Temporary Medicaid Rate Increase

Temporary Medicaid Rate Increase

Attention: Medicaid Contracted Providers

This letter is sent on behalf of the ALTSA Home and Community Services Division. In light of the unprecedented emergency circumstances associated with the COVID-19 pandemic, the Department of Social and Health Services (DSHS), will be issuing a temporary rate increase to Adult Family Homes (AFH), Assisted Living Facilities (ALF), and Enhanced Services Facilities (ESF) serving residents whose care is paid by Medicaid. The temporary rate increase will be retrospective to March 1, 2020 and continue to be available through June 30, 2020. The retrospective portion can be claimed as soon as it invoices in ProviderOne.

  • The temporary rate increase is:
     For AFHs, an additional rate of $17.68/Day.
     For ALFs, an additional rate of $9.31/Day, including Specialized Dementia Care.
     For ESFs, an additional rate of $64.87/Day.

The additional rate increase applies to all AFH and ALF contract types, including specialty contracts. This pandemic-related additional rate will appear as a separate line. You may submit a claim for the retrospective portion immediately by following the steps on the attached instruction sheet. This additional rate will be available until the end of the fiscal year, June 30, 2020.
The Department of Social and Health Services, will also temporarily pay retainer payments to AFHs, ALFs, or ESFs for 70% of the Medicaid resident’s current daily rate for a maximum of 30 consecutive days in the following specific pandemic-related circumstances:

1. The ALF, ESF, or AFH was prevented from providing services to a Medicaid resident due to the provider temporarily closing in response to local, state, federal, or medical requirements or orders; or
2. The ALF, ESF, or AFH was prevented from providing services to a Medicaid resident due to the resident temporarily leaving the facility because of a positive or suspected COVID-19 diagnosis;

Additionally, in order to receive a retainer payment the following requirements must also apply:
1. The Medicaid resident is likely to return to the ALF, AFH, or ESF; and
2. The ALF, AFH, or ESF holds the Medicaid resident’s bed or unit for the period in which the retainer is paid.

3. The facility was providing care to the resident as of March 1, 2020 (It is not necessary for the client’s services to have been be paid through Medicaid. The provider can meet these requirements even if the client was paying for services privately. If, at any point during the 30 day authorization period or after the 30 consecutive day maximum is reached, an ALF, ESF, or AFH provides care to the Medicaid resident for at least 24 hours, and then one of the two pandemic-related retainer payment scenarios listed above reoccurs, the 30 day retainer payment period may start over. If no care is provided to the resident after the 30 day time period, a new retainer payment may not be authorized. However, the current Bed Hold process will continue to be available to Residential providers under existing policy when the COVID-19 related retainer payment is exhausted.

For hospitalizations or short stays in skilled nursing facilities for non-COVID-19 related reasons, the existing bed hold policy and rates apply. Bed hold and social leave policy have not changed.

For questions regarding this process, please contact Natalie Lehl for AFHs and ALFs and Sandy Spiegelberg for ESFs.
Natalie Lehl, Residential Policy Program Manager; (360) 725-2370 – natalie.lehl@dshs.wa.gov
Sandy Spiegelberg, Residential Support Waiver Program Manager
(360) 725-2576 – sandra.speigelberg@dshs.wa.gov

Please note:
 Authorizations of pandemic-related retainer payments may be retroactively authorized
back to March 1, 2020 if one of the two pandemic-related retainer payment
circumstances listed applies.
 Providers must not claim a retainer payment for any Medicaid resident on the same date
for which a service is provided. Claiming a retainer payment on the same date as
claiming for the provision of care to a resident will result in an overpayment.

May 4, 2020

ALTSA: AFH #2020-021
ALTSA: ALF #2020-025
ALTSA: ESF #2020-018