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DOH Issues July 2019 Rates

By now, nursing home members should have had a chance to download and review their July 1, 2019 Medicaid rate sheets that were posted on the Healthcare Financial Data Gateway section of the Health Commerce System (HCS) on Oct. 10th. The rates reflect a new methodology for calculating the case mix index used to adjust the direct component for acuity. Instead of a single picture date, the Department of Health (DOH) is using all Medicaid assessments filed between Aug. 8, 2018 and March 31, 2019 that result in a Resource Utilization Group (RUG) assignment. Discharge assessments and tracking records are not included in the calculation. The associated Dear Administrator Letter (DAL) is available here.

Payment adjustments retroactive to July 1, 2019 are scheduled to be made in Medicaid payment cycle 2200, which has a check date of Oct. 21st and a release date of Nov. 6th. While we are seeking more detail on how resulting retroactive reductions will be incorporated in coming payment cycles, members should be prepared for their Nov. 6th Medicaid payment to reflect the new rate, along with the possibility of an additional recoupment percentage.

Other than the rate sheet schedule that provides a count of Medicaid assessments by RUG (labeled as “patient counts”), DOH has not provided any further data that would allow homes to validate which assessments were used in the calculation. We are seeking clarification from DOH on whether any additional data will be made available, but in the meantime, homes noting discrepancies should email DOH at nfrates@health.ny.gov.

We have been providing information to members directly on continuing efforts to counter or mitigate the catastrophic rate decreases many members are facing and encourage you to contact us with questions and concerns.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8383, ext. 128, or Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841