DOH Issues Announcement on CMI/Medicaid Lag Removal

On Dec. 5^th, the Department of Health (DOH) issued the below announcement to nursing homes in response to LeadingAge NY’s advocacy to ensure prompt action relative to the State Supreme Court’s preliminary injunction in LeadingAge New York, Inc. v. Zucker, et al., our case-mix index (CMI) litigation. It is our understanding that providers will have their November and December payments reconciled to reflect the January 2019 rates through an added Medicaid payment to be made tomorrow, Wed., Dec. 11^th.

The State Supreme Court’s Nov. 7^th preliminary injunction prohibited the State from implementing a change in how the CMI is calculated in July 2019 Medicaid rates until the Court is able to rule on the merits of the case. Since the Court’s order was issued after Medicaid rates had already been updated to reflect the State’s CMI change, providers had been receiving payments based on the new rates and, in many cases, were also experiencing Medicaid recoupment reductions attributable to CMI. On Nov. 19^th, DOH announced that they were suspending July 2019 rate-related recoupments, but facilities would not see the suspension take effect until Dec. 11^th due to the two-week Medicaid lag.

However, DOH planned to continue paying the July 2019 rates we challenged in the litigation until they were able to issue new, picture-date-based July 2019 rates, which could take several weeks. We and our attorneys strongly disagreed with this approach and asked the Court to direct the State to revert to January 2019 rates as soon as possible on an interim basis while it goes through the roster collection process to calculate revised July 2019 rates.

We are pleased to report that DOH has agreed to release an extra Medicaid payment on Dec. 11^th, which will reinstate the January 2019 rate for all periods retroactive to Nov. 6^th (when the disputed July 2019 rate was first paid) as well as for the payments normally scheduled to be released on Dec. 11^th and Dec. 18^th , and reverse all 15 percent recoupment amounts that have been taken in relation to the July 2019 rates. This additional Dec. 11^th payment would ordinarily have been released on Dec. 25^th. This effectively means that DOH is taking all nursing homes off the two-week lag by releasing two payments on Dec. 11^th and correspondingly moving up payment of cycles 2208 and 2209 by two weeks. We are further advised that the reinstated January 2019 rates have been loaded into the payment system by eMedNY and that the added payment is set to be released on Dec. 11^th, as is now planned.

As the message below indicates, DOH plans to reinstate the two-week lag when the revised, picture-date-based July 2019 rates are issued. This will mean that facilities will not be paid for a two-week period at the time these revised rates are ready for payment, which presumably will take place in the first quarter of 2020. In the meantime, members are encouraged to carefully review their remaining December Medicaid fee-for-service (FFS) payments to ensure that the January 2019 rates are properly reinstated and all July 2019 CMI-related rate recoupments are correctly restored.

We will keep members apprised of further developments.

Contacts: Dan Heim, dheim@leadingageny.org, 518-867-8866 and Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841 

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Dear Provider:

This note is to inform you that the Department has removed you from the Medicaid lag effective with cycle 2207 and plan to return you to the Medicaid lag when the July 1, 2019 rates are recalculated. The table below provides a schedule for the upcoming cycles: