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Nursing Homes See Payment Adjustments

Nursing home providers should be seeing payment adjustments related to the reinvestment of the .8 percent assessment (commonly referred to as “the 1 percent supplement”) as well as the 2018 Nursing Home Quality Initiative (NHQI) (“Quality Pool”) this week. These adjustments should be reflected in Medicaid payment cycle 2214, which has a check date of Jan. 27th. The Department of Health (DOH) is working on providing the back-up information to allow providers to identify the amounts, and we will let members know as soon as DOH posts or shares the information.

The assessment reinvestment payments are distributed proportionally based on Medicaid revenue and include specialty units. The NHQI adjustments will be positive for homes whose 2018 NHQI results were in the top three quintiles and negative for those in the bottom two. Negative adjustments will be offset against the assessment reinvestment payment. Continuing care retirement communities (CCRCs) and specialty facilities are not part of the NHQI.

Once the back-up information is made available, we suggest that members validate both the adjustment amounts and the data used in the calculation and let us know if discrepancies are noted.

The following week’s payment  Medicaid payment cycle 2215, with a check date of Feb. 3rd should reflect an adjustment for the 2018 cash receipts assessment reconciliation. The adjustment will be positive or negative based on an individual organization’s circumstances.

Although regular Medicaid payments for dates of service on and after Jan. 1, 2020 should be impacted by the recently imposed 1 percent across-the-board cut, the reduction should not apply to the retroactive adjustments.

Finally, we remind nursing home providers that they should reserve sufficient resources to endure two weeks without fee-for-service (FFS) Medicaid payments between now and April 1, 2020. Members will recall that to expedite the reversal of the retracted July 2019 rates, non-specialty nursing homes were removed from the two-week Medicaid payment lag. Because this resulted in homes receiving four weekly Medicaid payments over the course of two weeks, returning to the lag will require providers to endure two weeks when no payments are made.

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