powered by LeadingAge New York

Nursing Home Reimbursement Update

In a meeting with LeadingAge NY and other associations, Department of Health (DOH) staff provided updates on Medicaid rates and other nursing home funding issues. While providers should anticipate retroactive payment adjustments in the next several Medicaid payment cycles reflecting November 2018 and January 2019 rates, DOH could provide no further information regarding July 2019 rates, which will be based on a different case mix calculation methodology. These rates are under executive review, with no specified timeline for release.

DOH is holding internal discussions on the next round of Advanced Training Initiative (ATI) funding, which is expected to distribute two years worth of funding (2018-19 and 2019-20). The Department recently requested updated information on training programs from LeadingAge NY and other authorized ATI training providers, but eligibility details and payment timing are not known. Similarly, staff are developing calculations for the supplemental payments (assessment reinvestment) and Nursing Home Quality Initiative (NHQI) adjustments that will be made at a yet-to-be-determined time in the fall.

The Department clarified that the cash receipts assessment (CRA) reimbursement amounts shown on the Jan. 1, 2019 benchmark rate list (available here) are calculated by dividing assessment payments made in 2018 (trended by about 3 percent) by 2017 resident days. In prior years, the assessment reimbursement amount had been based on the reconciled amount from two years prior. DOH has changed the methodology in hopes of reducing funding swings when the eventual reconciliation is made. The amounts shown on the benchmark list will be used for fee-for-service (FFS) payments once Division of the Budget (DOB) approval is received.

The 2017 CRA reconciliation is awaiting executive approval.

The payment adjustment schedule reflecting November 2018 and January 2019 rates remains as previously outlined:

  • Medicaid Payment Cycle 2183 (check date June 24th, release date July 10th) will reflect the Nov. 1, 2018 rate retroactive to Nov. 1, 2018. This rate is the same as the July 1, 2018 rate but includes a 1.5 percent increase to the operating rate to reflect Health Care Transformation Fund funding.
  • Medicaid Payment Cycle 2184 (check date July 1st, release date July 17th) will reflect the Jan. 1, 2019 rate retroactive to Jan. 1, 2019. The rate will carry forward the July 2018 case mix index (CMI) constraint adjustment amount on line 15 for homes subject to the constraint.
  • Medicaid Payment Cycle 2185 (check date July 8th, release date July 24th) will reflect the REVISED Jan. 1, 2019 rates, updating the CMI constraint amount on line 15 from the July 2018 amount to January 2019. Adult Day Health Care (ADHC) rate adjustments will be included in this payment cycle.

We recommend that members verify that the retroactive adjustment amounts correspond with figures shown on their rate sheets and contact us if they do not.

DOH indicated that they intend to issue a frequently asked questions (FAQ) document on the recently adopted bed hold regulations that discontinue hospitalization bed hold payments for all residents other than those younger than age 21 or residents served by hospice. More information on this issue is available here. Although DOH was not able to share any information on July 2019 rates, the State has filed a State Plan Amendment (SPA) requesting federal approval to alter the case mix methodology effective July 1, 2019. More information on that issue is here.

We remind members that Medicaid cost reports as well as Executive Order (EO) #38 disclosures are due July 29th. Members should ensure that all needed Health Commerce System (HCS) and Financial Gateway permissions are in place for those individuals who will file and certify the report. We have received a few isolated comments from members encountering technical issues with the cost report that we have shared with DOH staff. The Department is not aware of any systemic problems but recommends that providers encountering an issue reach out to nfrates@health.ny.gov with “Cost Report Issue” in the subject line.

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