DOH Posts July 2021 Nursing Home Rate Sheets
The Department of Health (DOH) posted July 1, 2021 Medicaid rate sheets on the Healthcare Financial Data Gateway section of the Health Commerce System (HCS) on Oct. 13th. Payment adjustments retroactive to July 1st will be reflected in Medicaid payment cycles 2304 (checks dated Oct. 18th, released Nov. 3rd) and 2305 (checks dated Oct. 25th, released Nov. 10th). The payment adjustment in cycle 2304 is expected to update payments related to Medicaid residents who are Medicare Part B eligible (i.e., rate codes 3812 and 3839), while the adjustment in cycle 2305 should cover Medicaid residents who are not Medicare Part B eligible (i.e., rate codes 3810 and 3838).
The only updates being made by the July rates are to the Case Mix Index (CMI) and special population add-ons. As such, they do not impact specialty facilities, whose rates currently are not adjusted for CMI. Despite continuing advocacy that the change in methodology be delayed until after the pandemic, this marks the first rate cycle where DOH calculates CMI by averaging the Resource Utilization Group (RUG) weights of all Medicaid assessments filed during the six-month catchment period (in this case, Oct. 1, 2020 through March 31, 2021) rather than relying on a single, most proximate assessment to an established “picture date” for each resident. The note sent by DOH on Oct. 13th is copied below, and the Dear Administrator Letter (DAL) issued by DOH on Oct. 5th is available here.
We invite members to contact us with questions and concerns regarding the new rates.
Contact: Ken Allison, kallison@leadingageny.org, 518-867-8820
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From: doh.sm.BLTCR.NF.RATES <nfrates@health.ny.gov>
Sent: Wednesday, October 13, 2021 11:37 AM
Subject: 7-1-2021 Nursing Home Rates Posted to Healthcare Gateway
Good Afternoon,
Please be advised that the July 1, 2021 Medicaid reimbursement rates have been posted to the Healthcare Financial Data Gateway and can be found at the following location:
Publications → Nursing Homes → NH Rate Sheets → 2021 Nursing Home 7-1-2021 Rates
A previous email for this rate update mentioned that the payment for these rates will be made in cycle 2304 with check release date of 11/3/2021. Please be advised that a correction was needed for certain facilities and that correction will be effective in cycle 2305 with a check release date of 11/10/2021. Please be advised that rate sheets for the litigants affected by the residual equity lawsuit will be posted at a later date.