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OCTOBER 2021 RATES PUBLISHED BY AHCA

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After a false start last week, the Agency for Health Care Administration (AHCA) published the final Medicaid rates for the rate period beginning October 1, 2021 and ending September 30, 2022. AHCA originally posted the rates on Thursday, September 9th but had to make some corrections and republished final rates on Friday September 10th. You can access the corrected rates here:

https://ahca.myflorida.com/medicaid/cost_reim/xls/NH_Final_Rates_Details_2021-10-01.xlsx

AHCA is planning to release additional files over the next few weeks including rate letters and calculation sheets. These rates reflect rebased prices on audited cost components, updated quality scores, FRVS updates, and a reduction of the hold harmless rate to 95% of the September 2016 rates. The provider assessment pay-in rates are expected to be $25.89 normal volume Medicaid days and $4.61 high volume Medicaid Days.

Other observations of note:

  • The average rate for all PPS providers is $236.43, down slightly from the October 2020 average of $237.45

  • The quality point value increased to $0.80 per point from $0.76 per point

  • The new threshold for quality dropped from 14 points in 2020 to 13 points in 2021 

  • The cap on PPS gains (providers that saw their PPS rate rise significantly above their September 2016 hold harmless rate) was lifted from 3.64% in 2020 to 16.37% as a result of the 5% reduction to hold harmless rates for October 2021

  • The budget neutrality factor that adjusts total reimbursement dollars to the annual State Budget Appropriations was reduced from 9.27% to 8.61%

  • The South Peer Group prices fell overall compared to October 2020 prices as a result of rebasing. Direct Care decreased $2.01, Indirect Care increased $1.58 and Operating decreased $2.95

  • The North Peer Group prices fared better. Direct Care increased $1.16, Indirect Care decreased $1.48 and Operating increased $0.33

Link to: MCD Pricing Table Oct 2021 

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

Tracy Weixelbaum - tweixelbaum@mslcpa.com 
Carrie St. John - cstjohn@mslcpa.com 
Lorne Simmons - lsimmons@mslcpa.com 
Boris Kushnir - bkushnir@mslcpa.com