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DOH Posts Nursing Home Draft Rates

The Department of Health (DOH) has posted draft preliminary January 2019 nursing home and adult day health care Medicaid rates on the Health Commerce System (HCS). Please note that DOH now posts rate sheets on the new Healthcare Financial Data Gateway application within HCS.

For nursing homes, the rates include an update to the capital component (line 17), updated minimum wage funding on line 13 (additional 2019 amount added to the amount shown on 2018 rate sheets), and a 1.5 percent increase in the operating component (also included on line 13). The case mix index has not yet been updated in the draft rates and thus remains the same as used in the July 2018 rates.

The notification sent by DOH is copied below, and the Dear Administrator Letter (DAL) that accompanies the rates is available here. Along with the rates, the Department also posted a spreadsheet listing the individual amounts that are reflected on line 13 (minimum wage, 1.5 percent increase, 2 percent quality pool penalty for those homes subject to the penalty).

As detailed here and subject to federal approval, the 1.5 percent increase will be made to Medicaid rates effective Nov. 1, 2018 and will remain in the rates similar to a trend factor adjustment until at least March 31, 2022. Upon federal approval, DOH intends to issue Nov. 1, 2018 rates that will incorporate the increase for November and December of 2018.

We recommend that members review the capital component of the rates to verify that it accurately reflects any corrections submitted to DOH and check that the minimum wage funding increase roughly corresponds to the necessary additional funding reported on the home’s most recent minimum wage survey. DOH requests that questions be submitted by email to nfrates@health.ny.gov. Please indicate “2019 NF Rate Inquiry” in the subject line.

DOH has completed Nursing Home Quality Initiative (NHQI) and assessment reinvestment payment calculations and continues working toward issuing the resulting rate adjustments. A Medicaid payment cycle should be announced later this month.

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


January 1, 2019 RHCF and ADHC Notice Rates

Dear Administrator:

Attached, please find a Dear Administrator Letter that provides you with information about your draft preliminary residential health care facility (RHCF) and medical adult day health care (ADHC) Medicaid reimbursement rates for the period commencing January 1, 2019.

Please note the notice rates are provided on the Health Commerce System (HCS) new application (Healthcare Financial Data Gateway). The operating and capital rates are considered draft and the Department may make changes based upon review of additional information. These rates are posted on the Gateway directly under the posting of this DAL under Facility Reports. The preliminary calculations are not subject to appeal at this time. Appeal submissions will be accepted following the final published January 1, 2019 rates.

If you have questions regarding the rates please send an email with “2019 NF Rate Inquiry” in the subject line to nfrates@health.ny.gov and Jada Eberle or Cindy Treis will respond to your inquiry.