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AHCA NCAL Medicare Advantage 'Levels' Tools

All of the following resources are available to AHCA members free of charge, but you will need to register for each separately. You may participate in any and all modules that are of interest to you and the work you do. We recommend you start with either the “Introduction to the AHCA FFS to MA Levels Calculator Presentation” or the “Medicare Advantage Fee for Service to Levels Calculator – Overview” resources to orient you to the remaining resources. 

The tools available are:

  • Introduction to the AHCA FFS to MA Levels Calculator Presentation (27 mins)
  • Medicare Advantage Fee for Service to Levels Calculator – Overview
  • Patient Intake or Reassessment MA Risk Classification Tool
  • FY 2022 Wage Index Adjustment Factor Lookup Tool
  • FY 2022 Rural Provider Patient-Level MA Risk Calculator
  • FY 2022 Urban Provider Patient-Level MA Risk Calculator

Below is a summary of each tool. 

  • The AHCA Medicare Advantage (MA) Fee for Service to Levels Calculator was developed at member request to permit providers with MA contracts to quickly estimate the per-diem payment rate financial risk associated with: Accepting a new MA admission, and Continuing with a current MA rate, or a MA plan proposed adjusted rate related to a significant change in resident care needs during a stay.

    This is available to AHCA members. 

    The AHCA Medicare Advantage (MA) Fee for Service to Levels Calculator was developed at member request to permit providers with MA contracts to quickly estimate the per-diem payment rate financial risk associated with:

    1.  Accepting a new MA admission, and
    2. Continuing with a current MA rate, or a MA plan proposed adjusted rate related to a significant change in resident care needs during a stay.

    This overview document is designed as a “Read-Me-First” file that includes the following

    • Why should providers use the calculator
    • When should providers use the calculator, and
    • How do providers use the calculator

  • This simple tool is designed to be utilized at critical decision-making times - Prior to Accepting the Admission – Upon a Significant Change in Care Needs – and – Upon Contract Initiation and Renewal

    This is available to AHCA members.

    This simple tool is designed to be utilized at critical decision-making times - Prior to Accepting the Admission – Upon a Significant Change in Care Needs – and – Upon Contract Initiation and Renewal

    1. Like the SNF PDPM pre-admission process - providers should ask the MA plan and admitting hospital about information necessary to assure that the SNF is able to meet the patient’s care needs.  Special attention should be paid to those patient characteristics and clinical need factors associated with high-cost care needs to best assure that the SNF can provide the necessary level of care as well as receive an appropriate MA plan rate.    
    2. Additionally, some SNF patients admitted for care under MA plan coverage may experience a change in status and require an updated care plan.  Special attention should be made to assess whether the change in care needs is sufficient to justify a request for the MA plan to adjust the patient’s assigned rate ‘Level’.
    3. This tool can provide a quick analysis of the overall risk associated with the proposed reimbursement ‘Levels’.

     This tool differentiates patient care needs for nursing, therapy, and non-therapy ancillary services into high or low categories necessary for evaluation of MA levels payment risk in the rural or urban patient-level risk calculator tool. 

  • The AHCA MA patient-level risk calculator requires a provider to know whether they are classified as ‘Urban’ or a ‘Rural’ provider for Medicare payment purposes. For providers that do not know this detail, providers only need to know the county their SNF is located to use this wage index lookup file to quickly find the wage index adjustment factor that applies to the facility.

    This is available to AHCA members. 

    The AHCA MA patient-level risk calculator requires a provider to know whether they are classified as ‘Urban’ or a ‘Rural’ provider for Medicare payment purposes.  For providers that do not know this detail, providers only need to know the county their SNF is located to use this wage index lookup file to quickly find the wage index adjustment factor that applies to the facility.

    The facility-specific wage index adjustment factor is necessary for evaluation of MA levels payment risk in the rural or urban patient-level risk calculator tool.

  • The AHCA rural provider patient-level MA risk calculator takes three user entered data points to compare the MA plan offered rate for an individual patient with a facility-specific comparable Medicare fee-for-service per-diem rate determined by high or low nursing, therapy, and non-therapy ancillary care needs identified by the Patient Intake or Reassessment MA Risk Classification tool.

    This is available to AHCA members. 

    The AHCA rural provider patient-level MA risk calculator takes three user entered data points to compare the MA plan offered rate for an individual patient with a facility-specific comparable Medicare fee-for-service per-diem rate determined by high or low nursing, therapy, and non-therapy ancillary care needs identified by the Patient Intake or Reassessment MA Risk Classification tool.  The three data points are:

      • Facility Name
      • Facility Wage Index Adjustment Factor 
      • MA Plan Levels Rate Offered

     Providers should only use this file if they know the SNF is located in a county located in a Medicare core based statistical area (CBSA) designated as ‘Rural’.  If uncertain, providers should use the Wage Index Adjustment Factor Lookup Tool to identify the SNF’s rural/urban designation and wage index factor.

  • The AHCA urban provider patient-level MA risk calculator takes three user entered data points to compare the MA plan offered rate for an individual patient with a facility-specific comparable Medicare fee-for-service per-diem rate determined by high or low nursing, therapy, and non-therapy ancillary care needs identified by the Patient Intake or Reassessment MA Risk Classification tool.

    This is available to AHCA members. 

    The AHCA urban provider patient-level MA risk calculator takes three user entered data points to compare the MA plan offered rate for an individual patient with a facility-specific comparable Medicare fee-for-service per-diem rate determined by high or low nursing, therapy, and non-therapy ancillary care needs identified by the Patient Intake or Reassessment MA Risk Classification tool.  The three data points are:

      • Facility Name
      • Facility Wage Index Adjustment Factor 
      • MA Plan Levels Rate Offered

    Providers should only use this file if they know the SNF is located in a county located in a Medicare core based statistical area (CBSA) designated as ‘Urban’.  If uncertain, providers should use the Wage Index Adjustment Factor Lookup Tool to identify the SNF’s rural/urban designation and wage index factor.

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