Nursing Home Reimbursement Update
The Department of Health (DOH) has forwarded quality pool and 1 percent supplement payment adjustment schedules to eMedNY. Nursing home providers should receive notification along with a Dear Administrator Letter (DAL) providing the details of when the payments are expected and links to backup calculations. This and other information that DOH shared at the most recent monthly nursing home reimbursement meeting is outlined below.
1 Percent Supplement and NHQI. Medicaid payment cycles 2152 and 2153 will contain adjustments reflecting the 1 percent supplement (i.e., assessment reinvestment) and the results of the Nursing Home Quality Initiative (NHQI) (i.e., quality pool) covering 2013 through 2017. Cycle 2152 has a check date of Nov. 19th and a release date of Dec. 5th. Cycle 2153 has a check date of Nov. 26th and a release date of Dec. 12th. DOH sent a DAL on Nov. 20th explaining the funding and linking to backup documents showing how the amounts were calculated for each facility.
Census Roster Submissions. Due to a number of technical challenges, DOH staff needed to manually correct a large number of mismatched MDS assessments that providers brought to their attention. These were cases where the system selected an assessment other than the most proximate one to the picture date. That effort is continuing. We request that members who submitted correction requests more than two weeks ago but have not heard from DOH contact me (dkirstein@leadingageny.org). Additionally, associations were assisting DOH in reaching out to the 27 homes that had not successfully uploaded their rosters as of last week.
At this point, DOH is not able to provide any information on how the two picture dates will be used/blended to establish the case mix index that will be reflected in Jan. 1, 2019 rates. This will only be determined after case mix is calculated for all homes and the data is analyzed. We continue to stress that it is important for providers to have a basis for budgeting 2019 Medicaid revenue as soon as possible.
2019 Capital. DOH reports that 234 homes submitted attestations indicating that their 2019 capital calculation was correct, while 284 submitted correction requests that were accepted and are reflected in the draft preliminary 2019 Medicaid rate sheets. Only six correction requests were rejected outright. When draft preliminary rates were issued, Department staff was still working to finalize approximately 80 correction requests, so those homes may still see the uncorrected capital calculation in their draft preliminary rates. DOH expects to have the remaining correction requests processed and incorporated by the time final January 2019 rates are posted.
Minimum Wage Survey. The Department is finalizing a survey that will be used to reconcile 2017 minimum wage funding that is expected to be released later this month. It will be on the same platform (SurveyGizmo) as the most recent nursing home minimum wage survey and will resemble the format of prior surveys.
Other Issues. There are no new developments regarding the state budget provision that alters the Managed Long Term Care (MLTC) nursing home benefit. The State expects the Centers for Medicare and Medicaid Service (CMS) to act on their waiver amendment request sometime after the Nov. 23rd public comment deadline.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841