Three Nursing Home Deadlines Approaching
Batch Disenrollment Process. Members will recall that nursing home residents are disenrolled from Partially Capitated Managed Long Term Care (MLTC) plans after being a long-stay nursing home resident for three months if they meet required criteria and are not actively working toward a return to the community. To be disenrolled and revert to fee-for-service Medicaid, the individual needs to be in a Partially Capitated MLTC plan, be eligible for institutional Medicaid, and the required forms need to be on file with the local department of social services (LDSS) or the NYC Human Resources Administration (HRA) (LDSS-3559, “Residential Health Care Facility Report of Medicaid Recipient Admission/Discharge/Readmission/Change in Status” or equivalent).
The Department of Health (DOH) is currently preparing the next batch of disenrollments scheduled for Feb. 1, 2024. In preparation, DOH is asking that nursing homes help identify those residents who should not be disenrolled because they are actively working to transition to the community. In a Nov. 15th email that included a Dear Administrator Letter (DAL) (available here) and other related materials, DOH requested that providers submit a listing of residents who should not be disenrolled using a specified template (available for download here). The Department requests that homes upload their lists securely through the Health Commerce System (HCS) by Dec. 1st.
Capital Attestations. Nursing homes have until Dec. 6th to review their initial draft 2024 Medicaid capital reimbursement calculation. The draft rate sheets are posted on the Healthcare Financial Data Gateway section of the HCS. All homes need to submit an attestation indicating that they either agree with the DOH calculation or are requesting a correction. Correction requests need to be accompanied by a completed Capital Attestation Workbook and supporting documentation. The Attestation Form is here, and the associated DAL is here. More information and links to other resources helpful in the process are available here.
Quality Pool Score Sheets. DOH is asking nursing homes to review their draft 2022 Nursing Home Quality Initiative (NHQI) result sheets by Dec. 8th. This process allows nursing homes to review the individual measure scores before they are finalized and become the basis for Medicaid payment adjustments. The score sheets are posted on the HCS in the same place as Medicaid rate sheets, and the DAL which includes a guide for interpreting the results can be accessed here. Providers have until Dec. 8th to pose questions or request correction of any calculation error. We urge members to review their facility scores (which are based mostly on 2021 performance) to ensure that they are in line with their understanding of the facility’s performance. After the review process is complete, DOH will finalize the scores, assign overall quintiles, and make payment adjustments. Those in the top three quintiles will receive positive adjustments, while those in the bottom two quintiles will see negative adjustments.
While not yet due, we remind nursing home members that they have until Jan. 8, 2024 to review the list of outstanding rate appeals covering 2009-2021 rate years. Information and resources are here.
Finally, DOH has signaled that the process for nursing homes to review the MDS data that will be used to calculate the case mix index that will govern January 2024 rates is about to begin. We will circulate that DAL when available.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841