More Nursing Home Medicaid Rate Updates Coming

The Department of Health (DOH) posted another set of nursing home Medicaid rate sheets on the Health Commerce System (HCS) on March 4, 2014. This is in addition to those posted last week. The message DOH sent to notify providers of the posting is copied below. The latest update includes:

Rate sheets dated 7/1/13 updated to reflect a January 2013 Case Mix Index (CMI);
Rate sheets dated 1/1/14 updated to reflect a January 2013 CMI; and
A Dear Administrator Letter (DAL) detailing how the CMI constraint is applied for homes whose CMI increases by more than five percent in a six month period.

Last week's posting included:

Operating and capital rate sheets dated 1/1/13 updated to reflect a July 2012 CMI;
Operating and capital rate sheets dated 4/1/13 updated to reflect a July 2012 CMI (the only difference between the 1/1/13 and 4/1/13 rates should be the bed reservation related cut reported on line 14);
Operating and capital rate sheets dated 1/1/14 updated to reflect a July 2012 CMI and to include any material capital corrections that DOH was made aware of since issuing the draft preliminary rates in November;
Adult Day Health Care (ADHC) rate sheets dated 1/1/14 updating the capital component of the rates; and,
Two Dear Administrator Letters (DALs)-- one accompanying the 2013 rates, the other associated with 2014 rates.

Payment schedules associated with these rate sheets have been sent to e-MedNY. The resulting rate adjustments should be reflected in Medicaid rate cycles 1905, 1906 and 1907. The check date for cycle 1907 is 3/10/14 with a release date of 3/26/14. The rate that providers are currently being paid was updated to reflect the 1/1/14 rate.

Please note that homes whose CMI changed by more than five percent in a six month period have their CMI capped at five percent change pending MDS audit.

Quality pool payments for 2013 are not included in this rate update because the state has not yet received federal approval. The 1/1/14 rates will eventually be updated to reflect a July 2013 CMI. DOH intends to make that update in May.

The LeadingAge NY Rate Template available here can be used to model the impact of future CMI updates. Please let us know if you encounter difficulty accessing your rates or notice errors on your rate sheets.

Additionally, 65 homes awaiting Hurricane Sandy reconciliation payments should see those adjustments in Medicaid rate cycle 1907 as well. The only homes pending final hurricane payment reconciliation after these payments are made should be homes that DOH has contacted regarding unique circumstances.

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

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TO ALL NURSING HOME ADMINISTRATORS:

This is to inform you that the Medicaid rates for your facility effective July 1, 2013 (case mix), and January 1, 2014 (case mix) and supporting documentation along with the associated Dear Administrator letters are now available on the Health Commerce System (HCS). To access, please follow these instructions:

Go to Website - https://commerce.health.state.ny.us

Security Screen - enter your “HCS” id and password

Health Commerce System Welcome Page - select "NH Rate Sheets 4/2009-Forward" under the heading "My Applications"

Nursing Home Rates - 4/1/2009 and Forward screen - select "NH July 2013 Case Mix Update for Jan", "NH January 2014 Case Mix Update for Jan" from the drop-down list under "Nursing Home Rates Selection List"

Identify your facility in the drop-down list under "Nursing Home Selection List" and then select "SHOW REPORTS"