DOH Provides Nursing Home Rate Update, Presents Capital Webinar

Nursing home providers should see Medicaid payment adjustments reflecting a July 2017 rate update in mid-August. The Department of Health (DOH) shared this and other nursing home reimbursement news in a meeting with LeadingAge NY and other associations last week. Discussion highlights are provided below.

Cost Reports. RHCF Medicaid cost reports along with required electronic certifications are due July 31^st. No extensions will be available. Organizations should have all the Health Commerce System (HCS) permissions in place for those individuals who must certify the report.

Minimum Wage Survey. DOH is preparing to release the next minimum wage survey that will require nursing homes to report worker hours by wage band in a similar way as was required last year. The reported data will be used to establish minimum wage rate add-ons as well as to reconcile the add-ons that are currently in the Medicaid rate. Nursing homes should expect to receive the survey in July.

Medicaid Rate Updates. The Division of the Budget (DOB) has approved several rate packages that are being processed for payment and are expected in Medicaid rate cycle # 2084, with a check release date in mid-August. This includes July 1, 2017 rates that incorporate a January 2017 MDS assessment-based case mix index, 2017 capital rates for those homes whose attestations DOH was unable to review in time to process updates earlier in the year, and January 2017 rate case mix updates for a small number of homes whose updates had been delayed.

MDS Audits and OMIG. While DOH still intends to contract with an outside entity to perform MDS assessment audits, delays in the process for soliciting candidates mean that the Office of the Medicaid Inspector General (OMIG) will be the entity that performs 2015 MDS audits. DOH has sent 2015 data to OMIG, whose auditors will be contacting providers selected for review shortly.

Other Payment Issues. There is no further news regarding when the 1 percent rate supplement or the third payment of the Universal Settlement will be paid, although DOH has updated the Medicaid Rate Inventory indicating late fall target dates for both. Nursing Home Quality Initiative rate adjustments remain on hold pending resolution of litigation. The Centers for Medicare and Medicaid Services (CMS) has approved the 2016 upper payment limit on which Intergovernmental Transfer (IGT) payments for public nursing homes are based, and the state is awaiting the official letter. DOH is preparing the payment package for review and approval.

Capital Reimbursement Webinar. DOH staff presented a capital reimbursement webinar on July 13^th during which they reviewed the capital rate schedule as well as the statutes and regulations that govern capital rate calculations. The state is intent on issuing January 2018 Medicaid rates as close to Jan. 1^st as possible and hopes to provide draft 2018 capital calculations for provider review on Sept. 1^st.

As in previous years, providers will have the opportunity to submit corrected calculations along with an attestation verifying their accuracy. A primary goal of the webinar was to help ensure that providers are familiar with capital rate setting regulations to help maximize the percentage of acceptable attestations. With shortened timelines and limited staff availability, DOH will not be able to process all of the requests if they include a high proportion of requests that are not appropriate for the attestation process. DOH will be posting the webinar on the HCS shortly and is collecting questions to address in a forthcoming Frequently Asked Questions (FAQ) document. Questions should be submitted to DOH via nfrates@health.ny.gov by July 31^st.

The materials from the webinar can be accessed below:

Finally, Steven Simmons, Director of the Bureau of Residential Health Care Reimbursement, has announced that he will be retiring toward the end of July. Steve guided the Bureau through the transition from fee-for-service into managed care at a time of dwindling staff and resources, and we will miss his thoughtful and helpful leadership. No replacement has been named at this time.

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