powered by LeadingAge New York

DOH to Revert to January NH Rates

The Department of Health (DOH) has notified nursing homes that the July 2019 Medicaid fee-for-service (FFS) rates currently being paid will be replaced by the prior January 2019 rates as an interim step while DOH goes through the process of calculating case mix for the July rates based on a Jan. 30th picture date. We will let members know the timing and rate cycles of the adjustment when they become known.

Members will recall that on Nov. 7th, in response to litigation filed by LeadingAge NY and a coalition of health care associations, the State Supreme Court granted a temporary injunction prohibiting the State from implementing a change in how the case mix index (CMI) is calculated in July 2019 Medicaid rates until the Court was 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, have also been subject to an additional recoupment amount.

Last week, DOH announced that they would be suspending July 2019 rate-related recoupments. Please note that due to the Medicaid payment lag, the suspension may not be reflected until homes receive checks dated Nov. 25th (which are scheduled for release on Dec. 11th). DOH also notified managed care plans that the July 2019 nursing home benchmark rates have been removed until further notice.

On Nov. 21st,  DOH notified homes that they will be reverting to the CMI picture date methodology to recalculate July 2019 rates. The Dear Administrator Letter (DAL) distributed by DOH lays out the timeline for the process, which mirrors prior roster submissions. Homes are required to upload their Jan. 30, 2019 resident census roster (all payers) between Dec. 5th and 26th. DOH will match residents listed on the roster with their most proximate Minimum Data Set (MDS) assessment and calculate the CMI using assessments for Medicaid, Medicaid pending, and Medicaid managed care residents (including Programs of All-Inclusive Care for the Elderly (PACE) and Medicaid Advantage Plus (MAP))). Certifications are due on Dec. 30th. The State will download the federal database on Dec. 3rd, so providers should make sure that any allowable MDS corrections that are needed to avoid defaults are submitted before Dec. 2nd.

We urge members to ensure that MDS Coordinators have a copy of the roster submission DAL, are taking the necessary steps to prepare for the upload (e.g., ensuring assessments are complete and that staff responsible for roster upload have Health Commerce System (HCS) access), and are aware that the State intends to use July 31, 2019 as the picture date for calculating the CMI that will be used in January 2020 rates.

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


DOH email notice, Nov. 26, 2019

Dear Provider:

This note is to inform you that the July 2019 Nursing Home rates that were announced in the October 9, 2019 letter will be reversed and the rates will revert back to the January 2019 rates. Refer to the November 21, 2019 letter regarding the timeline/process regarding updates to the July 2019 rates.