Nursing Home Medicaid Rates

Nursing homes are currently being paid 4/1/13 fee-for-service Medicaid rates that reflect a case mix adjustment based on January 2012 census rosters.  DOH intends to send 1/1/13 and 4/1/13 rates updated to reflect July 2012 roster CMI (constrained to a five percent change from the January 2012 roster CMI) for processing next week.  Rate adjustments based on this update should be reflected in Medicaid payments made about six weeks later.

Towards the end of January, DOH expects to send 1/1/14 rates updated to reflect July 2012 roster CMI (constrained to a five percent change from the January 2012 roster CMI) for processing.  These rates will incorporate corrections to initial 2014 capital.  Rate adjustments based on this update should be reflected in Medicaid payments made about six weeks later.

By mid-February, DOH hopes to send for processing 7/1/13 rates reflecting the January 2013 roster CMI (constrained to a five percent change from the July 2012 roster CMI). Rate adjustments based on this update should be reflected in Medicaid payments made about six weeks later.

OMIG continues to audit homes whose CMI increased by more than five percent since the previous cycle with the hope to have all of January and July 2012 MDS audits completed  by April 2014.  Current OMIG audit activity is centered in New York City and Long Island.  We ask members who are selected to let us know of their audit experiences.

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