DOH to Issue Rate Update, Cost Report Software

DOH provided a number of updates on nursing home Medicaid issues in a meeting with LeadingAge NY and other associations last week.  DOH staff reviewed state budget items and indicated that the state is discussing the possibility of modifying the Fully Integrated Duals Advantage (FIDA) proposal to include nursing home populations.  This could potentially require current dually eligible nursing home residents in the eight-county FIDA region to enroll into managed long term care earlier than the previously discussed date of 2016.  The decision is expected to be made by May.

Language for a universal appeals and litigation settlement is being developed by the govenor's office.  DOH hopes to move the process along as quickly as possible but no timeline was shared.  The department has been having internal discussions on the possibility of making NAMI collection no longer a nursing home responsibility.  They are looking at several options and expect the issue to be on the agenda of any work group focused on transitioning nursing home residents to managed care.

The Office of the Medicaid Inspector General (OMIG) expects to have completed MDS audit work on the 76 homes slated for the initial round of audits this week.  DOH hopes to evaluate the results and make a determination on issuing final July 2012 rates reflecting actual Case Mix Index (CMI) figures for those homes initially capped at five percent growth.  The intention is to complete this by the end of April.  OMIG will continue to audit the remaining homes whose CMI increased by five percent or more. 

DOH is awaiting approval of a rate schedule that will reduce the across-the-board cut imposed on 1/1/2013 rates to about one fourth of the current amount.  That change is effective 4/1/2013.

Finally, members should receive notification as early as this week about the posting of the Medicaid cost report software.  The notification will spell out due dates and likely highlight changes to the software which include a new Schedule Q that will mimic the look of the current capital rate sheet and allow homes to enter what they believe their capital reimbursement calculation should be.  

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