DOH Posts January NH Rates
The Department of Health (DOH) has posted Jan. 1, 2019 rate sheets for nursing homes on the Financial Data Gateway of the Health Commerce System (HCS). The associated Dear Administrator Letter (DAL) is available here. Payment for nursing homes was scheduled for Medicaid cycle 2184 (with a check date of July 1st and a release date of July 17th), although an issue described below may alter this timing. Please note that payment for adult day health care (ADHC) programs is scheduled for rate cycle 2185 (check date July 8th, release date July 24th). At this time, 2019 ADHC rate sheets are not available on the HCS.
The case mix index (CMI) used in the January 2019 rates is based on Minimum Data Set (MDS) assessments tied to the July 25, 2018 picture date. However, it appears that the case mix constraint that is applied to limit case mix changes relative to the prior rate period to 5 percent (and appears as a dollar amount adjustment to the rate on line 15 of the rate sheet cover page) was not updated. Instead, even though the CMI is updated, the same July 2018 rate constraint amount seems to be reflected on the January 2019 rate sheets. We urge members to closely review their rate sheets and to be aware of this discrepancy if it affects them. There were 174 homes whose July 2018 rates were subject to the CMI constraint. Please note that the constraint can be either a positive or negative adjustment. We ask that members who identify potential issues with their rate let us know.
The January 2019 rate includes the 1.5 percent increase funded by the Health Care Transformation Fund (at the same amount as in the recently issued November 2018 rate) as well as 2019 minimum wage funding. These amounts are combined on line 13 of the rate sheet. Line 13 also reflects the amount of last year’s 2 percent quality penalty for those homes that were subject to the penalty in 2018 (and which will be updated shortly to 2019, with rate adjustments made for impacted homes retroactive to Jan. 1, 2019). Members seeking an individual listing of the 1.5 percent increase, minimum wage, and quality penalty amounts reflected on line 13 can view the breakout on the Jan. 1, 2019 benchmark list (available for download here).
This rate posting comes on the heels of a recent notification that Nov. 1, 2018 rates were posted to the HCS and will be reflected in Medicaid payment cycle 2183 (check date June 24th, release date July 10th). The DAL associated with the November rates is available here.
Please let us know if you have questions or need assistance estimating an accurate January 2019 rate. We will let members know as soon as DOH indicates the approach that will be used to correct the CMI constraint issue.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841