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Nursing Home Reimbursement Update

While finalizing a streamlined roster verification process for updating case mix, the Department of Health (DOH) is moving forward with new January 2020 capital rates. This was the featured news as LeadingAge NY and other associations discussed Medicaid funding issues with DOH last week. Highlights of the discussion are provided below. 

January 2020 Medicaid Rates. DOH is moving forward with issuing Jan. 1, 2020 rates with an updated capital component calculation and 2020 minimum wage funding. These “first wave” rates will continue the Case Mix Index (CMI) reflected in the July 2019 rates until such time as a Jan. 1, 2020 CMI can be established. Once the data needed for the CMI update is collected, DOH will re-issue Jan. 1st rates reflecting the new calculation. While no distribution date has been set, DOH is preparing a Dear Administrator Letter (DAL) that will instruct nursing homes on the roster verification process. We expect that the case mix used to adjust January rates will be based on a July 31, 2019 picture date. DOH rate setting staff have been working with programmers to streamline the roster submission/verification/correction process. The Department is hopeful that the new process will help reduce the time and effort required to address correction requests. We expect that instead of submitting a census roster to DOH, the first step for providers will be to review a list that DOH will compile and post on the Health Commerce System (HCS) showing the residents that DOH believes were in house on the picture date, along with the most proximate assessment. DOH intends to develop a webinar to outline the new process. As soon as we have insights on timing, we will let members know.

Medicaid Cost Report. While no due date for the 2019 Residential Health Care Facility (RHCF) Medicaid Cost Report has been announced, the software has not yet been made available on the HCS. DOH anticipates setting the due date based on when the software is posted, giving providers the typical timeframe to complete the report.

Financial Relief. While staff indicate that requests for pandemic-related financial relief are under discussion at the Executive level, no additional information is available at this time. Along with additional funding to assist providers significantly impacted by the pandemic, we have requested that DOH consider removing providers from the Medicaid lag and suspend assessment penalty and interest provisions as needed to sustain cash flow. While the 1 percent across-the-board cut to Medicaid payments that was effective Jan. 1st continues, further budget cuts that are to be retroactive to April 1, 2020 have not yet been scheduled for implementation.

Assessment. Final decisions on whether relief funding is subject to the cash receipts assessment are still pending at DOH. We continue to argue that provider relief funding should not be subject to assessment, not only since it should be viewed as excluded Medicare revenue, but also because providers will need to document that the funding was used as terms and conditions specified. 

Transition to Fee-for-Service. Those involved in operationalizing the Managed Long Term Care (MLTC) nursing home benefit limit, which will shift long-stay nursing home residents from MLTC to fee-for-service (FFS) Medicaid, indicate that the Department may share some information on the timing of the shift as soon as this week. The long-delayed shift was to occur on May 1st statewide, but was delayed due to the pandemic.

If you have questions or if your organization is encountering critical cash flow concerns, please contact us.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-461-5993