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DOH Posts 2020 Nursing Home & ADHC Rates

In keeping with rate notification rules, the Department of Health (DOH) has posted January 2020 nursing home and Adult Day Health Care (ADHC) Medicaid notice rates on the Health Commerce System (HCS). To access them, navigate to the Healthcare Financial Data Gateway section of the HCS.

The 2020 nursing home operating rate incorporates an updated Case Mix Index (CMI) that is based on all Medicaid Minimum Data Set (MDS) assessments filed from April 1st through Sept. 30, 2019. It also reflects updated facility-specific minimum wage funding on line 13. As with the July rates, no additional CMI back-up is provided other than a count of assessments used in the CMI calculation by Resource Utilization Group (RUG)-III category. We recommend that members review these assessment counts, compare them with their own data, and request additional information or correction from DOH, if discrepancies are noted, by emailing nfrates@health.ny.gov.

For homes that requested a correction to their original 2020 capital calculation, the capital rate sheet is accompanied by a form that indicates that the requested correction was either approved, denied, adjusted by DOH, or requires additional information. Any additional information required should be submitted by Nov. 15th.

Members will recall that changes to the CMI calculation implemented with July 2019 Medicaid rates are under legal challenge. The outcome of that litigation may have an impact on these rates as well.

The Dear Administrator Letter (DAL) announcing the posting is available here. Please share your rate sheet with us by emailing it to dkirstein@leadingageny.org or kallison@leadingageny.org.

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