Department of Medical Assistance Services
RATE SETTING

The Governor signed the budget on June 21, 2014 with the following changes to reimbursement effective July 1, 2014 for FY15. Official rate notifications will be forthcoming
Eliminate inflation for inpatient hospital operating, GME, DSH and IME payments and implement a new DSH methodology.
Replace cost-based reimbursement methodology for nursing facilities with a price-based reimbursement methodology and reduce the rental rate floor for capital reimbursement to 8%.
Reduce clinical lab fees by 12 percent.
Reduce DME rates to Medicare competitive bid rates if they are lower than DMERC minus 10 percent.
Eliminate inflation adjustments for outpatient rehabilitation agency rates.
Eliminate inflation adjustments for home health agency rates.
CPT CODES & PROCEDURE FEE FILES
Search CPT Codes, Rate History For DMAS CPT Codes & Procedure Fee Files
INPATIENT HOSPITAL RATES (DRG, Psych, Rehab)
ANNOUNCEMENT: APR-DRG expected implementation of October 1, 2014
Hospital Rates
OUTPATIENT FACILITY RATES (Hospital, Ambulatory Surgery Center)
Outpatient Rates
Ambulatory Surgery Center
Outpatient Hospital EAPG
OUTPATIENT REHAB AGENCIES
Background on Rehab Reimbursement Changes
Outpatient Rehab Fee Schedule
PHYSICIAN
Anesthesia Reimbursement for Physicians
DME
DME Codes defined in Provider Manual
OTHER FEE-FOR-SERVICE (FFS)
Community Mental Health and Substance Abuse Services
MEDICAID REIMBURSEMENT IN EDUCATION
Medical & Administrative Reimbursement
NURSING FACILITES
Cost Reporting and Case Mix Information
MDS 3.0 Guidance Document
NURSING FACILITY COST CEILING & COST ESCALATORS
July 2008 through June 2014
RS Means Construction Cost Limits & FRV Values
Nursing Facility Limits for Administrators, Medical Directors, and Management Fees
Price-Based Payment Methodology Effective July 1, 2014 (**See Medicaid Memo – Revised June 25, 2014)
Nursing Facility Price-Based Payment Methodology FAQs (NEW)
Proposed Nursing Facility Price-Based Payment Methodology FAQs Glossary
SFY 2015 Price-Based Rates (also applicable to the Medicare-Medicaid Financial Alignment (Dual Demonstration))
Nursing Facility Price-Based Reimbursement Rates Effective July 1, 2014 through October 31, 2014
Nursing Facility Price-Based Reimbursement Rates Effective November 1, 2014 through June 30, 2015
Specialized Care Rates
Medicaid Rates for Medicare-Medicaid Financial Alignment (Dual Demonstration)
Medicaid Rates for Medicare-Medicaid Financial Alignment (Dual Demonstration Rates) FAQs
Medicaid Rate File for Medicare-Medicaid Financial Alignment (Dual Demonstration) – Effective January 1, 2014 through June 30, 2014
Medicaid Rate File for Medicare-Medicaid Financial Alignment (Dual Demonstration) – Effective July 1, 2014 through June 30, 2015
HOME AND COMMUNITY BASED CARE (HCBC) WAIVER SERVICES
NOVA Localities
Waiver Rates
HOME HEALTH
Rates
NOVA Localities
HOSPICE
Rates
MANAGED CARE
FAMIS Ratebook 2015
Medallion 3.0 Ratebook 2015
Medallion II Ratebook 2014
FAMIS Ratebook 2014
PACE Ratebook 2014
Medallion II Ratebook 2013
FAMIS Ratebook 2013
PACE Ratebook 2013
Medallion II Ratebook 2012
FAMIS Ratebook 2012
PACE Ratebook 2012
Medallion II Ratebook 2011 (Revised October 1, 2010)
FAMIS Ratebook 2011 (Revised October 1, 2010)
PACE Ratebook 2011 (Revised October 1, 2010)
Medallion II Rate Book 2011
FAMIS Rate Book 2011
PACE Rate Book 2011
Medallion II Rate Book 2010
FAMIS Rate Book 2010
PACE Rate Book 2010
Medallion II Rate Book 2009
FAMIS Rate Book 2009
FAMIS MOMS Rate Book 2009
PACE Rate Book 2009