Skilled Nursing Facility Provider Tax Rates, Final CMI Resident Rosters, and Interim/Temporary Rate Increase Update

This bulletin provides updates on NC Medicaid’s Skilled Nursing Facility (SNF) reimbursement program.

This bulletin provides updates regarding the following aspects of NC Medicaid’s Skilled Nursing Facility (SNF) reimbursement:

  • SNF Provider Assessment rates
  • Final Q1 2023 final SNF Case Mix Index (CMI) resident rosters
  • SFY 2024 SNF temporary/interim rate increases

NC Medicaid intends to systematically reprocess SNF claims retroactive to July 1, 2023. This reprocessing will ensure that providers receive the full value of any state plan requirements and receive the full value of any legislated increases.

Tax Assessment Update

Effective July 1, 2023, NC Medicaid SNF provider assessments were adjusted to new levels, as communicated in the March 31, 2023 Medicaid Bulletin, REMINDER: Updates to Skilled Nursing Facility Provider Assessment Rates.

This adjustment will allow NC Medicaid to maximize the effective reinvestment of the assessment in the SNF per diem rates as the enhanced Federal Medical Assistance Percentage (FMAP) associated with the federal Public Health Emergency gradually phases out.

As of July 1, 2023, the SNF provider tax assessment structure is as follows:

  • The per diem assessments are imposed on non-Medicare patient days as allowed for under 42 CFR 433.68(d).
  • The assessments imposed on nursing facilities will be calculated as follows:
    • Continuing Care Retirement Centers and Tribal Facilities will be assessed at a uniform per diem rate equal to $0.00 per non-Medicare day.
    • Nursing facilities with a total annual census greater than 42,000 will be assessed at uniform per diem rate equal to $9.45 per non-Medicare day.
    • All other nursing facilities that do not meet the criteria of (a) or (b) above will be assessed at a uniform per diem rate equal to $29.25 per non-Medicare day.

All SNF provider assessment rates will be retroactively adjusted to reflect the appropriate new tax assessment amounts. The reinvestment of these adjusted assessments will be included in the final SNF provider rates for the current quarter ending Sept. 30, 2023, through the end of SFY 2024 (June 30, 2024).

NC Medicaid has already loaded the above provider assessment rates in the Nursing Home Assessment portal beginning with the July 2023 service month. Providers must remit their July 2023 service month assessments by Aug. 15, 2023, using the assessment rates currently loaded in the portal.

CMI Roster Updates

As of July 1, 2023, the final SNF resident rosters for the Jan. 1, 2023 through March 31, 2023 Minimum Data Set (MDS) reporting period were not available. Thus, the CMI rate factor included in the July 1, 2023, SNF rates previously released were based on the preliminary SNF resident rosters available at that time.

Now that the Final Q1 2023 MDS Assessment resident rosters are available, the final CMI rate factor will be applied accordingly in the upcoming SNF rate adjustment scheduled to occur prior to the end of this current quarter.

The delay in release of the final resident rosters required the development of a long-term solution that aligned historical MDS assessment data with the new CMS Patient ID numbers created when CMS transitioned to the Internet Quality Improvement & Evaluation system (iQIES) for MDS transmissions and validation, to ensure appropriate assessment connection and relation over time.

Providers should review their internal software systems and reporting to ensure the changes to iQIES by CMS that require a crosswalk from Resident ID to Patient ID have not impacted any current processes or procedures.

Status of Temporary/Interim Estimated Budget Increases

As we get closer to Aug. 31, if a state budget has not yet been finalized, NC Medicaid will evaluate whether it is feasible to extend the temporary/interim increases at some level.

Once a state budget has been finalized, NC Medicaid will implement any permanent increases at the levels appropriated in the budget and intends to systematically reprocess claims (or direct managed care organizations to reprocess claims, as applicable) retroactive to July 1 to adjust payments to the level of the appropriated permanent increases. This reprocessing will ensure that providers receive the full value of the legislated increases.


NCTracks Contact Center: 800-688-6696 

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