HCPCS codes affected are as follows:
*The requirement to pass through the HCBS increase of 1.4% does apply to Assisted Living Facility codes, thus include those codes for which AHCCCS does not establish a FFS rate. The cap rates will including funding for these expenses.
Keep in mind that this pass through of rates is based on your individual contract with Mercy Care Plan or Mercy Maricopa Integrated Plan. Please refer to your individual contract for additional detail.
Nursing Facility Per Diem rates will be increased by 0.7% across the board.**
Revenue Codes affected are as follows:
- 0183 - LOA/Therapeutic
- 0185 - LOA/Nursing Home
- 0191 - Subacute Care Level I
- 0192 - Subacute Care Level II
- 0193 - Subacute Care Level III
** The requirement to pass through the Nursing Facility increase of 0.7% does apply to all codes, including those for which AHCCCS does not establish a FFS rate - e.g. specialty rates. The increase is being applied to 100% of the capitation Nursing Facility spend, thus specialty rates and add-ons are included.
The Nursing Facility pass through requirement is not limited to ALTCS MCOs - this applies to all lines of business when a Nursing Facility stay is covered. Cap rates will be amended accordingly.
Keep in mind that this pass through of rates is based on your individual contract with Mercy Care Plan. Please refer to your contract for additional detail.
Language regarding the mandated pass through will be included in a contract amendment. The contract amendment and cap rate adjustment will occur sometime in early calendar year 2018, retroactive to January 1, 2018.
The changes proposed for the rates in this notification are proposed to assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available at least to the extent that such care and services are available to the general population in the geographic area.
As always, don't hesitate to contact your Mercy Care or your Mercy Maricopa Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care Plan or Mercy Maricopa website.
Thanks for all you do!