July 1, 2021 these funds will be placed back into the base appropriations for PPS which will benefit providers who are receiving a true PPS rate (i.e. not on a hold harmless rate) by reducing the budget neutral adjustment and increasing the cap on gains.

What does this mean to you? If you are currently being reimbursed based on your hold harmless rate, your rate will revert back to your original hold harmless rate based on the published rate as of September 2016 for your facility. If you are currently reimbursed your PPS calculated rate, the redistribution of these funds will increase your rate, even if it is capped. The average increase in PPS rates is estimated to be around $2 per Medicaid patient day but individual rate changes will vary. All rates will be effective through September 30, 2021 at which time rates will be reset based on the first rebasing of PPS effective October 1.

For more information, contact your MSL representative who will be happy to assist your organization. Please contact us at 1-800-683-5401.