Rate Analysis & Development

Medicaid Rate Reviews

NRS 422.2704 requires that, every four (4) years, the Nevada Medicaid Division of the Nevada Health Authority reviews the rate of reimbursement for each service or item provided under the State Plan for Medicaid to determine whether the rate of reimbursement accurately reflects the actual cost of providing the service or item. If the Division determines that the rate of reimbursement for a service or item does not accurately reflect the actual cost of providing the service or item, the Division must calculate the rate of reimbursement that accurately reflects the actual cost of providing the service or item and recommend that rate to the Director of the Nevada Health Authority for possible inclusion in the State Plan for Medicaid.

Methodology and Schedule of Reviews

Nevada Medicaid has established a schedule for completing rate reviews by provider type. Surveys will be made available on this page for the designated providers. Completed surveys must be emailed to QRR@nvha.nv.gov in Excel format. Various channels may be used to notify affected providers of the availability of surveys for selected provider types that include email and blasts from Nevada Medicaid's fiscal agent (Gainwell Technologies), correspondence to provider associations, Web Announcements on the Provider Portal, and updated postings at the bottom of this webpage.

Provider surveys will request information regarding the Cost of Providing Service for each CPT/HCPCS/Revenue code allowed under the designated provider type. Providers should ensure that surveys are completed and submitted by the deadline listed on the survey. These surveys will help Nevada Medicaid determine if the current reimbursement rates paid to providers accurately reflect the cost of providing the service or item.