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Closing the Books on 2018

With January 2019 nursing home Medicaid rates and other adjustments delayed due to state budget negotiations, we want to provide a brief review of Medicaid funding adjustments made in 2018. Members may find this information helpful for their financial audits since eMedNY no longer provides the type of reconciliation reports that were available previously.

  • The 2016 cash receipts assessment reconciliation was reflected in Medicaid payment cycle 2106, released on Jan. 17, 2018.
  • January 2018 Medicaid rates were paid retroactively to Jan. 1, 2018 in Medicaid payment cycle 2122, released on May 9, 2018.
  • The Department of Health (DOH) began paying July 2018 rates on or very near July 1st, requiring no retroactive payment.
  • The per-day assessment reimbursement amount was updated to reflect the 2016 reconciled amount in mid-2018. The adjustment, retroactive to Jan. 1, 2018, was reflected in Medicaid payment cycle 2131, released on July 11, 2018.
  • The fourth Universal Settlement payment was sent in mid-October. Homes should have received their check for appeals settlement during the week of Oct. 15th from LeadingAge NY. Homes that were party to individual lawsuits covered by the settlement would have received payment related to individual litigation from the attorney handling the specific litigation.
  • DOH issued revised July 2018 Medicaid rate sheets reflecting the carve-out of transportation from the Medicaid rate in October, and the payment adjustment retroactive to July 1, 2018 was made in Medicaid payment cycle 2145, released on Oct. 17, 2018.
  • Payment adjustments for five years (2013-2017) of the Nursing Home Quality Initiative (NHQI) as well as the supplemental payments funded by the continuing 0.8 percent assessment were reflected in Medicaid payment cycles 2152 and/or 2153. Homes with negative NHQI adjustments received paper checks netting the two amounts. Homes with a negative NHQI adjustment that exceeded the supplemental payment may have seen adjustments over several additional payment cycles and may want to review the information available here.
  • The Office of the Medicaid Inspector General (OMIG) is currently auditing 2016 MDS submissions. The January 2015 rate was the latest one updated to reflect OMIG audit results and the lifting of the 5 percent Case Mix Index (CMI) constraint. While all 2015 MDS audit reports have been finalized, the July 2015 and January 2016 rates have not yet been revised to reflect OMIG audit results, and the CMI constraint is not yet lifted.
  • Members should keep in mind that the State has indicated that it intends to reconcile minimum wage funding that homes receive based on projected hours to actual hours. DOH is in the process of calculating the 2017 reconciliation based on surveys completed by providers earlier this year.
  • While DOH reports that discussions with the Centers for Medicare and Medicaid Services (CMS) are ongoing regarding the provision in last year’s enacted state budget that would require permanent residents enrolled in Medicaid managed care to revert to fee-for-service Medicaid after three months, no implementation date has been suggested. 
  • DOH has provided clarification that Vital Access Provider (VAP), CYNERGY, and Delivery System Reform Incentive Payment (DSRIP) funding is not subject to assessment. Universal Settlement, Advanced Training Initiative (ATI), and NHQI distributions are assessable. While no final determination has been made, DOH has instructed homes to treat the 1 percent supplemental payments as non-assessable at this time.

Please let us know if you have questions or need additional information on the listed adjustments.

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