Further Progress Made on Universal Settlement
Progress is being made on multiple fronts on the proposed universal settlement of nursing home rate appeals and litigation. Reportedly, the Centers for Medicare & Medicaid Services (CMS) is close to approving the arrangement; the draft settlement agreement is nearing completion; and the Department of Health (DOH) will be advising facilities of their determinations on excluded appeals and lawsuits.
The $850 million proposed settlement requires CMS approval since 50 percent of the funding will be provided by the federal government. DOH has been having regular discussions with CMS to address their questions and concerns about the proposed settlement. LeadingAge NY has provided assistance to DOH on what may be the final remaining open issue with CMS, namely, the so-called “upper payment limit” calculations which define how much the state can pay various groups of providers under its Medicaid program based on Medicare principles of reimbursement. DOH is actively working to resolve this issue with CMS, and we expect to receive a progress report this week.
DOH met with LeadingAge NY’s general counsel and a group of other legal counsels with Medicaid rate cases on July 1 to go over comments made by the counsels on the draft settlement agreement. When finalized, this agreement will serve as the release that all current and prior operators who are parties to the settlement will be expected to execute. The state is working with us to address remaining unresolved issues related to the settlement agreement including the payment schedule for this state fiscal year (i.e., 4/1/15-3/31/16); the proportion of facility operators that will need to sign the agreement for it to be considered a “universal” settlement; facilities’ rights to litigate on certain issues in the future; and law firms that may act as payment agents for the State.
As previously reported, DOH has completed a review of the facility-submitted lists of rate appeals and litigation to be excluded from the settlement as well as Medicaid audits that should be discontinued. According to the Department, the facilities will be receiving a Dear Administrator Letter via email within a week’s time that will inform them of the rate appeal/lawsuit exclusions and audit discontinuance determinations, and direct them to the Health Commerce System where they can access their facility-specific list of determinations. The Dear Administrator Letter will also provide instructions on how to contest any adverse DOH determinations.
LeadingAge NY remains very involved in universal settlement discussions, and will continue to keep members posted on any new developments.
Contact: Dan Heim, dheim@leadingageny.org, 518-867-8383, ext. 128