Medicaid Funding Issues
Of 76 audits OMIG has done of January 2012 MDS assessments, only 21 (28 percent) have resulted in rate reductions. For these 21 homes, the average daily reduction was $2.71 yielding the state a projected savings of $3.3 Million. DOH shared this information and provided updates on the spectrum of other nursing home Medicaid funding issues when we met with them last week. Brief highlights are provided below.
Case Mix Audits. DOH now has the data and financial impact figures that they need to make the decision whether to pay the January 2012 case mix (i.e., July 2012 Medicaid rates) in full and will make the determination by Mon., June 17. A number of homes in Western NY and the Capital Region whose CMI increased by more than five percent from Jan. 2011 to Jan. 2012, received letters announcing an impending audit of their Jan. 2012 assessments, but have heard nothing since. This is because OMIG is in the process of reviewing whether some of the 250 facilities that they have selected for audit of July 2012 assessments may also be slated for an audit of their Jan. 2012 assessments with the hope of auditing two assessment periods in one visit. The state has also been exploring ways of supplementing OMIG staff for these audits by contracting with IPRO or a temp service.
Hurricane Sandy Payments. DOH has been working with the data reported on Hurricane Sandy surveys to match transferred residents so as to make payments. They are encountering difficulties matching some residents, but expect to provide lists to associations for review in early July. They continue discussions on how to handle ancillary issues such as NAMI, Medicare Part B and capital cost reporting. The next workgroup meeting is scheduled for early July.
Vital Access Provider (VAP). Negotiations with CMS for state plan approval of the VAP program are progressing well. DOH staff is meeting with strategic planning firms to gauge whether they could offer expertise to DOH, and possibly to providers, in this process. DOH has completed reviews of the VAP applicants with the greatest financial distress. The majority of VAP applicants are hospitals. While some of the money originally appropriated for the first year of the program may have been diverted, DOH expects to pay out $29 million this year and hopes to make more significant sums available in the second year and going forward. They envision creating an ongoing VAP application process that would allow providers to apply when and as needed.
Universal Settlement. DOH has recalculated benefit estimates of the universal settlement. The draft language of the settlement has been circulating internally and DOH and the Division of the Budget has been in discussions. According to DOH, homes would see the benefit of the additional $100 million added to the rates by the universal settlement via benchmark rates that DOH would issue. These benchmark rates would be the basis of developing the managed care premiums that the state would pay plans, resulting in an expectation that plans would have sufficient funding to pay homes at or near the benchmarks. Based on separate workgroup discussions on transitioning current nursing home residents into managed care, plans may be required to pay existing fee-for-service Medicaid rates for a two year period, after which the benchmark process would become relevant.
A/R Recovery Initiative. Providers with outstanding Medicaid liabilities will be receiving a letter from DOH outlining the state’s proposal to allow homes that pay off liabilities by a certain date to avoid some or all interest payments. Details of the revised proposal were not shared, but DOH promised to provide a copy of the letter for our review when ready. DOH will seek to coordinate rate updates and other payment due to providers with this initiative.
Other Issues. Work on forming a workgroup to address nursing home capital issues in a managed care world is continuing, as are discussions on the potential state takeover of NAMI collections.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841