DOH Seeks Personal Care Rate Enhancement from CMS for Rural Areas of State

The Department of Health (DOH) submitted a State Plan Amendment in late March to the Centers for Medicare and Medicaid Services (CMS) seeking a rate enhancement for Medicaid-qualified personal care providers in Federally Designated Frontier and Remote (FAR) areas of the state. This rate enhancement originates from 2018-19 State Budget language authorizing the Rural Health Council to look at the need for such an enhancement.

The adjustment will apply to specific counties (not select zip codes) as long as providers are eligible based on combined losses in Personal Care II, Nursing Supervision, and Nursing Assessment services compared to current reimbursement rates. A difference will be calculated between actual cost and current rates paid for the sum of Level II, Nursing Assessment, and Nursing Supervisor using Cost Report data. Counties affected include Allegany, Clinton, Delaware, Essex, Franklin, Hamilton, and St. Lawrence.

This proposed amendment pertains to Fee-for-Service (FFS) care only. Upon approval, the rate adjustment will be retroactive from Jan. 1, 2019. DOH plans to amend the Nursing Home Transition and Diversion (NHTD)/Traumatic Brain Injury (TBI) waiver for a similar rate enhancement later this summer.

To view the proposed amendment, click here.

Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871