Latest on Nursing Home Funding
Roster submissions, capital attestations, and the 1 percent rate supplement were part of the discussion when LeadingAge NY and other associations met with the Department of Health (DOH) last week on nursing home Medicaid funding issues. Highlights of the dialogue are summarized below.
MDS Census Rosters. Nursing home members should upload their July 26, 2017 "picture date" census roster to the Health Commerce System (HCS) promptly to ensure sufficient time to address any problems that may arise. DOH reports that the uploads have been going smoothly so far. The submission will be the basis of the case mix calculation used in Jan. 1, 2018 Medicaid rates. DOH staff is focused on expediting the various pieces of the rate setting process to ensure that rates are updated as quickly as possible and has stressed that they intend to move forward with rate updates for those homes whose census submissions are complete by Sept. 29th. Homes that do not have complete and certified submissions by the Sept. 29th deadline risk having their rate updates delayed or receiving a default case mix index (CMI). Providers should no longer use ground mail but rather submit the associated certification by email to email@example.com. The submission DAL is available here.
Minimum Wage Survey. DOH is currently reviewing the minimum wage survey submissions that were due by Aug. 30th. Approximately 94 percent of nursing homes completed the survey, which will be the basis for 2018 Medicaid rate adjustments aimed at helping to cover the costs of increases in the minimum wage that providers face. DOH will use cost report data to estimate the minimum wage impact for providers that did not complete the survey. The adjustment amount is shown on line 13 of the Medicaid rate sheets. Unlike last year, contracted staff data was not collected on this year’s survey. We have been working with DOH staff to address this omission because contract workers represented a significant portion of minimum wage costs on last year’s survey. DOH reports that they are in discussions with the Division of the Budget (DOB) on the issue but have made no final decisions on if and how this will be addressed.
MDS Audits. Rate adjustments related to Office of the Medicaid Inspector General (OMIG) MDS audits (including the release of CMI constraints) for rates effective July 1, 2014 and Jan. 1, 2015 have been reviewed and will be scheduled for payment soon. We will let members know the cycle numbers for these rate adjustments as soon as we know them. Although DOH is interested in contracting with an outside entity to perform MDS audits going forward, OMIG will still be auditing 2015 MDS assessments and will attend the next monthly meeting between DOH and associations to discuss audit timelines.
Capital Attestations. With 2016 cost reports in, DOH is working to calculate initial 2018 capital and to provide draft capital rates to providers for review as quickly as possible. To help expedite the process, DOH asked nursing homes to verify and update their mortgage information in August.
As in previous years, homes will have the opportunity to submit a corrected capital calculation if they find errors or omissions in the draft rates they receive from DOH. Correction requests will need to be accompanied by an attestation certifying that the rate calculation being proposed is accurate. DOH staff will review the proposed correction and, if it conforms to DOH capital rate setting policies and regulations, will use it as the capital component subject to OMIG audit.
A Frequently Asked Questions document addressing capital rate setting issues is available here. Unlike past years, DOH intends to require that all homes respond to the draft capital rates by submitting an attestation either agreeing with the rate as is or requesting a correction. While the goal of the attestation process is to minimize capital rate appeals, it does not impede a provider’s right to file an appeal if it so chooses.
IGT. Approximately $198 million was available for 2016 Intergovernmental Transfer Payments (IGT) for public homes. The Centers for Medicare and Medicaid Services (CMS) has approved the 2017 Upper Payment Limit (UPL) calculation, paving the way for 2017 IGT payments, which are currently under review by DOB. Public homes will be able to claim the $167 million available for 2017 in two transfers: one in September 2017, and the second in March 2018. DOH officials hope that the approval of the 2017 UPL will facilitate CMS consideration of other outstanding State Plan Amendments.
One Percent Rate Enhancement. As DOH awaits CMS approval to supplement nursing home Medicaid rates by 1 percent retroactive to April 2014, the Department continues to express concern about making the payments without the resolution of litigation that could undermine the Medicaid global cap. Discussions on addressing the issue continue.
Universal Settlement. During their session at the LeadingAge NY Financial Professionals Conference, DOH officials reported that they are targeting this fall for making the third Universal Settlement payment. While intended timelines sometimes slip, it seems likely that the payment will be made in calendar year 2017. The Universal Settlement agreement requires the state to make the third payment by the end of the 2017-18 State Fiscal Year (i.e., March 31, 2018).
Other Issues. DOH promised to investigate whether providers could access the retroactive rate adjustment information provided by the no longer available Foxpro Remittance Reports in some alternative way. The state is interested in rekindling the energy efficiency discussion and remains interested in learning why there has been low interest. Providers interested in information on energy efficiency or having an energy audit performed are encouraged to let us know or reach out directly to DOH.
Contact: Darius Kirstein, firstname.lastname@example.org, 518-867-8841