Nursing Home Medicaid Rates

In a meeting with LeadingAge NY and other associations, DOH provided their intended schedule for updating Medicaid rates for case mix changes. Most nursing homes are currently still receiving Medicaid rates reflecting case mix adjustments based on a January 2012 "picture date." 

DOH intends to send the first set of rate updates to e-MedNY in December.  This will update rate sheets dated 1/1/13 and 4/1/13 by incorporating the case mix based on the July 2012 picture date.  Homes whose Case Mix Index (CMI) increased by five percent or more from January to July 2012, will have their CMI increase constrained to five percent pending OMIG review. 

In mid-January, DOH hopes to issue 1/1/14 rates reflecting material corrections to capital of which they would have been made aware early enough.

By the end of February, DOH hopes to send 7/1/13 and 1/1/14 rates to e-MedNY that incorporate case mix adjustments from the January 2013 picture date.  Homes with case mix growth exceeding five percent between July 2012 and January 2013 will have their CMI growth capped at five percent pending OMIG review. 

We remind members to review the recently posted rate sheets, especially the capital schedules, and to notify DOH as soon as possible, of any material errors.  Any home whose recently submitted July 2013 census roster did not have 100 percent record match with the MDS database should ensure that any needed MDS submissions be made as soon as possible.  DOH has been in contact with all homes in this situation. 

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