2012 NH Occupancy Rates
July 2012 Nursing Home Medicaid Rate Update
(posted Nov. 2, 2012)
The statewide Medicaid case mix index (CMI) rose by six percent from Jan. 2011 to Jan. 2012 causing DOH to delay issuance of 7/1/2012 Medicaid rates as it seeks to ensure that the increase is warranted. This memo provides an update on the release of the July 2012 rates and related issues.
Initial July 2012 rates & 2010 cash receipts assessment reconciliation. DOH has sent the initial July 2012 rates to the Division of the Budget for approval. These rates incorporate the Jan. 2012 Medicaid case mix index (CMI) with the percentage change in CMI capped at five percent. In other words, for homes whose Medicaid case mix changed by more than five percent from Jan. 2011 to Jan. 2012, DOH would use the home’s Jan. 2011 CMI increased (or decreased) by five percent when computing the initial July 2012 rate. We anticipate these rate adjustments, retroactive to July 1, 2012, to be reflected in Medicaid cycle 1840 with a check release date of December 12, 2012.
DOH has completed calculating the reconciliation of the 2010 cash receipts assessment which may be included in the same payment cycle or in one shortly thereafter. While the net impact of this 2010 cash receipt reconciliation is a $30 million positive payment to providers, some homes will see a negative reconciliation due to individual facility circumstances. In January 2013, DOH will update the cash receipts assessment reimbursement add-on amount to reflect the 2010 assessment reconciliation. DOH intends to reconcile 2011 and 2012 assessment payments in 2013 as well.
As is the standard practice, the state will intercept retroactive payments, related to both CMI and assessment reconciliation, to satisfy or offset outstanding Medicaid liabilities.
Final July 2012 rates. LeadingAge NY and other associations are working with DOH to establish a system for auditing MDS assessments to ensure accuracy and prevent rate update delays going forward. This includes our participation of researching, vetting and helping to select the audit firm that would perform MDS audits pursuant to audit protocols being developed by DOH and OMIG with provider input. As part of this discussion, we are strongly advocating that DOH set a firm date by which final July 2012 rates (i.e., rates that reflect the full case mix adjustment) would be issued, irrespective of whether audits of the Jan. 2012 MDS assessments are fully completed. We are also seeking confirmation from DOH that it is the state’s intent to fully reimburse facilities for changes in case mix that occurred between Jan. 2011 and Jan. 2012 which are upheld on audit and/or not selected for audit.
Assessment Rate. Members should remember that the cash receipts assessment rate decreases from 7.0 to 6.8 percent on November 1, 2012. The portion of the assessment exceeding six percent is not reimbursable and was enacted in lieu of a 2 percent across-the-board Medicaid cut. Although this provision is scheduled to sunset March 31, 2013, the state has made it clear that it will seek to extend it, therefore we recommend that members budget a 6.8 percent assessment (6 percent reimbursable and .8 percent non-reimbursable) for all of 2013.
Case mix MDS collection period. As we work to resolve retroactive CMI-related issues, members should also be looking forward. If 2013 is like the previous years, DOH will use January 30, 2013 (the last Wednesday in January) as a census roster date, meaning that the 92-day look-back period for this roster began October 31.
Appeals Deadline for 1/1/2012 Medicaid Rate. DOH has extended the deadline for rate appeals for the 1/1/12 Medicaid rates that were posted on July 11, 2012 by 30 days. The new deadline date is December 10, 2012.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841