Home and Community Based Services Enhanced FMAP

Home and Community Based Services Enhanced FMAP

DSHS has received approval from CMS to implement their plan for the enhanced FMAP.  As previously stated, the enhanced FMAP for assisted living is approximately $8.7 million with $7.7 million going towards a rate increase of $9.30 ppd with the remaining $1 million set aside to be used for retainer payments for residents that have been under the assisted living bed hold policy due to COVID-19 related hospital treatment or lost census.  If a resident left your facility because they have gone home with a family member, you should be utilizing social leave in these instances.  Clients are eligible for up to 18 days of social leave.  After 18 days, case managers have been given the discretion to extend social leave through a local ETR as necessary depending on the client’s needs.  To be eligible for social leave the client must intend on returning to the facility.  The facility must also commit to holding the client’s room/unit.

Increased AL Rate-

For the $9.30 ppd, DSHS has set up a new service code that you will need to claim for all of your Medicaid residents.  This service code will be automatically authorized for each day you are authorized to deliver regular services going back to March 1.  You do not need to adjust any previously submitted claims, but you will need to go back and claim the new service code for those dates.  Going forward, you will need to claim both the regular service code as well as the new service code.

Retainer Payments for Adult Day Programs

As above states, CMS has approved retainer payments for adult day health and adult day care programs.  These payments are expected to cover 70% of the full rate you would normally have claimed had you been open or able to serve at full capacity.  These retainer payments will also have a separate service code and will be capped at 30 days.  The 30 day cap should be thought of on a client basis which means the retainer payments will extend beyond a 30 day calendar period. Clients don’t typically have consecutive days of service but usually attend programs 2-3 days per week.  

DSHS is working to get all of these new service codes active by May 1st so that you may begin claiming them starting May 4th.  In the coming days, the department will send out instructions, through a Management Bulletin, regarding the increased AL rates and the assisted living and adult day retainer payments.  We will keep you posted as well




David Carter
| Director, Health Care Finance & Policy

C 360.888.5702