Medicaid FFS Paying Updated Nursing Home Rates

In late July, the Department of Health (DOH) and eMedNY updated the nursing home Medicaid rate that is currently being paid to reflect the July 1, 2017 rate. The update incorporates the Case Mix Index (CMI) based on the January picture date. Rate sheets have not yet been posted, but DOH is working to do so as quickly as possible. The current best estimate is the end of this week. The retroactive adjustment back to July 1, 2017 is reflected in Medicaid payment cycle 2084 checks that are being released this week.

While the July rate update impacts all homes, there are two other rate updates included in cycle 2084 that will impact only certain homes.

The first is a capital update for those homes whose capital attestations were not reviewed in time to be included with the issuance of 2017 rates. For these homes, cycle 2084 will include the retroactive adjustment to update their capital back to Jan. 1, 2017.

The second is a case mix update to the Jan 1, 2017 rate for a small number of homes whose case mix had not been updated. For these homes, the retroactive adjustment reconciling rates for the first half of 2017 to reflect the CMI based on the July 2016 picture date will be in cycle 2084 as well.

We have asked DOH to post the updated benchmark rate list as quickly as possible and will notify members as soon as we hear that rate sheets are available.

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