powered by LeadingAge New York

DOH Suspending July Rate Recoupments

Nursing home members will recall that in response to litigation filed by LeadingAge NY and a coalition of health care associations, the State Supreme Court on Nov. 7th granted a temporary injunction prohibiting the State from implementing a retroactive change in how the Case Mix Index (CMI) is calculated in Medicaid rates until the Court is able to rule on the merits of the case. Since the order was issued after the rates had been updated to reflect the change, providers have been receiving payments based on the new rates and, in many cases, are also subject to an additional recoupment amount as the Department of Health (DOH) works to make the appropriate payment system changes to comply with the injunction.

This has been a topic of discussion between the State and attorneys representing the associations, and we anticipate further information on the steps DOH is taking to comply with the injunction this week. Earlier today, DOH announced that they are suspending July 2019 rate-related recoupments (text of DOH message copied below), although due to the Medicaid payment lag, the suspension may not be reflected until homes receive checks dated Nov. 25th (with a release date of Dec. 11th). DOH also notified managed care plans that the July 2019 nursing home benchmark rates have been removed until further notice. We will be sharing additional details with members in the coming days. In the meantime, we urge any member that may be experiencing a cash flow crisis to contact us immediately.

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


DOH Notice

November 19, 2019

Dear Provider:

This note is to inform you that recoupment has been suspended for provider adjustments associated with the recently released July 1, 2019 rates. Managed Care plans have also been notified that the recently released July 1, 2019 benchmark rates have been removed from the Department of Health website until further notice. Consistent with past practice, the Department will be releasing a Dear Administrator Letter providing notice to nursing homes regarding the timeline for calculation of new July 1, 2019 rates using the prior calculation.