18 Jan 2012
There is so much happening--and not happening--in Community MR Programs.
The ratesetting for FY 2011-12 is a travesty. FY 2010-11 rates continued into FY 2011-12 through November 14, 2011. Effective November 15, 2011, new rates were issued, mostly based on the unit costs generated by the FY 2009-10 cost report and including a 6% RAF. The outlier policy also continued in FY 2011-12, which AZTAC strongly believes is flawed data. So hopefully, you filed appeals for any rates that are inadequate to serve your consumers.
ODP recently issued Revenue Reconciliation letters for both FY 2009-2010 and FY 2010-11 on January 11, 2012 and January 18, 2012, respectively. Very simplistically, these letters are intended to account for claims that have processed/paid since the previous final reconciliation for that fiscal year. If your letter did not have a change to the revenue target, you need to verify the change in the claims paid. If your letter included a change to your revenue target, you need to ask your fiscal officer for details and calculations. You should attempt to work with your regional fiscal officer to resolve differences, and you should appeal these letters within 30 days if you do not agree. If your letter included a change in the revenue target based on information from your fiscal office, you will note that the footnotes are incorrectly referenced.
For FY 2011-12, ODP has not submitted a request to CMS for revenue reconcilation, as of January 17, 2012. We believe this request will not be submitted, and we expect ODP to issue a letter stating that there will not be revenue reconciliation for FY 2011-2012. In other words, you will have to live with the rates you received (unless you filled appeals). We expect ODP to issue information in the next week or two.
For FY 2012-13, we expect that non-residential services and residential ineligible services will be moved to fee for service. We also expect that cost reports will not be required for these services in the future.
ODP has stated that they will be issuing program and fiscal regulations for Community MR very soon. They are in the "final stages" in ODP review. Be reminded that Secretary Alexander currently has authority by the legislature to issue regulations without the IRRC process.
Many appeals are currently in process for varous years for Community MR programs. Please contact AZTAC if you or your counsel need assistance.