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UPDATE: Change to Medicaid Therapy Reimbursement for Medicaid Only Patients

Medicaid reimburses therapy and laboratory/radiology services separately for Medicaid only patients (patients without Medicare B). Department for Medicaid Services (DMS) is tentatively planning to cease reimbursing therapy separately and include therapy as a line item in the 7/1/24 SNF rate.

Also, DMS is tentatively planning to cease reimbursing oxygen separately and include oxygen as a line item in the 7/1/24 SNF rate.

This will be advantageous for SNFs in several ways.

1. Medicaid can pay higher overall rates. The inclusion of therapy increases the Upper Payment Limits.

2. SNFs will no longer have to bill Medicaid for therapies.

3. SNF’s will no longer have to bill Medicaid for oxygen.

4. SNFs will no longer have to obtain therapy prior authorizations.

3. SNF’s will no longer have to obtain oxygen prior authorizations.

Tentatively, the therapy component included in the 7/1/24 Medicaid rate will be based on prior years therapy claims submitted.  Starting with the 2024 cost report submission, SNFs will report the therapy provided to Medicaid only patients by therapy discipline, by HCPC, and by month AND oxygen provided to Medicaid patients by HCPC and by month.

Please watch for further updates as the changes become available.