Nursing Home Medicaid Rates Posted

The Department of Health (DOH) has posted 2014 nursing home rates, by component, on its website.  There has been some confusion about the location.  You can access them here.  Please note that there are separate links for geriatric ("January 2014 Rates") and specialty rates ("Specialty Rates Worksheet"). 

Members should be aware that managed care organizations are reviewing these data as they make contracting decisions. The geriatric rates file details individual 2014 Medicaid rate components including capital, cash receipts assessment reimbursement, 2013 quality pool add-on, as well as the amount included in the home’s non-comparable component for each ancillary service. 

The figure shown in the column titled “NHQP (Quality) Adjustment - Not Yet Approved” represents the adjustment amount that will be incorporated in the 2013 Medicaid rate once CMS approval is received.  This is a net amount, meaning that the contribution a home is making to fund the pool is combined with any distribution the home will receive.  Homes in the top three quintiles should see a positive amount in this column while homes in the fourth and fifth quintiles, as well as those homes disqualified from the pool due to survey or fraud/abuse provisions, will see a negative amount. 

The column titled “Case Mix Percent Adjustment” represents the rate adjustment to constrain a home’s case mix to five percent growth pending audit.

Please let me know if you have questions.  Should you note errors in the listing, please notify DOH at nfrates@health.state.ny.us and copy us on your email.

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