Nursing Home Medicaid Rate Adjustments

Nursing home providers should see retroactive rate adjustments in Medicaid payment cycles #1924 and 1925.  The first will cover Case Mix Index (CMI) updates to rates effective 1/1/14.  The second will reflect the reconciliation of 2011 cash receipts assessment payments.  Payment cycle #1924 has a release date of 7/23.  Payments for cycle #1925 will be released on 7/30.

DOH is working on posting the assessment reconciliation worksheets and hopes to have them available this week.

Although the Dear Administrator Letter refers to Jan. 2012 when describing the five percent case mix increase constraint, members are reminded that the constraint is applied for each six month period with a "floor" and "ceiling" calculated based on the growth during the past six month periods.  An example of how DOH calculates these floors and ceilings is available here.    

Contact:  Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841