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DOH Notifies Nursing Homes of Payment Adjustments

The Department of Health (DOH) notified nursing home providers that they have prepared Nov. 1, 2018 Medicaid rates and have scheduled payment in Medicaid payment cycle 2183 (check date of June 24th, with a payment release date of July 10th). The Nov. 1, 2018 rates are identical to the July 1, 2018 rates but incorporate a 1.5 percent increase to the operating component funded by the Health Care Transformation Fund enacted in the 2018-19 State Budget. Updated rate sheets have been posted to the Healthcare Financial Data Gateway on the Health Commerce System (HCS), and the associated Dear Administrator Letter (DAL) is available here. The payment will reflect the 1.5 percent increase retroactive to Nov. 1st.

The adjustment applies to all nursing home Medicaid rates, including specialty rates, and is calculated by multiplying the operating component of the July 2018 rate by 1.5 percent. It appears on line 13 of the first page of the Medicaid rate packet. Because line 13 may also contain other adjustments, DOH has posted a back-up worksheet on the HCS detailing the amounts included on line 13 for all homes. This breakout is also shown on the Nov. 1, 2018 Transformation Fund Rates benchmark rate list available here.

Along with posting the Nov. 1, 2018 benchmark list reflecting the 1.5 percent increase, DOH has notified managed care plans of the change and has indicated that they expect plans to include the adjustment in reimbursement to all homes regardless of contractual reimbursement terms. The June 14th communication to plans is posted here.

DOH also made payment adjustments in Medicaid payment cycle 2178 (check date May 20th, release date June 5th) updating July 2015 and January 2016 Medicaid rates for those homes that had Office of the Medicaid Inspector General (OMIG) Minimum Data Set (MDS) audit findings related to these rate periods. Additionally, the Case Mix Index (CMI) constraints applied to these rate periods for any home that experienced a CMI change greater than 5 percent relative to the previous rate period have been removed. Updated rate sheets for affected homes have been posted to the Healthcare Financial Data Gateway. Because the notification was delayed, homes should have already seen the associated rate adjustments in early June. The associated DALs are available here (July 2015) and here (January 2016).

As of today, final Jan. 1, 2019 rates and the 2017 Cash Receipts Assessment Reconciliation have not been scheduled for payment. We will let members know as soon as more information becomes available.

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