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LeadingAge NY, Other Groups Raising Major Concerns About Case-Mix Proposal

As noted in our recent Intelligence article, LeadingAge NY is very concerned about the Department of Health's (DOH) plans to implement a change to Medicaid case-mix determination effective for the July 1, 2019 rates. The final budget for State Fiscal Year (SFY) 2019-20 authorized a workgroup to discuss and make recommendations on the methodology used to calculate case-mix adjustments to nursing home rates and reflects an administrative savings of $123 million to the State ($246 million total impact, inclusive of federal funds) during SFY 2019-20 from such a change. LeadingAge NY has joined with other associations represented on the workgroup to communicate its concerns in writing and meet with top administration officials to advocate for a reasonable approach to this change.

During the first workgroup meeting on May 22nd, DOH signaled that the workgroup’s focus would be on making recommendations on the case-mix determination process for future rate periods and not for the July 1, 2019 rates. Although the law indicates that “The workgroup shall review recent case mix data and related analyses conducted by the department with respect to the department’s implementation of the July 1, 2019 change in methodology…,” DOH has not shared any data for the period Aug. 8, 2018 – March 31, 2019, which they seek to use for the July 2019 rates.

The joint association letter raises several questions and concerns discussed during the workgroup meeting, including the workgroup’s charge, the lack of detailed data and analyses relative to the July 2019 change, the operational realities of conducting Minimum Data Set (MDS) assessments and taking credit for services that could affect RUG-III scoring, how unrepresentative the MDSs for the Aug. 8th – March 31st period are for rate setting, and the unpredictable and potentially devastating impact that this cut will create for many facilities.

The workgroup is supposed to conclude its work by June 30, 2019. LeadingAge NY will keep its members posted on additional developments.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866