Medicaid Rate Reviews
NRS 422.2704
requires that, every four (4) years, the State of Nevada, Division of Health
Care Financing and Policy (DHCFP) review 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 Health and Human Services (DHHS) for
possible inclusion in the State Plan for Medicaid.
Methodology and Schedule of Reviews
DHCFP 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@dhcfp.nv.gov in Excel format. Various channels may be used to notify affected
providers of the availability of surveys for selected provider types to
include: email and fax blasts from DHCFP’s fiscal agent (Gainwell Technologies),
correspondence to provider associations, Web
Announcements on the Provider Portal, and updated postings on 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 DHCFP determine if the current
reimbursement rates paid to providers accurately reflect the cost of providing
the service or item.
Provider Type (PT) Survey Instructions and Templates – The deadline for completing the surveys is Friday, September 29th, 2023
- Anesthesia
- PT 10 Outpatient Surgery, Hospital Based
- PT 12 Hospital, Outpatient
- PT 14-300 Behavioral Health Outpatient, Qualified Mental Health Professional
- PT 14-301 Behavioral Health Outpatient, Qualified Mental Health Associate
- PT 14-302 Behavioral Health Outpatient, Qualified Behavioral Aide
- PT 14-305 Behavioral Health Outpatient, Licensed Clinical Social Worker
- PT 14-306 Behavioral Health Outpatient, Licensed Marriage & Family Therapist
- PT 14-307 Behavioral Health Outpatient, Clinical Professional Counselor
- PT 14-308 Behavioral Health Outpatient, Day Treatment Model
- PT 15 Registered Dietitian
- PT 25 Optometrist
- PT 26 Psychologist
- PT 30 Personal Care Aide – Provider Agency
- PT 41 Optician, Optical Business
- PT 46 Ambulatory Surgical Centers
- PT 54 Targeted Case Management
- PT 60-960 School Based
- PT 82 Behavioral Health Rehabilitative Treatment
- PT 83 Personal Care Aide – Intermediary Service Organization
- PT 85-310 Applied Behavioral Analysis, Licensed & Board Certified Behavior Analyst
- PT 85-311 Applied Behavioral Analysis, Psychologist
- PT 85-312 Applied Behavioral Analysis, Licensed & Board Certified Assistant Behavior Analyst
- PT 85-314 Applied Behavioral Analysis, Registered Behavior Technician