DOH Posts Nursing Home Rate Sheets

Last week the Deparment of Health (DOH) posted updated nursing home Medicaid rate sheets on the Health Commerce System (HCS). Homes have been receiving Medicaid payments based on an updated Jan. 1, 2016 rate, but due to technical staff availability issues, the rate sheets had not been posted.

Most homes should be able to access their July 1, 2015 rate sheet reflecting a Case Mix Index (CMI) based on Jan. 2015 census rosters and Jan. 1, 2016 rate sheets reflecting a CMI based on July 2015 census. Please note that DOH continues to work on roster submission issues for approximately 100 homes for each of the rate cycles. Those homes whose CMI is not final will not have an updated rate sheet posted for the rate period governed by the CMI that is still being finalized.

DOH also posted rate sheets (labelled "Audit Unwind") reversing MDS audit related adjustments for any home that had an audit of 2012-2013 MDS assessments. This includes the temporary re-imposition of the 5 percent CMI constraint for these rate periods until such time as OMIG issues final audit reports.

DOH sent the table copied below as an index of rate sheets that have been posted. We have asked for confirmation of which Medicaid payment cycle will contain which adjustment and we will share that when it is clear. We are also seeking clarification of when the cash receipts assessment reimbursement amount paid in 2016 will be updated from 2010 to 2014.

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

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Dear Administrator-

This is to inform you of the posting of rates which have recently been sent to the eMedNY payment system. The following rates are available on the Health Commerce System (listed in order of appearance on the Health Commerce System):

Listing Name	Description	Effective Dates	NOTES
2015 July Case Mix Update	Updates the July 2015 rates to include the MDS Census Collection from January 2015.	07/01/2015 – 12/31/2015	A number of facilities had data issues during the January 2015 data collection and these facilities are not updated herein. These facilities have had their data examined and corrected and will have a rate update processed shortly. Facilities which have not certified the census data are likewise not processed. These facility will be processed upon receipt of the certification.
2016 January Case Mix Update	Updates the January 2016 rates to include the MDS Census Collection from July 2015.	01/01/2016 – 06/30/2016	Data from the July 2015 Census collection has been updated and new data will be posted to the HCS for facilities which have not been processed. Facilities which have not certified the census data are likewise not processed. These facility will be processed upon receipt of the certification.
July 2012 OMIG Audit Unwind	Reverses the inclusion of OMIG audit result before the audits themselves were final	07/01/2012 – 12/31/2012	Facilities not impacted by an OMIG audit are not included in this rate set. Each facility audited by OMIG will see results after the audits are declared final by OMIG.
2013 January OMIG Audit Unwind	Reverses the inclusion of OMIG audit result before the audits themselves were final	01/01/2013 – 06/30/2013	Facilities not impacted by an OMIG audit are not included in this rate set. Each facility audited by OMIG will see results after the audits are declared final by OMIG.
2013 July OMIG Audits Unwind	Reverses the inclusion of OMIG audit result before the audits themselves were final	07/01/2013 – 12/31/2013	Facilities not impacted by an OMIG audit are not included in this rate set. Each facility audited by OMIG will see results after the audits are declared final by OMIG.
2014 January OMIG Audits Unwind	Reverses the inclusion of OMIG audit result before the audits themselves were final	07/01/2014 – 12/31/2014	Facilities not impacted by an OMIG audit are not included in this rate set. Each facility audited by OMIG will see results after the audits are declared final by OMIG.