Nursing Facility Rate List
The Nursing Facility Rate List contains various information on nursing facilities participating in the MO HealthNet program. The information contained in this report is current as of the date indicated on the report and is true and accurate to the best of MHD’s knowledge. This report is updated at the beginning of each month.
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This report contains the rates MHD has reimbursed or is currently reimbursing nursing facilities for services provided to MO HealthNet participants. The effective dates indicated in the column headings correspond to changes in the nursing facility regulations that resulted in global, industry-wide per diem rate changes. However, there may be circumstances for individual facilities where the effective date of the rate may not correspond to the date in the column such as for new nursing facilities or facilities that had their prospective rate established.
The legend at the bottom of the report explains the rate type, entity code, and the various other notations included in the report. Please note in particular, payments to facilities based on rates that are not final (i.e., rate is under appeal or facility is operating under an interim rate) may be subject to retroactive settlement, including recoupment. MHD will make any retroactive settlements to the provider of record, regardless of the provider for the applicable dates of service.
This report is for informational purposes only and MHD is not responsible for how outside parties utilize the information. Anyone using this report should be aware of the general program policies. The policies and procedures governing the MO HealthNet nursing facility program, including the reimbursement methodology, cost reporting requirements, etc. is set forth in 13 CSR 70 – 10.015 Prospective Reimbursement Plan for Nursing Facility Services. This regulation, as well as other applicable nursing facility regulations, may be accessed on the Missouri Secretary of States Web site at http://sos.mo.gov/adrules/csr/current/13csr/13c70-10a.pdf
Hospice providers that furnish services to MO HealthNet participants in a nursing facility will be reimbursed 95% of the nursing facility’s per diem rate for room and board. Hospice providers operating in nursing facilities without a final rate are also subject to retroactive settlement. The general policies and procedures governing the MO HealthNet hospice program is set forth in 13 CSR 70 – 50.010 Hospice Services Program and may be accessed on the Missouri Secretary of States Web site at http://sos.mo.gov/adrules/csr/current/13csr/13c70-50.pdf
If you have any questions regarding this report or the MO HealthNet nursing facility program, please contact the Nursing Facility Policy & Reimbursement Manager of the Institutional Reimbursement Unit at (573) 751-5663.