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DOH Processes CMI-Related Rate Adjustments

The Department of Health (DOH) has processed adjustments revising July 2014 and January 2015 nursing home Medicaid rates. The adjustments impact those homes whose Case Mix Index (CMI) growth was subject to a 5 percent constraint during one or both of these rate periods as well as homes with MDS audit findings related to these rate periods.

Positive adjustments for the July 2014 rate period equaled $14.8 million, while negative adjustments totaled $16.4 million. Positive adjustments to the January 2015 rates totaled $12.5 million, while the negative adjustment total was $13.8 million.

Please note that the adjustments only impact the six-month period governed by the respective rate (i.e., the January 2015 rate adjustment impacts dates of service between Jan. 1, 2015 and June 30, 2015). Homes that were not subject to a CMI constraint and who were not audited (or had no audit findings) will see no rate adjustments.

The adjustments should be reflected in Medicaid payment cycle # 2097, and revised rate sheets for affected homes should be posted on the Health Commerce System (HCS) by the end of the week.

In other case mix adjustment news, DOH has indicated that they are finalizing and will soon distribute the “Dear Administrator” Letter announcing the 2018 CMI “picture dates” and roster submission windows. The picture dates will remain the last Wednesday of January and the last Wednesday of July. With the next picture date scheduled for Jan. 31, 2018, assessments completed between Nov. 1, 2017 and Jan. 31, 2018 will be the basis of the CMI calculation. Providers should have systems in place to ensure that MDS assessments are completed accurately and submitted in a timely manner.

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