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Nursing Home Reimbursement Update

In a meeting with LeadingAge NY and other associations, Department of Health (DOH) staff provided updates on several key Medicaid rate and funding issues. Please note that one key issue discussed can be found in a stand-alone article: nursing home capital reviews are due May 13th and are covered here.

2022 Medicaid Rates. The Department has completed calculating the Jan. 1, 2022 operating component of the rate, which has been forwarded for executive review. Due to delay in the processes that determine the capital component of the rate, DOH anticipates updating the January 2022 rate in two phases: the first being the operating component, the second being the capital component when finalized. Capital attestations must be filed by all homes, whether they are requesting a correction or not, and are due by Fri., May 13th. More information is available here.

Budget Initiatives. State Plan Amendment (SPA) requests for budget provisions are in process. The 1 percent Medicaid rate increase will be retroactive to April 1, 2022, and the 1.5 percent cut to Medicaid payments has been discontinued effective with Medicaid payment cycle 2330. The Bureau of Residential Health Care Reimbursement does not have any additional information on other budget provisions such as bonuses and minimum spending at this time.

2021 Cost Report. DOH anticipates posting the 2021 Residential Health Care Facility (RHCF) cost report software and issue the Dear Administrator Letter (DAL) with the due date this week. While the final due date is pending, indications suggest that it will likely be due in the second week of July. There are no major changes to the report schedules, but there is a change in the accountant certification.

CMI Constraint Release. With the elimination of the 5 percent constraint on case mix index changes relative to the previous six months starting with July 2021 rates, the Department is exploring the possibility of clearing the constraints for all of the rate periods from July 2017 through January 2021. DOH would make a single payment adjustment that would encompass the removal of the constraint for all eight rate periods in a single adjustment. We are in the process of reviewing potential impacts.

Please contact us if you have questions or concerns regarding the above.

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