DOH Updates Nursing Home Medicaid Rates

Nursing home members checking their Medicaid remittance file for payment cycle 1905 should see adjustments to rates retroactive to Jan. 1, 2013. This update reflects the incorporation of the July 2012 Case Mix Index (CMI) into 2013 and 2014 Medicaid rates. As of Feb. 25th, DOH had not posted rate sheets that would correspond to these updates, but we expect them to be available on the Health Commerce System (HCS) shortly.   

Nursing homes that experienced a CMI change greater than five percent from January 2012 to July 2012 have their CMI constrained to a five percent change pending audit. Please note that rates covering the period July 1, 2013 through Dec. 31, 2013 will eventually be updated again to incorporate the January 2013 CMI. Rates for Jan. 1, 2014 through June 30, 2014 will eventually be updated to incorporate the July 2013 CMI.   

The Medicaid rates that providers are currently receiving have also been updated to reflect a Jan. 1, 2014 rate calculated using a July 2012 CMI. 

The 2013 rate adjustments do not reflect the 2013 quality pool adjustment that is still awaiting CMS approval. Initial DOH numbers suggest that the negative rate adjustment to nursing homes that fall into the 4th and 5th quintiles will be about one percent of their 2013 Medicaid operating rate. Nursing homes in the top quintile should see a net positive adjustment totaling roughly 1.1 percent of their operating rate. Nursing homes in the second quintile should see a net positive adjustment of about 0.6 percent of their daily operating rate while the net adjustment for homes in the third quintile should be about 0.1 percent of the rate.            

While we hope that rate sheets are posted by mid-week, members encountering difficulty in untangling their retro amount are encouraged to contact us.   

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