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Nursing Home Medicaid Rates

Nursing homes should be reviewing their preliminary 2015 capital rates that were posted to the Health Commerce System (HCS) in early September for homes filing RHCF-4 Medicaid cost reports. Requests for capital rate corrections should be sent to BVAPR@health.ny.gov by Oct. 3 to be included in November notice rates. Once the notice rates are issued, homes will have until Dec. 1 to notify DOH of any additional capital rate corrections that may be needed. DOH intends to publish initial rates in mid-January 2015.             

The next Case Mix Index (CMI) update to nursing home rates will be the incorporation of the Jan. 2014 CMI into July 1, 2014 rates. DOH anticipates making rate adjustments in October or November. Shortly after that, the State hopes to finalize July 2012 rates by issuing adjustments based on OMIG MDS audits and lifting the constraint on homes whose CMI changed by more than five percent from January to July 2012. OMIG will issue draft audit reports. Homes should be ready to submit their July 2014 census rosters in the first three weeks of October.

Rate adjustments to reconcile 2012 cash receipts assessment payments are expected in November. When CMS approval is received, DOH intends to implement rate increases expected to equal approximately one percent of the Medicaid rate to reflect the April 1, 2014 lifting of the across-the-board Medicaid rate cut (implemented for nursing homes as an increase in the cash receipts assessment). The 2013 quality pool rate adjustments are pending CMS approval, as well.

The transition of the nursing home benefit into managed care is delayed from October 2014 to January 2015 for downstate areas. Upstate implementation will follow six months after downstate kick-off. Although the Special Terms and Conditions have not been issued, CMS has provided the State with a number of pre-requisite tasks that need to be implemented in advance of the transition.

DOH staff provided an overview of the $1.2 billion in capital funding contained in the 2014-15 State budget. The State prefers to distribute the bulk of the funding as part of the capital component of DSRIP projects, but will also consider high value capital projects that are in line with DSRIP goals that are not part of a formal DSRIP application. DSRIP project capital applications would need to be made by the Lead DSRIP organization with the funds being provided to the DSRIP network provider engaged in the capital project. DOH is working on the application materials and will begin accepting applications Nov. 1 with a deadline of mid-December. An applicant conference is being planned for early November.

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