DOH Posts January 2021 Nursing Home Benchmark Rates, Loads July Rates to eMedNY
The Department of Health (DOH) has posted January 2021 nursing home Medicaid benchmark rates on its website here. The list reflects a Case Mix Index (CMI) update based on July 2020 picture date Minimum Data Set (MDS) assessments, captures recent corrections issued by DOH, but may not reflect all of the changes related to for-profit nursing home residual capital litigation. The benchmark list also provides updated cash receipt assessment (CRA) reimbursement amounts: figures on the benchmark rate list are based on reconciled 2020 assessment payments, while fee-for-service (FFS) Medicaid assessment reimbursement is based on 2019 reconciled payments. Note that FFS CRA payment and reimbursement is always eventually reconciled, while managed care CRA is not. The benchmark rates also include an update to the facilities that are subject to the 2 percent quality penalty based on the most recent Nursing Home Quality Initiative (NHQI) results, while that update is still pending and will be done as a retroactive adjustment on the FFS side.
Along with the benchmark list, DOH has posted a backup file associated with line 13 (“Misc.”) of the Jan. 1, 2021 Medicaid rates showing the per-Medicaid-day amounts associated with the 5 percent capital cut, the 1.5 percent investment (in place since November 2018), the 2021 minimum wage adjustment (if any), and the 2 percent quality penalty (if any). The backup file is available here under the “Current Rates” section, “MISC Per Diem Backup” selection. Members have been able to access their individual January 2021 rate sheets on the Health Commerce System (HCS) since August.
In addition to these postings, members may begin observing rate updates retroactive to July 1, 2021 in their Medicaid remit information. This represents July 2021 rates, which the Division of the Budget (DOB) approved and which were just forwarded to eMedNY. Rate sheets are not yet available but are anticipated in mid-to-late October. Payment adjustments retroactive to July 1st are scheduled to be in Medicaid payment cycle 2304 (checks dated Oct. 18th, released on Nov. 3rd). The only updates being made by the July rates are to CMI and special population add-ons. As such, they do not impact specialty facilities, whose rates currently are not adjusted for CMI. This will mark the first rate cycle where the CMI is calculated using all Medicaid assessments filed during the six-month catchment period (in this case, Oct. 1, 2020 through March 31, 2021) rather than the one most proximate assessment to the picture date for each resident. The Dear Administrator Letter (DAL) issued by DOH on Oct. 5th is available here.
Contact: Ken Allison, kallison@leadingageny.org , 518-867-8820