Further Delays on Quality Pool

LeadingAge New York has learned that Medicaid payment adjustments associated with the Nursing Home Quality Initiative (NHQI) will not be made for 2013 and 2014 until authorizing state regulations are adopted. 

The Centers for Medicare & Medicaid Services (CMS) had previously granted approvals to the State for the 2013 and 2014 NHQI payment adjustments.  The Department of Health (DOH) had completed the calculations and obtained Division of the Budget approval for the 2013 quality pool adjustments, and was in the process of finalizing the calculations for 2014. 

More recently, however, DOH’s Division of Legal Affairs has determined that the Department should promulgate regulations prior to implementing any rate adjustments for 2013 or 2014.  For this purpose, DOH is reportedly planning to publish emergency regulations in the State Register authorizing the NHQI within the next few weeks. New York’s emergency rule making process allows an agency to adopt a rule on a temporary basis for a maximum of 90 days. An emergency rule may be re-adopted, but each such re-adoption can only be effective for up to 60 days and the agency must initiate the process to formally adopt the rule on a permanent basis. Emergency rules can take effect on the date filed with the Department of State.

LeadingAge NY is advocating for payment of these and other pending rate adjustments, and will be meeting with DOH on July 15. We have also asked DOH to provide us with a copy of the completed run with 2014 facility-specific NHQI amounts to share with members. We will continue to keep members posted on further developments.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8383, ext. 128