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Nursing Home Reimbursement Update

In a meeting with LeadingAge NY and other associations on nursing home financial issues, staff from the Department of Health (DOH) indicated that development of the State Plan Amendment (SPA) requesting federal approval of the recently enacted Medicaid rate increase is underway. While the State Budget language was not clear on whether the increase would be at 6.5 or 7.5 percent, the Department confirmed that the SPA submission will reflect a 7.5 percent increase to the operating component of the nursing home Medicaid rate. In separate communications, we have urged the State to expedite paying the increase, including payment of the State share if possible, and asked DOH to ensure that the increase to Adult Day Health Care (ADHC) rates is at 7.5 percent as well. While decisions to release the State share of the increase involve decisionmakers at the highest level of the Department, the Bureau staff promised to move forward quickly if able to do so.

The process for reviewing and certifying Minimum Data Set (MDS) data that will be the basis of the acuity adjustment in July 2023 rates is underway. A brief technical glitch did not allow individuals to access the system until a day after the announcement. All should be working now, and DOH has extended the review deadline by one day to June 8th, with certifications now due June 15th. More complete information on the process is available here.

DOH anticipates that Residential Health Care Facility (RHCF) Medicaid cost report software for 2022 will be posted on the Health Commerce System (HCS) for download within a week. The report will be due 60 days from the announcement. No substantive changes other than the addition of a section for young adult specialty units are anticipated. There is no further information on when the overdue Intergovernmental Transfer (IGT) payments for county nursing homes will be available, although DOH indicates that they anticipate the process moving forward smoothly from here. The delay in the prior year’s payments should have no bearing on the current year’s Upper Payment Limit (UPL) calculation process or payments.

Almost all hospital-based homes that file the RHCF-2 Medicaid cost report and that were asked to complete a survey to help DOH evaluate their eligibility for safe staffing money successfully submitted the requested information. DOH is evaluating the submissions. We will let impacted members know when we have an indication of the payment date. These funds were paid to eligible RHCF-4 filers at the end of March. Note that the distributions are for State share (i.e., 50 percent) of the full $187 million allocation, pending federal approval of the initiative. Because safe staffing funding issues, including determinations of compliance with 70/40 minimum spending requirements, are outside the purview of the Bureau of Long Term Care Reimbursement, questions should be addressed to the established safe staffing email address (NHSafeStaffing@health.ny.gov).

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