July 2014 Rate Sheet Posted

Most nursing homes whose case mix change was constrained to five percent in their July 1, 2014 Medicaid rate were subject to an erroneus rate adjustment.  DOH has recalculated the dollar amount adjustment related to the constraint and reissued corrected July 1, 2014 rate sheets that are now available on the Health Commerce System (HCS).  The adjustment-- positive for some homes, negative for others-- is reflected in Medicaid payment cycle 1983.  Also included in that payment cycle is the retroactive update to the Jan. 1, 2015 rates to reflect a July 2014 case mix, capped at a five percent change from the previous six months. The Jan. 1, 2015 rate sheets are available on the HCS as well. 

Both the corrected case mix constraint on July 1, 2014 rates and the constraint on the Jan. 1, 2015 rates will be lifted after the Office of Medicaid Inspector General (OMIG) completes audits of selected home MDS submissions for those time periods.        

Homes had payment adjustments related to their 2013 cash receipts assessment reconciliation reflected in Medicaid rate payment cycle 1981 which was released on Aug. 26.

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