Nursing Home Capital Methodology Retained

The calculation of the capital component of nursing home Medicaid rates will remain mostly intact.  The RHCF-4 Medicaid cost report will be revised to allow providers to calculate capital reimbursement amounts for their home.  Additional edits and safeguards will be incorporated into the software, but homes will be responsible and accountable for the accuracy of their capital calculations.  The final reimbursable capital will be determined through audit, which will be done by the Office of the Medicaid Inspector General (OMIG) or its contractor.  We support this approach but stressed the need for training, clear instructions, availability of DOH guidance and a timely audit process, to minimize the need for recoveries years later.  DOH has pledged to conduct educational sessions and make staff available for facility questions.

In concert with the Transition of Nursing Home Benefit and Population to Managed Care policy document that requires managed care plans to pay nursing home fee-for-service rates, including capital and assessment reimbursement, for three years for permanently placed enrollees, this decision ensures some level of capital reimbursement stability for nursing homes for the transition period. 

The work group continues its work on a streamlined approach to capital refinancing as well as energy efficiency initiatives.

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