Nursing Home Reimbursement Update
During the monthly meeting between associations and the Department of Health (DOH) on nursing home Medicaid reimbursement issues, the Department unveiled the cost report filing deadline and discussed the timing of the upcoming change that will shift many nursing home residents from Managed Long Term Care (MLTC) to fee-for-service (FFS) Medicaid. The information was followed by the release of several Dear Administrator Letters (DALs) that DOH distributed last week. Brief highlights of the meeting are provided below.
After a two-year wait for federal approval and additional delays due to the pandemic, DOH is set to implement the next phase of the provision that limits members of partially capitated MLTC plans who are in a long-term nursing home stay to three months of MLTC enrollment. On Aug. 1st, DOH will batch disenroll nursing home residents who meet this criteria from their plan and transfer them to FFS Medicaid. DOH issued an updated DAL that outlines the process and requested that nursing home providers identify and inform DOH of any residents who are enrolled in partially capitated MLTC but are actively working toward return to the community to ensure that they remain enrolled in their plan. DOH requested that this list be submitted by June 16th, and we urge any members who have not yet responded to do so at their first opportunity. To help DOH ascertain that all homes responded to the request, we recommend that members respond to DOH even if they have no MLTC members who are residents working toward a discharge. The DAL is available here.
DOH is using a two-step process to issue January 2020 rates. The first January 2020 rates that will be paid will provide a capital update but no case mix update, since the process to establish the case mix index (CMI) that will be used in January 2020 rates is just beginning. On June 12th, DOH issued the DAL laying out the schedule for collecting and verifying the Minimum Data Set (MDS) data that will be used when calculating the CMI for January 2020 rates. The new process that DOH has developed will be outlined during a June 17th webinar that will also be available for viewing on demand. Information on the CMI update process is provided here.
Finally, DOH announced that the 2019 Residential Health Care Facility (RHCF) Cost Report software is now available for download on the Health Commerce System (HCS) and that the report will be due on Sept. 15th. Other than the addition of a place to enter an email address, DOH made no changes to the report.
DOH did not have updates on several key issues, so we continue to wait for a final determination from the State regarding the assessability of certain pandemic-related funding, even as we make the case that most, if not all, should not be subject to the cash receipts assessment.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841