Guam Medicaid: Public Notice of Intent to Amend State Plan SNF Reimbursement Methodology

Press Release No. 2021.023

December 18, 2020

The Guam Department of Public Health and Social Services (DPHSS), Guam Medicaid Program, pursuant to the requirements of 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act, gives notice of the following actions regarding its methods and standards for setting payment rates for skilled nursing facility services under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Effective for services provided on or after January 1, 2021, DPHSS will amend the Guam Medicaid State Plan reimbursement methodology for Skilled Nursing Facility (SNF) by:

  1.   Providing payments to Skilled Nursing Facilities (SNF) based on a per diem rate that is developed based on total Medicaid payments made for fiscal year 2019, divided by total Medicaid days paid for the same period;
  2.   Applying an inflation factor change increase in the CMS SNF market basket index levels from fiscal year 2019 to fiscal year 2021;
  3.   Each fiscal year thereafter, Guam Medicaid will adjust the per diem with an annual inflation factor equal to the change in CMS skilled nursing facility market basket index levels between the current and upcoming fiscal years.

DPHSS is implementing actions 1 through 3 in order to determine Medicaid reimbursement rates based upon the Centers for Medicare and Medicaid Services (CMS) recent changeover from the Prospective Payment System (PPS) Resource Utilization Group (RUG-IV) model to a Patient Driven Payment Model (PDPM) which became effective October 1, 2019, and will ensure that such Medicaid payments will not exceed the nursing facility upper payment limit as defined in 42 CFR 447.272, and will not pay more than the billed amount.

As a result of the above actions relating to the Medicaid nursing facility reimbursement methodology changes effective for services provided on or after January 1, 2021 to September 30, 2021, the SNF Per Diem rate is $357.25. Thereafter, the per diem rate will follow action item 3 above.

Copies of this notice are available at the Government of Guam, Department of Public Health and Social Services website at https://dphss.guamdev.com/skilll-nursing-facility-snf-reimbursement-methodology/ for public review. Additional information concerning this action is available upon request at the address cited below.

Public input from beneficiaries, providers, and other stakeholders can be provided for the next 10 days up through December 26, 2020 via email to Jeffrey San Nicolas at jeffrey.sannicolas@dphss.guamdev.com or Janet Cruz at janet.cruz@dphss.guamdev.com. Any written comments submitted may be reviewed by the public online at the DPHSS website, or in person by appointment due to COVID-19 at the Division of Public Welfare (DPW), Bureau of health Care Financing Administration (BHCFA), Room 7, Castle Mall, University Drive, Mangilao, by calling 735-7475 or 735-7471, Monday through Friday between the hours of 8:00 A.M. and 5:00 P.M.

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