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July 2019 Nursing Home Rates Updated

The Department of Health (DOH) has posted revised July 2019 nursing home Medicaid rates to the Health Commerce System (HCS) and has announced the schedule for returning homes to the two-week Medicaid payment lag. The associated Dear Administrator Letter (DAL) is available here. Please note that you must access the rate sheets by first entering the Healthcare Financial Data Gateway section of the HCS.

Along with updating the case mix index (CMI) using data based on a Jan. 30, 2019 picture date, these rates also reflect an updated 2 percent poor quality penalty for those homes subject to the penalty. It is assessed on those who scored in the lowest quintile in the 2018 Nursing Home Quality Initiative (NHQI) and also scored in one of the lowest two quintiles in 2017.

Payment adjustments reflecting the July 2019 rates will be included in Medicaid payment cycle 2217, with a check date of Feb. 17th (to be released Feb. 26th). Members will recall that to expedite the reversal of the previously retracted July 2019 rates, non-specialty nursing homes were removed from the two-week Medicaid payment lag. Because this resulted in homes receiving four weekly Medicaid payments over the course of two weeks, returning to the lag requires providers to endure two weeks when no payments are made.

To return Medicaid payments to the two-week lag, nursing homes will receive no Medicaid fee-for-service payments during the week of Feb. 19th and the week of March 11th.

We recommend that members review their July rate sheets to verify that the CMI incorporated in the rate is accurate and let us know if discrepancies are noted.

DOH has also posted the July 2019 benchmark rate list on the reimbursement section of its website and issued a letter notifying managed care plans that updated benchmark rates are available (letter here).

Also available now are the back-up calculations for payment adjustments related to the 2018 NHQI and the 0.8 percent assessment reinvestment (“supplemental 1 percent”) reflected in Medicaid payment cycle 2214 (check date of Jan. 27th). The DAL outlining the calculations, as well as detailed back-up data, can be accessed here by selecting “Nursing Home Quality Pool (NHQP) and 1% Supplemental Payment.”

Payment adjustments related to the 2018 NHQI are positive for homes that scored in the top three quintiles and negative for those in the bottom two quintiles. Negative NHQI adjustments were offset against the 1 percent supplemental payment due to the home.

Note that the allocations include some corrections to last year’s supplemental payment distributions. We recommend that members review the calculations and the data on which they are based and let us know if they encounter discrepancies. Please note that the NHQI funding is subject to the cash receipts assessment. The 1 percent supplemental payment is NOT assessable. Neither payment is subject to the recently imposed 1 percent across-the-board cut.

Finally, payment adjustments related to the reconciliation of 2018 assessment payments and reimbursements are included in Medicaid payment cycle 2215 (check date of Feb. 3rd). The DAL and correction request form are available here, and the back-up calculations are here. We suggest that members review the calculations closely and submit correction requests as needed to DOH using the form provided with the DAL.

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