Nursing Home Medicaid Payment Updates

Most homes awaiting Hurricane Sandy related payment reconciliations should see these in February.  DOH is processing approximately $11 million in the next round of payments for 69 homes.  This should complete the payments for all but the homes with which DOH is working individually to address unique circumstances.  At the same time, 19 homes that transferred patients but were instructed to continue billing will face significant recoupments.  

DOH reports that nursing home Medicaid rate updates are on schedule to be forwarded to e-MedNY next week, with payments reaching providers approximately six weeks later.  As part of this update, homes will be receiving rate sheets dated 1/1/13 and 4/1/13, reflecting a case mix based on July 2012 MDS census rosters.  Each facility’s Case Mix Index (CMI) change (up and down) will be constrained to five percent based on a comparison of January 2012 to July 2012 “picture date” CMI pending OMIG audit.   

DOH intends to post draft initial 1/1/14 rates computed using January 2013 MDS census roster based CMI and reflecting capital corrections of which DOH was notified.  DOH hopes to process these rates for payment in mid-February, meaning providers would receive payments in March. 

Reconciliation of the 2011 cash receipts assessment is likely to occur in March with payment adjustments expected in April.  The timing of adjustments to 2012 Medicaid rates to collect and pay out $50 million in quality pool payments remains unknown pending CMS approval of the relevant state plan amendment.

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