County Nursing Facility MDOI Payments

Beginning 7/1/2016

A quarterly MDOI will be calculated for each qualified county nursing facility.
To qualify for a quarterly MDOI payment, the facility must be a county nursing facility both during the entire quarter for which the payment is being made and at the time the payment is made. A facility will no qualify for a quarterly payment if they are located in a geographic zone where Community Health Choices operates during the entire quarter for which the payment is made. 

The Department will calculate each qualified county nursing facility’s quarterly MDOI payment based on the following formula:

• The total funds allocated for the quarter will be divided by the total MA days for all qualified county nursing facilities to determine the quarterly MDOI per diem. 

• The total MA days used for each county nursing facility will be the MA days identified on the most recent Provider Reimbursement and Operations Management Information System (PROMISeTM) data file used to determine the facility’s eligibility for disproportionate share incentive payments.

• The quarterly MDOI per diem will be multiplied by each qualified county nursing facility’s paid MA days identified on the most recent PROMISe data file used to determine eligibility for disproportionate share incentive payments, to determine its quarterly MDOI amount.

Prior to July 1, 2016
An annual MDOI will be calculated for each qualified county nursing facility, to be paid out in quarterly installments.
To qualify for an MDOI quarterly installment payment, the facility must be a county nursing facility both during the entire quarter for which the installment payment is being made and at the time the installment payment is made.

The Department will calculate each qualified county nursing facility’s MDOI quarterly installment payment based on the following formula:

• The total funds allocated for the MDOI payments for the rate year will be divided by the total MA days for all county nursing facilities to determine the MDOI per diem for the rate year.

• The total MA days used for each county nursing facility will be the MA days identified on the most recent PROMISe data file used to determine the facility’s eligibility for disproportionate share incentive payments.

• The MDOI per diem for the rate year will be multiplied by each qualified county nursing facility’s paid MA days identified on the most recent PROMISe data file used to determine eligibility for disproportionate share incentive payments, to determine its annual MDOI amount.

• Each qualified county nursing facility’s annual MDOI amount will be divided by four to determine the facility’s MDOI quarterly installment payments for the rate year.