Please complete questionnaire below. 

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* 1. Please enter facility name. 

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* 2. Please enter the number of nursing beds in your facility.

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* 3. Please enter the average % of Medicaid residents in your facility for FY 2016 (or most recent cost report data).

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* 4. Please enter actual/estimated Medicaid shortfall based on FY 2016 Medicaid Cost Report data.

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* 5. Please enter the average daily Medicaid rate paid to your facility in FY 2016 and FY 2017 (if available).

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* 6. Please enter actual/estimated additional annual (2017/2016) cost of STAR+PLUS/DUAL MMP Medicaid managed care implementation. (i.e. compliance, administrative, staffing, software).

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* 7. Per month, how many additional staff hours are spent on STAR+PLUS/DUAL MMP administrative tasks in comparison to FFS model?

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* 8. As of February 2018, please enter the total amount of STAR+PLUS/DUAL MMP payments that are outstanding (have not been paid).

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* 9. Please enter actual/estimated annual costs due to Affordable Care Act, i.e. Employer Health Insurance Mandate for FY 2016, IRS Form 1095-C preparation, etc.

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* 10. Please enter annual estimated cost to implement CMS Payroll Based Journal on July 1, 2016. 

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* 11. If your facility has additional costs not captured in Medicaid Cost Report or questions above please itemize and include those below.

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* 12. Please detail the top issues your facility is having related to Medicaid managed care, i.e. clean claims, delayed payment, claim/payment reconciliation, Medicaid pending claims, prior authorizations, service coordination, etc.

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