The Executive Office of Health and Human Services earlier this week issued the proposed 2021 Medicaid rate regulation that will invest significant funds in Rate Year 2021 (RY 2021), ranging up to $145 million for quality nursing home care covering (1) a new integrated rate structure for the RY 2021 rate and beyond, and (2) targeted COVID-19 Supplemental Funding. The EOHHS proposal builds upon prior Accountability and Supports programs designed to promote and ensure quality nursing home care. The regulation is expected to be adopted later this month with a retroactive effective date of October 1, 2020.
Beginning in October 2020, MassHealth will invest $85 million in new funding in order to establish a single integrated rate based on more current costs (2018 with a cost adjustment factor to calendar year 2020) that will then be adjusted based on facility-specific quality performance, occupancy, Medicaid usage and the number of residents requiring specialized behavioral health services. The rate investment is linked to reforms centered on resident care and safety, as well as initiatives intended to strengthen the direct care workforce, including a minimum Hours Per Patient Per Day (HPPD) requirement beginning this winter and the establishment of a direct care cost quotient (DCC-Q) standard requiring no less than 75% of total nursing facility revenues be spent on direct care staff which will replace the current direct care add-on. MSCA continues to work with EOHHS, the Executive Office of Labor and Workforce Development (EOLWD) and other stakeholders to increase the supply of staff available to work in nursing homes. The state will also require facilities to reconfigure in order to eliminate the 3rd and 4th beds in multi-bed rooms, with a glide path of over one year for planning purposes.