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DOH Gunning for Timely Rate Update

The Department of Health (DOH) reports a smooth roster collection cycle and hopes to receive capital attestations from all homes as soon as possible in their push to publish 2018 Medicaid rates by Jan. 1st. LeadingAge NY and other associations met with DOH last week to discuss these and other Medicaid funding issues. The highlights of the meeting are outlined below.

Audit-Related Rate Revisions. DOH has received approval for the bulk of the 2014 MDS audit-related rate adjustments from the Division of the Budget (DOB). These impact Medicaid rates dated July 1, 2014 and Jan. 1, 2015 and include the impact of any OMIG MDS audit findings as well as the release of the 5 percent CMI growth constraint on homes whose CMI increased by more than 5 percent from the previous rate issuance. Related payment adjustments should be reflected in payment cycle 2097 or 2098.

Several homes are still in the process of completing their audit appeal process. Rate adjustments for those homes will be done upon completion of the appeals process.

2015 MDS Audits. Although DOH is exploring alternative audit entities, OMIG will be responsible for auditing 2015 MDS assessments (i.e., January 2015 picture date governing July 2015 Medicaid rates and July 2015 picture date governing January 2016 rates). OMIG intends to audit 2015 assessments for approximately 200 homes. All of the audits will examine MDS assessments associated with both the January and July picture dates. Audits will begin in Western NY, with homes selected for audit receiving notice letters starting in October, and then move to other regions of the state.

Roster Collection Process. DOH reports that almost all homes have submitted their July 2017 picture date MDS rosters and that the Department has addressed most of the issues of unmatched residents that were brought to their attention. Please let us know if you believe that your home has an unresolved roster issue. If a resident on a home’s July 26th census roster does not match to an MDS assessment in the Centers for Medicare and Medicaid Services (CMS) database, that resident is presumed to be a Medicaid resident and is assigned the lowest RUG score, which can have a negative impact on reimbursement.

Capital Attestations. As of the due date of Oct. 13th, DOH had not received capital attestations from about 200 homes. The 2018 draft capital rates have been available for homes to review since Sept. 29th. Please note that DOH is requiring all homes to submit an attestation, whether they are requesting a correction to their capital calculation or are in agreement with the Department’s calculation. We urge homes that have not yet responded to do so as soon as possible or email DOH to request an extension if needed.

Other Issues. We continue to spotlight the importance of providers having access to MMIS Recoupment Reports that have been recently discontinued. DOH is aware of the value of the report and had scheduled internal meetings to discuss the issue. While there are ongoing discussions on ways to address DOH concerns regarding the state’s potential financial exposure related to litigation that would allow the 1 percent rate supplement to move forward when approved by CMS, no further insight is available as to when those rate changes might be made.

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