Nursing Home Medicaid Funding Update
LeadingAge NY and other associations met with the Department of Health (DOH) last week to discuss nursing home Medicaid rate updates and other funding-related issues. Highlights from that meeting are summarized below.
MDS Audits & Roster Submission: Beginning with the January 2015 “picture date” MDS assessments, the Office of the Medicaid Inspector General (OMIG) will no longer be responsible for MDS audits. The state will be issuing a Request for Proposals (RFP) for an entity to perform MDS audits as well as several other functions such as hospital and managed care cost report audits. DOH intends to use this opportunity to clarify audit protocols and is interested in feedback from providers regarding past audit inconsistencies and problem areas. We have discussed these issues with DOH previously and will provide feedback, but ask that members who have encountered MDS audit issues or ambiguities bring these to our attention. The 2014 MDS audits are in the process of being finalized.
We remind members that March 13th begins the three-week period during which nursing homes are required to upload their January 2017 census rosters, which will be used for case mix calculations.
Medicaid Lag: All Medicaid providers receive their Medicaid payment two weeks after the check issuance date, a statutory requirement referred to as the “Medicaid lag." Providers under financial stress have had the opportunity to request to be “removed from the lag,” and DOH reports that over the years, a number of nursing homes have made this request. DOH is making it a priority to reinstate the lag for these homes and recently sent a communication to affected providers asking whether there was a compelling reason why that should not be done. DOH is evaluating the responses they received and will make case-by-case determinations.
DOH intends to put those homes that did not respond to the communication back on the lag, meaning providers would not receive Medicaid checks for two payment cycles. If Medicaid payments to your home are not subject to the two-week lag and you have not responded to the DOH request for information, you should do so as soon as possible.
Advanced Training Initiative (ATI) Survey: DOH is finalizing a survey for homes that have received ATI funding. The survey is designed to collect basic information to be used to advocate for continuation of the funding and will ask respondents to indicate the training program(s) that homes have implemented/are implementing and the number of staff trained. We ask members to complete the survey without delay when they receive it, which will most likely be in late March or April.
Capital and Rate Setting Process: DOH is working to finalize the capital components for those homes whose capital attestations they were not able to review by the rate issuance date, and staff anticipate having those completed in April or May. A webinar reviewing capital issues and the attestation process is being developed, but no date has been set. The state is hoping to move most of the pieces of the rate setting process to earlier in the year to ensure that rates are finalized by Jan. 1st. While the cost report due date has not been finalized, DOH is not likely to set that date any earlier than July 1st.
Other issues: DOH reported no new developments on the litigation that has stalled quality pool rate adjustments or on the 1 percent supplement to the rates, which is awaiting approval from the Centers for Medicare & Medicaid Services (CMS). Guidance on shared savings from mortgage re-financing is being finalized. There is no set date as to when the third Universal Settlement payment that is due prior to the end of the 2017-18 State Fiscal Year (i.e., March 31, 2018) will be made.
The 2017 benchmark rates have been posted here. The Department hopes to post 2015 cash receipts assessment reconciliation calculation sheets on the Health Commerce System (HCS) shortly. Please note that while the 2017 benchmark rate list includes the 2015 reconciled CRA amount, the assessment add-on used with 2017 fee-for-service rates will continue to be based on the 2014 reconciled amount.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841