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Nursing Home Reimbursement Update

In a meeting with LeadingAge NY and other associations, Department of Health (DOH) staff shared several updates regarding nursing home Medicaid funding. Although a final decision from the DOH legal team is still pending, the preliminary determination has been made that federal Provider Relief Funding as well as Paycheck Protection Program dollars are not subject to the cash receipts assessment (CRA). The Department also indicated that once the January 2020 rates are updated to reflect the appropriate case mix index (CMI) (i.e., based on Minimum Data Set (MDS) assessment data through July 2019), it would begin the roster verification process to gather MDS data to calculate CMI for both the July 2020 and January 2021 rates at the same time. Other updates gleaned from the discussions are summarized below.

January and April 2020 Rate Updates. The rates with case mix updates are in executive review. When released, DOH will make Medicaid payment adjustments retroactive to the effective dates. Along with the case mix updates, the rates are expected to reflect the 2020 minimum wage adjustment. When these rates are updated, DOH also intends to update the CRA per-day reimbursement amount for 2020 from the current figure based on reconciled 2018 CRA payments to 2019 reconciled figures.

2019 CRA Reconciliation. DOH expects to reconcile the 2019 CRA and make associated payment adjustments shortly.

Capital Attestations. Approximately half of the nursing homes statewide have filed their 2021 capital component attestations, which are due Nov. 13th. All homes are required to submit attestations (by email to nfrates@health.ny.gov with "2021 Capital Preview Attestation" in the subject line) whether they are requesting corrections or not. More information is available here.

Supplemental Payment and Nursing Home Quality Initiative (NHQI). The final results of the 2019 Quality Pool and associated rate adjustments as well as the supplemental payments representing the reinvestment of $140 million from collection of the .8 percent assessment are under executive review, but DOH reports that they are moving forward.

Advanced Training Initiative (ATI). The Department is close to issuing the annual survey for ATI-eligible homes to select the training program(s) that they intend to implement. The funding is available to free-standing nursing homes with staff retention rates above the statewide median. While no list of eligible homes is available yet, we are pleased that the funding will be distributed through Medicaid fee-for-service payments rather than as managed care pass-throughs.

Minimum Wage. Nursing homes in counties where the minimum wage is set to increase at the end of 2020 should watch for a minimum wage survey that DOH intends to distribute shortly. Consistent with prior years, the survey will collect hourly wage information by wage band and be used to determine 2021 minimum wage funding.

Please let us know if you have questions, and we will let you know as soon as we have more information on the timing of the provisions discussed above.

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