2013 Rates Updated for Audit Results

Nursing homes whose July 2012 picture date MDS assessments were audited and for whom the audit resulted in a Medicaid rate change should be able to access updated Medicaid rate sheets dated Jan. 1, 2013 and April 1, 2013 on the Health Commerce System (HCS). Homes whose case mix growth was still capped at 5 percent for this period should have seen the cap removed in the updated rate sheets. Associated Medicaid payment adjustments were reflected in a mid-December rate cycle, and the related Dear Administrator Letter is available here.

Some members report that the negative amount on line 14 (bed-hold related cut) of their updated April 1, 2013 rate sheet increased. This amount should NOT change from the amount shown on the previously-issued April 1, 2013 rate sheet. DOH believes that this issue only impacts a small number of hospital-based homes and is processing a correction. We recommend that homes with updated rates review them carefully and let us know if you note any problems.

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