LeadingAge NY Opposes Medicaid Case-Mix Regulations

LeadingAge NY has filed extensive written comments on the Department of Health’s (DOH) proposed regulations seeking to change the methodology for calculating Medicaid case-mix index (CMI) adjustments to nursing home rates. The Jan. 29, 2020 issue of the New York State Register memorialized DOH’s proposal to revise the CMI determination for the July 1, 2019 rates by using all Minimum Data Set (MDS) assessments of Medicaid residents for the period Aug. 8, 2018 – March 31, 2019, rather than the longstanding approach of a snapshot of the Medicaid residents on a given date.

Our comments make the following points:

• The proposed methodology for determining CMI adjustments is at odds with the New York State legislation creating the CMI Workgroup.
• DOH failed to properly notify the public that this regulation was under consideration.
• The proposed regulations would retroactively change CMI calculations for at least two rate periods.
• Removal of the 5 percent constraint would add to rate volatility and is contrary to state law.
• The July 1, 2019 rates would be based on less timely resident assessment data.
• The new methodology is not transparent and could result in inaccurate payment.
• The proposed change could negatively impact beneficiary access to quality care.
• The proposed regulation would likely increase costs to regulated entities.

The proposed regulation specifies that adjustments to the direct component of Medicaid rates for the July 1, 2019 rates would be based on Medicaid CMI data from Aug. 8, 2018 through March 31, 2019. For rate periods on and after Jan. 1, 2020, CMI adjustments would be made in January and July of each calendar year and be based on all MDS data for Medicaid residents from the prior six-month period. Under this methodology, facilities would no longer be required to submit census rosters, and the 5 percent cap on period-to-period changes in CMI would be repealed. The published notice indicates that DOH expects the gross Medicaid impact to nursing homes to be a $246 million reduction in payments.

On Nov. 7, 2019, Acting State Supreme Court Justice Kimberly O’Connor issued a preliminary injunction preventing DOH from implementing the CMI change envisioned by these proposed regulations. We are awaiting a decision in the underlying case. The Centers for Medicare and Medicaid Services (CMS) has not yet granted its approval of this change either, with action still pending on State Plan Amendment (SPA) 19–33 “Nursing Home Case Mix Adjustments.” LeadingAge NY will continue to keep members updated.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866