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Adjustments Hitting December Medicaid Payment Cycles

As nursing home providers begin seeing the impact of Quality Pool adjustments and supplemental payments in their Medicaid payment cycles, we remind members that it is important to track and reconcile the payments to the backup documents that the Department of Health (DOH) has made available. The Dear Administrator Letter (DAL) announcing payment adjustments related to five years of the Nursing Home Quality Initiative (NHQI) as well as the supplemental payment reflecting reinvestment of the .8 percent assessment is available here. The DAL outlines how the figures were calculated and provides links to backup documentation showing the data used in the calculations. The adjustments are reflected in Medicaid payment cycles 2152 and 2153. Although DOH intended to have both adjustments coincide in the same Medicaid payment cycle, some members report that in some cases, they are reflected in separate cycles.

Subsequent to the original DAL, DOH sent two additional communications related to these payment adjustments. The first, copied below, indicates that homes whose supplemental payments were offset to fulfill a Quality Pool liability (i.e., all homes that had a negative Quality Pool adjustment) should anticipate receiving a paper check instead of the typical electronic funds transfer for their entire Medicaid payment for cycle 2152 and/or 2153. This also applies to homes that had outstanding Medicaid liabilities prior to this transaction. The cycle 2152 paper check mailing date is Dec. 5th, and the cycle 2153 check mailing date is Dec. 12th.

The second communication, a DAL issued Nov. 30th and available here, warns homes that have a negative Quality Pool adjustment exceeding the benefit of their supplemental payment that the entire remaining liability is likely to be offset against their regularly scheduled Medicaid payment for cycle 2154. In other words, instead of the expected 15 percent recoupment, DOH will apply 100 percent of the remaining liability against the cycle 2154 payment. To adjust for this offset, the Department will not make the expected 15 percent recoupments in Medicaid payment cycles 2155 through 2160. If this accelerated recoupment is expected to cause a financial hardship, impacted homes should contact DOH at nfrates@health.ny.gov. We have reached out individually to affected members but invite you to contact us with questions or concerns.

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

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From DOH (Nov. 30th):

This is to notify nursing homes that the Department of Health has revised the Summary schedule for the Nursing Home Quality Pool (NHQP) and the 1% Supplemental Payments which were generated in cycles 2152 and 2153. The link for this posting is, https://www.health.ny.gov/facilities/long_term_care/reimbursement/nhr/.

For those Nursing Homes that incurred a liability as a result of the Quality Pool distribution, 1% payments were withheld from your weekly cycle check (cycle 2152 and 2153) to effectuate payment of the Quality liabilities.

In addition, for those Nursing Homes with outstanding Medicaid liabilities, Both Quality Pool payments and 1% payments may have been intercepted and applied to outstanding Medicaid liabilities.

If a withhold is listed on the above spreadsheet for your NH’s, the Cycle 2152 and/or Cycle 2153 EFT payment was intercepted and paper check will be mailed to your facility for any remaining portion of the check - including payments of claims submitted for payment.

These checks will be mailed on the following dates to the mailing address on file for your facility on the eMedNY system:

Cycle #                  Distressed                          Non-Distressed

2152                       11/21/18                              12/05/18

2153                       11/28/18                              12/12/18

To obtain more information regarding the cycle 2152 and/or 2153 mailed checks please call CSRA directly at 1-800-343-9000.

If you have any questions regarding the amounts withheld please send an email to Bimamail@health.ny.gov.