Public Notice of Final Action for Setting Payment Rates for Long-term Care Facility Services

The South Carolina Department of Health and Human Services (SCDHHS), pursuant to the requirements of Section 1902(a)(13)(A) of the Social Security Act, gives notice of the following actions regarding its methods and standards for setting payment rates for long-term care facility services (excluding state-owned nursing facilities) under the South Carolina Medicaid State Plan (State Plan) under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Effective for services provided on or after Oct. 1, 2025, SCDHHS will amend the South Carolina Title XIX reimbursement methodology for long-term care by:

1. Providing payments to nursing facilities based on the most recent cost report data available (i.e., fiscal year ending [FYE] Sept. 30, 2024).
2. Updating the cost center standards using the most recent cost report data available (i.e., FYE Sept. 30, 2024), as well as determining the general services standards at 105% of the mean and laundry, housekeeping and maintenance standards at 105% of the mean.
3. Applying a 2.6% inflation factor in the calculation of the Oct. 1, 2025, payment rates.
4. Decreasing the square footage allowance used for capital cost reimbursement purposes from $283.25 to $274.71 in accordance with the annual change reflected in the RS Means Construction Cost Data publication.

The minimum occupancy factor used to determine individual Medicaid reimbursement rates effective Oct. 1, 2025, is 90%. The cost of capital reimbursement calculation remains at 90% minimum occupancy level. The cost center standard for rates effective Oct. 1, 2025, is at 90% occupancy.

The percent skilled used in establishing each nursing facility's Oct. 1, 2025, Medicaid reimbursement rate will be based on the state fiscal year 2025 Medicaid paid days.

SCDHHS projects that based upon these actions, annual aggregate expenditures will decrease by approximately $1.5 million total dollars including Medicaid days paid while the recipient is under the hospice benefit.

Copies of this notice are available at each SCDHHS Healthy Connections Medicaid office and at www.scdhhs.gov for public review. Additional information concerning these actions is available upon request at the address cited below.

Any written comments submitted may be reviewed by the public at the SCDHHS, Division of Long Term Care Reimbursements, Room 1216, 1801 Main Street, Columbia, S.C., Monday through Friday between 9 a.m.-5 p.m.

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