​Act 2021-56 Ventilator Care and Tracheostomy Care Payments

Act 56 of 2021

Senate Bill 108 amends Section 443.1 (Medical Assistance Payments for Institutional Care) of the Human Services Code to provide for an additional payment of $130 per eligible Medicaid ventilator or tracheostomy day for qualified medical assistance nonpublic and county nursing facilities. Payments will begin on or after fiscal year 2020-2021 and are to be made on a quarterly basis. The Department of Human Services is required to ensure the payment distribution is made to all qualifying nursing facilities in the fee-for-service and managed long-term care services and supports programs. A nonpublic or county nursing facility will qualify for payment if, during any quarter of the year, either of the following criteria is met: For FY 2020-21 and thereafter (1) the facility had ten or more medical assistance recipient residents who received medically necessary ventilator care or tracheostomy care according to the most recently available Picture Date CMI Report and (2) 17% or more of the facility's medical assistance resident population received medically necessary ventilator care or tracheostomy care according to at least one of the three most recently available Picture Date CMI Reports. Senate Bill 108 requires the department to publish the information contained in the Supplemental Ventilator Care and Tracheostomy Care Payment file on the department's publicly accessible internet website on a quarterly basis.

Supplemental Ventilator Care and Tracheostomy Care Payments

Supplemental Ventilator Care Payments

Supplemental ventilator care payments (SVCP) payments will be made to qualifying MA nonpublic and county nursing facilities each quarter effective July 1, 2012, based on the following:

A nonpublic and county nursing facility will qualify for the SVCP if both of the following criteria are met based on each Picture Date:

  • The facility has a minimum of ten MA-recipient residents who receive medically necessary ventilator care.
  • The facility has a minimum of 10% of their MA-recipient resident population receiving medically necessary ventilator care calculated as the number of MA ventilator care residents divided by the total number of MA residents listed on the Picture Date CMI Report.

The determination of medically necessary ventilator care is based on whether there is a positive response to MDS 3.0 Section O0100F1 or O0100F2 on the MDS assessment identified on the Picture Date CMI Report.

The SVCP per diem is calculated as (percentage of MA ventilator care residents x $69 x percentage of MA ventilator care residents). The quarterly SVCP to qualifying facilities is calculated as the SVCP per diem times the number of paid MA facility and therapeutic leave days for the calendar quarter that contains the Picture Date used to determine the qualifying criteria.

​Picture Date

​Authorization Schedule

​Paid Facility & Therapeutic Leave Day Quarter

​February 1

​September

​January 1-March 31

May 1​

​December

​April 1-June 30

​August 1

​March

​July 1-September 30

​November 1

​June

​October 1-December 31

SVCP Payments