DOH Readies Several Nursing Home Payment Updates
The waning calendar year brings with it several annual payment adjustments as well as deadlines. The Department of Health (DOH) has scheduled three nursing home payment adjustments, including the release of supplemental funding that provides lump sum payments of approximately 2 percent of annual Medicaid revenue to nursing homes. Those payments will be in Medicaid payment cycle 2362, with a release date of Dec. 14th. Rate adjustments to reflect updated case mix retroactive to July 1, 2022 as well as 2022-23 Advanced Training Initiative (ATI) funding for prequalified facilities are also expected in the same Medicaid payment cycle. These issues, along with some important reminders, are outlined below.
2 Percent Supplemental Payment
With all past “catch-up” years now covered, the annual supplemental lump sum payment (“2 percent supplemental”) providers should expect this year and each year going forward should approximate 2 percent of annual Medicaid revenue, a total distribution of $140 million statewide. (Due to a retro year included in last year’s payment, the total distributed in 2021 was $210 million.) The 2 percent supplemental includes the 1 percent ($70 million) that has been in the mix for five years as well as an additional 1 percent ($70 million) that was previously used to fund the Universal Settlement. The entire $140 million is generated by the un-reimbursable 0.8 percent portion of the cash receipts assessment: New York collects about $70 million from facilities, then reinvests it with a federal match into nursing homes to get to the $140 million figure. The $140 million being distributed in cycle 2362 is for State Fiscal Year (SFY) 2022-23 and is allocated based on Medicaid revenue, including specialty unit revenue. While DOH has not posted the backup calculations or issued a formal notice, many members have noticed this funding when checking on their Medicaid cycle 2362 payment.
We are grateful that the Department moved forward with the supplemental payments while the Nursing Home Quality Initiative (NHQI) payment adjustments, which are usually made at the same time, had been delayed pending federal approval. That approval has now been received, so members should expect to see their 2021 NHQI preview score sheets fairly soon.
July 2022 Rate Update
DOH has posted July 2022 rates with updated case mix index (CMI) adjustments on the Health Commerce System (HCS). The CMI in the new rates is based on Minimum Data Set (MDS) assessments with reference dates from Oct. 1, 2021 through March 31, 2022. Formal notification of the posting is expected early this week, and payment adjustments will be reflected in Medicaid payment cycle 2362, with a release date of Dec. 14th. This update does not impact specialty units. A copy of the Dear Administrator Letter (DAL) is available here.
2023 Capital Rate Review Attestations
We remind members that attestations indicating agreement with, or requesting corrections to, the DOH 2023 capital rate calculations are due Nov. 30th. More information with links to the attestation form and other resources is available here. Please be sure to submit the attestation even if you are not requesting any corrections.
MDS Assessments for January 2023 CMI
DOH distributed a notification late on Nov. 25th indicating that the review process of the MDS assessments that will be used for calculating the CMI for January 2023 rates will begin on Nov. 30th. Providers will have until Dec. 14th to complete the MDS data review process. Certifications must be submitted by email seven days after the review is finalized, but no later than Dec. 21st. This process does not impact specialty facilities. The notice is available here. The certification document is here.
Transition from MLTC to FFS
DOH is preparing for another batch disenrollment of long-stay nursing home residents who are enrolled in Managed Long Term Care (MLTC). As in previous cycles, the Department is asking nursing home providers to submit information regarding any long-stay resident enrolled in a partially capitated MLTC plan who is working toward returning to the community to ensure that they are not disenrolled. More information with links to the materials and data collection form is available here.
ATI
Nursing homes that were prequalified by DOH as eligible for 2022-23 ATI funding and completed the survey selecting the training program(s) that they will implement should receive the funding in Medicaid payment cycle 2362, with a check release date of Dec. 14th. DOH circulated the notice on Nov. 28th. The payment should total roughly $3.96 for each 2021 Medicaid Fee-for-Service (FFS) and Medicaid Managed Care day. CINERGY funding is pending federal approval.
Financial Survey
Thanks to those who have completed the nursing home financial survey. For those yet to complete it, please do so at your earliest convenience. The information will be critical for our collective advocacy efforts as we head into the State’s budget-making season. The link to the survey is here, and the Excel sheet that can be used to compile the figures for online entry can be downloaded here.
(Please note that LeadingAge NY is partnering with the Greater New York Hospital Association (GNYHA) in this data collection effort. If your downstate organization participates with both LeadingAge NY and GNYHA, the request to complete the survey would have come from GNYHA. Submitting a survey to either organization is sufficient. Your responses will be available only to the association(s) of which you are a member.)
Health Care Worker Bonus (HWB) Program
A reminder that the extended window for submitting claims for claiming period 2 ends Nov. 30th. Please note that claiming for any employee types who may have been added to the eligibility list by the Nov. 17th HWB expansion (e.g., security guards) should NOT be submitted until a special expansion submission period is announced by DOH.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841