Unraveling Assessment Reimbursement Changes
Last week, the Department of Health (DOH) notified nursing homes that the assessment reimbursement amounts on the managed care benchmark rate list have been updated. The benchmark list shows the rates that Medicaid managed care plans pay, inclusive of assessment reimbursement, unless the home and plan have a mutually accepted alternative payment arrangement. The list now uses the 2018 reconciled assessment (i.e., reflecting actual 2018 assessment payments) as the per diem amount incorporated into the benchmark rate. Prior to this change, the assessment reimbursement amount used in the 2019 benchmark list had been based on DOH estimates using 2018 payments and had been labeled "2019 Cash Receipts (CRA) Per Diem." The column label now reads "2018 Cash Receipts (CRA) Per Diem."
Meanwhile, the assessment reimbursement amounts paid through the Medicaid fee-for-service (FFS) billing system were updated several weeks ago. Those amounts were updated to the assessment reimbursement per diem amounts that appeared on the original 2019 benchmark list (i.e., those based on DOH 2018 payment estimates and listed on the 2019 benchmark list until last week). The payment adjustments related to that update were included in Medicaid payment cycle 2197 (checks released Oct. 16th) or 2198 (checks released Oct. 23rd). More information with links to the associated Dear Administrator Letters (DALs) is available here. Note that the CRA reimbursement amounts used in FFS Medicaid are placeholders that are eventually reconciled to actual assessment payments.
While DOH is now using reconciled 2018 assessment payments as the basis of assessment reimbursement in the benchmark rate, 2018 FFS assessment payments have not yet been reconciled. The most recent FFS reconciliation was for 2017.
With the number of changes involved, we recommend that members validate assessment reimbursement amounts when possible and track the potential impact of future reconciliations.
LeadingAge NY Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841