DOH Provides Additional Insights on Budget Provisions
During the April nursing home Medicaid reimbursement meeting with LeadingAge NY and other associations, Department of Health (DOH) Division of Long Term Care staff answered questions on provisions in the recently enacted state budget impacting nursing homes and provided updates on other key funding issues. The transition of permanent nursing home residents from managed care to fee-for-service (FFS) received the greatest amount of discussion. Highlights of that discussion and other updates are presented below. The full summary of 2018-19 State Budget provisions of interest to long-term/post-acute care providers prepared by LeadingAge NY is available here.
Permanent Nursing Home Residents
The enacted budget limits Single Capitated Managed Long Term Care (MLTC) Plan enrollment to three months for permanent nursing home residents. This change does not impact Programs of All-Inclusive Care for the Elderly (PACE), Fully Integrated Duals Advantage (FIDA), Medicaid Advantage Plus (MAP), or Mainstream Medicaid Managed Care. DOH envisions implementing the transition in a three-prong approach:
- Beginning May 3rd, dually eligible Medicaid beneficiaries who are not enrolled in MLTC and who are “permanently placed” will not be required to enroll into MLTC and will be covered by FFS Medicaid from the start;
- Medicaid beneficiaries who are enrolled in MLTC and permanently entering a nursing home will remain enrolled in MLTC for the first three months, then disenroll and revert to FFS;
- Those enrolled in MLTC who were permanently placed prior to April 1, 2018 will revert to FFS beginning in July 2018, pending approval of the technical amendment to the 1115 Medicaid Waiver that the State has submitted to the Centers for Medicare and Medicaid Services (CMS). DOH expects such transfers to begin in July, but to possibly be staged over the course of several months.
The change would not alter the MLTC nursing home benefit for temporary nursing home stays or the need for providers and plans to assist residents desiring to return to the community to do so. The three months would begin after any Medicare coverage has ended.
DOH anticipates that transfers from managed care to FFS will be effective on the first of the month and has issued a “Dear Health Plan Administrator” letter to health plans outlining this and other state budget provisions. Current nursing home residents will receive notification of this change from DOH, while plan members living in the community will receive notice of this benefit change from their plan (DOH will provide model notice). Permanently placed members who are disenrolled from a plan will be presumed to have six months of coverage for community-based services to streamline the process for those returning to the community and reenrolling into MLTC.
DOH intends to reconvene a similar group of plan and provider representatives that helped guide the transition to managed care to discuss operational issues related to this new change.
Penalties on Homes with Low NHQI Scores
The enacted budget includes a provision that reduces Medicaid revenue by 2 percent for homes that scored in the lowest quintile in the most recent Nursing Home Quality Initiative (NHQI) year if they also scored in one of the lowest two quintiles in the previous year. The provision specifies that DOH will not apply the penalty to homes in financial distress. DOH has used negative unrestricted fund balances as a proxy for financial stress in their internal modeling and is discussing the definition of financial distress to include in the Medicaid State Plan Amendment. The State intends to submit the plan amendment to CMS by mid-May and expects that it will be approved for the penalties to become effective April 1, 2018.
CMI
DOH intends to convene a workgroup to address Case Mix Index (CMI) concerns and develop a strategy that would result in a $15 million all-funds savings. The provision was prompted by concerns about increasing Office of the Medicaid Inspector General (OMIG) MDS audit findings, continuing growth in CMI, and seasonal CMI fluctuation that correlates with picture dates. Any change to the rates associated with this provision is likely to be reflected in July 2018 Medicaid rates.
Consistent with these concerns, DOH will not provide advance notice of the next CMI picture date and is likely to tighten up the roster submission process going forward. The recently ended January roster upload period was successful, and the final 16 homes that had not submitted by the April 6th deadline were notified. DOH staff reports that all issues of unmatched records have been addressed. Should you have any outstanding submission issues, please let us know.
Advanced Training Initiative
The Advanced Training Initiative (ATI) funding has been approved by the Division of the Budget (DOB) but has not been assigned a Medicaid rate payment cycle. This year, the funding will be distributed through MLTC plans, and contracts between plans and homes must be finalized before the money can be released. We expect each home to be assigned an individual MLTC plan that will distribute the full ATI amount designated for the home within 30 days of receiving it from the State.
Cost Report
DOH expects to release the 2017 RHCF Medicaid Cost Report software in early May. The due date is expected to be in July but will be formally announced with the release of the software.
NHQI and Rate Supplement
LeadingAge NY has been working with DOH on the most efficient methodology for making NHQI rate adjustments to ensure that homes waiting for several years for promised positive adjustments receive funding as soon as possible without the process causing financial hardship for homes that are facing negative NHQI adjustments. DOH intends to make five years of retroactive NHQI adjustments.
At the same time, DOH is seeking to finalize the methodology for reinvesting part of the money collected through the .08 assessment into nursing home services as a funding supplement. Originally anticipated to be distributed as an increase to statewide prices, the State is looking to make lump sum retroactive payments that in this fiscal year would total $140 million and be distributed based on Medicaid revenue. The current intention is to release the funding supplement in the same Medicaid payment cycle as the negative retroactive NHQI adjustments to mitigate the impact on homes with negative adjustments. The NHQI State Plan Amendments have CMS approval, while final approval for the funding supplement is still outstanding. We will keep members apprised of the discussion and anticipated timing of the adjustments.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841