Medicaid Nursing Facilities

Medicaid Nursing Facilities

MEDICAID NURSING FACILITIES

Medicaid oversees nursing facility reimbursement, the Nursing Facility Quality Payment Program, Behavioral Care Units (BCUs), Preadmission Screening and Resident Review (PASRR) and Special Rates.

Idaho nursing facility rate setting and reimbursement methodologies
  • Nursing Facilities: IDAPA 16.03.10, Section 235 – 296 
  • Hospice Providers in nursing facilities: IDAPA 16.03.10 Section 459.08

Nursing facility reimbursement questions may be directed to:

Medicaid Reimbursement Team
208-287-1180
MedicaidReimTeam@dhw.idaho.gov

Specific nursing facility rate information can be requested via a public records request by following the link below:
https://healthandwelfare.idaho.gov/AboutUs/PublicRecordsRequest/tabid/132/Default.aspx

Preadmission Screening and Resident Review (PASRR):

Preadmission Screening and Resident Review (PASRR) is federally mandated for all individuals, regardless of payment source, admitting to a Medicaid nursing facility. The PASRR screens for serious mental illness (SMI) and intellectual/developmental disability or related condition (ID/RC). The goal of PASRR is to prevent the warehousing of individuals with SMI and/or ID/RC in nursing facilities by ensuring nursing facility placement is appropriate. If nursing facility placement is appropriate, and the individual would benefit, specialized services or specialized rehabilitative services are offered and provided.

PASRR Level I (87) screenings are completed in the order they are received, Monday through Friday between 8am and 5pm.

 

For PASRR questions related to specific individuals please contact the region Bureau of Long Term Care office.

Region I
Fax: 208-666-6856
Phone: 208-769-1567		 Region II
Fax: 208-799-5167
Phone: 208-334-0940
Region III
Fax: 208-454-7625
Phone: 208-455-7150		 Region IV
Fax: 208-334-0953
Phone: 208-334-0940
Region V
Fax: 208-736-2116
Phone: 208-736-3024		 Region VI
Fax: 208-239-6269
Phone: 208-239-6260
Region VII
Fax: 208-528-5756
Phone: 208-528-5750		  


For general PASRR questions, PASRR compliance, and requests for PASRR training, please contact Alexandra.Fernandez@dhw.idaho.gov.

PASRR education and forms:

PASRR Education and Forms:

NF COVID PASRR Job Aid (PASRR COVID Nursing Facility Job Aid.pdf

 

Special rates

Nursing Facility Special Rates are an add on rate to the per diem reimbursement to care for participants whose care needs exceed what is typically covered in a nursing facility. Cares that exceed the per diem amount are ventilator and tracheostomy care or specialized durable medical equipment (DME). Special Rates are approved on a case by case basis. Ventilator and tracheostomy care are fixed add on rates. These rates are updated on a yearly basis to account for changes in costs to supplies and nursing care.

  • Current Ventilator Reimbursement Rate: $348.07
  • Current Tracheostomy Reimbursement Rate: $205.97

All Special Rate Forms should be faxed to 1-877-314-8782.

If you would like more information about Special Rates, please contact MedicalCareUnit@dhw.idaho.gov.

Special rate forms
Behavioral Care Units (BCUs)

Behavioral Care Units (BCUs) are nursing facilities with a Medicaid approved status that provide care to individuals with high needs behaviors. BCUs provide at least 20% of their total Medicaid days to individuals with qualifying behaviors. These facilities must meet certain requirements such as specially trained staff, individualized interventions, and weekly BCU team meetings.

All BCUs must reapply annually for BCU status.

Initial and annual BCU applications must either be faxed, emailed or submitted in person or via mail on a flash drive. Paper copies will no longer be accepted.

If you would like more information about BCUs, please contact Alexandra.Fernandez@dhw.idaho.gov

Current Behavioral Care Units:

  • Aspen Park of Cascadia - Moscow
  • Caldwell Care of Cascadia - Caldwell
  • Canyon West of Cascadia - Caldwell
  • Cascadia of Boise – Boise
  • Clearwater of Cascadia – Orofino
  • Coeur d’Alene of Cascadia – Coeur d’Alene
  • The Cove of Cascadia - Bellevue
  • Creekside Transitional Care and Rehabilitation - Meridian
  • Desert View Care Center – Buhl
  • Gateway Transitional Care Center - Pocatello
  • Lewiston of Cascadia - Lewiston
  • Lincoln County Care Center - Shoshone
  • Meadow View Nursing and Rehabilitation - Nampa
  • Mini-Cassia Care Center - Burley
  • Mountain Valley of Cascadia - Kellogg
  • Oak Creek - Kimberly
  • Orchards of Cascadia - Nampa
  • Parke View Nursing and Rehabilitation- Burley
  • Shaw Mountain of Cascadia – Boise
  • Valley Vista of Sandpoint - Sandpoint
  • Valley Vista of St. Maries – St. Maries
  • Weiser Care of Cascadia - Weiser
BCU forms
Nursing Facility Quality Payment Program (NFQPP)

The work group meets semi-annually and is open to nursing facility administrators, Directors of Nursing, nursing facility representatives and interested stakeholders. The purpose of the work group is to have ongoing discussions regarding trends and concerns and to negotiate changes to the program as needed to avoid inadvertently creating barriers to access for Idahoans who require skilled nursing level of care. If you are interested in joining or would like more information about the program, please contact Alexandra Fernandez at Alexandra.Fernandez@dhw.idaho.gov.

NFQPP Information: