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Nursing Home Reimbursement Update

Although payment dates are not yet known, and the payments will not be made in the immediate future, a number of nursing home rate adjustments are making their way through the approval process now that the state budget has been finalized. Department of Health (DOH) staff provided these and other Medicaid funding updates during a meeting with associations this week. Highlights of the discussion are provided below.

Jan. 1, 2019 Rates. The January 2019 rates have been calculated and forwarded for executive review. Members will recall that the January 2019 draft initial rates circulated in the fall of 2018 included a 1.5 percent adjustment to the operating component to help defray increasing workforce costs. Funding for the adjustment comes from the Health Care Transformation Fund established with managed care conversion dollars in the 2018-19 State Budget. During the 2019-20 budget process, the Executive had proposed to eliminate the funding, but it was fully restored in the final budget agreement. The rates sent for review incorporate a Case Mix Index (CMI) based on Minimum Data Set (MDS) data associated with the July 25, 2018 picture date.

Because the 1.5 percent adjustment is effective Nov. 1, 2018, providers can also expect to receive Nov. 1, 2018 rate sheets that mirror their July 2018 rate sheets but include a 1.5 percent increase to the operating component. Subject to federal approval, the increases will remain in the rates at a set dollar amount until at least March 31, 2022. Once federal and state approvals are received, the rates will be paid retroactive to their effective dates.

Also in executive review are updated July 2015 and January 2016 rates reflecting findings of the Office of the Medicaid Inspector General (OMIG) MDS audits as well as the removal of any CMI constraint affecting these rate periods.

Cash Receipts Assessment. DOH has calculated the 2017 cash receipts assessment reconciliation, which is under executive review. The assessment reimbursement add-on that will be paid in 2019 will be based not on the reconciled 2017 assessment, but on 2018 assessment payments. More information on this is forthcoming, but DOH hopes to reduce the magnitude of reconciliations by using more recent data on which to base the current year’s assessment reimbursement add-on.

Case Mix Workgroup. The enacted state budget requires DOH to form a case mix workgroup prior to making acuity adjustment methodology changes beginning in July 2019. The Department is reviewing nominees to the group now and will communicate additional details as early as next week. The group will be expected to form and perform their work prior to the June 30th date established by law. DOH has signaled that their intention is to employ a methodology that uses data from more assessments than are currently used and indicated that they would provide information on whether providers would be required to upload rosters. While the contours of the new methodology are not known, the State’s intention of using more assessments suggests that providers should make sure that all MDS assessments contain accurate and complete data for all items used in CMI calculation.

Cost Reports. Medicaid Cost Report software for 2018 is expected to be posted in May, with a likely due date in late July. DOH reports that there have been minimal changes made to the report. To avoid delays in accessing rate sheets and filing cost reports, especially if new staff is involved, DOH is requesting that providers ensure that they have the proper permissions to access the Health Commerce System (HCS) as well as specific sections that may require additional permissions. For example, to access rate sheets, providers need access not only to the HCS, but also specific permission to the Healthcare Finance Data Gateway within the HCS. In order to reduce the processing time of granting permissions, DOH is asking that all facilities check that their staff have the proper permissions to access the systems listed below and contact rhcf-hcs@health.ny.gov to obtain permissions where needed:

  • HCS – Health Commerce System
  • Healthcare Finance Data Gateway
  • Nursing Home (NH) Appeal System
  • NH Cost Report – both CPA and Operator certification permissions.

Nursing Home Quality Initiative (NHQI). DOH has now addressed issues with Statewide Planning and Research Cooperative System (SPARCs) data that has delayed the calculation of rates of potentially avoidable hospitalizations and, consequently, 2018 NHQI scores. Providers should be asked to review their results later this month. Rate adjustments reflecting the 2018 NHQI are likely to be made at the same time as the 1 percent supplemental payments are issued (as was done last year). Members are reminded that employee immunization reports are used in the NHQI and must be filed by May 1st. The Dear Administrator Letter (DAL) with information on filing the reports is available here.

Intergovernmental Transfer (IGT). Public homes were notified this week that the second half of 2018-19 IGT payments will be made in April. Counties will be required to make the transfer on April 12th, with payments expected to be available on April 19th. DOH is working with the Centers for Medicare and Medicaid Services (CMS) to finalize the calculation of next year’s Upper Payment Limit.

We hope that several of the payments referenced above will be made in May and will provide information as soon as it becomes available.

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