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Date ArticleType
11/1/2015 Payment/Reimbursement
Reporting of Medicaid Managed Care Days & UPL Calculations

Indiana contacted IHCA on October 30th concerning the reporting of Medicaid Managed Care (MMC) days for cost report purposes and the impact of those days on the UPL calculations.  Below are the takeaways:

1. Indiana Medicaid will be instructing nursing facility providers to report their MMC days as Medicaid and make no coding distinctions between FFS and MMC on their MDS records.  There will be no changes in the cost report forms at this time.
2. Since CMS does not permit UPL Supplemental payments to be made for MMC days, Indiana Medicaid will run a utilization analysis in conjunction with each final SFY supplemental payment, and remove those number of MMC days from each facility's UPL final payment calculation.  Indiana Medicaid will also be monitoring MMC nursing facility days, on an annual basis, in case utilization changes materially, which they anticipate will occur.
3. Indiana Medicaid will issue guidance via a bulletin and the information will be available on the M&S website. 
4. Indiana Medicaid also said that this change will be included in a rule amendment, the same rule that will make the change to RUGs IV 48 grouper.

IHCA has asked Indiana Medicaid for additional clarification on the above as to when the MMC utilization report will be run and if it will impact the upcoming final UPL payment.  IHCA also asked when they expect to issue the new guidance and RUGs IV rule.  Indiana Medicaid has not yet responded.

If you have not already done so, IHCA recommends that you begin analyzing how many MMC days your facilities have experienced for SFY 2015, and going forward, and also discuss with your hospital partners if you are in the UPL program regarding the impact on the final UPL calculation.  Please contact Zach Cattell at zcattell@ihca.org or 317-616-9001 with questions.