Nursing Home Medicaid Reimbursement Update
While no payment dates have been set, key Department of Health (DOH) rate setting staff report that outstanding payments and rate adjustments continue to inch forward. Most notably, the final Universal Settlement payments have received approval from the Division of the Budget (DOB). DOH expects to complete final updates to outstanding liability offsets and forward them to the settlement trustees within a month. Payment adjustments reflecting the results of the 2018 Nursing Home Quality Initiative (NHQI) as well as assessment reinvestment supplemental payments (“1 percent”) remain under executive review.
Also in executive review are the results of the 2018 Cash Receipts Assessment reconciliation. Members will recall that DOH recently updated the assessment reimbursement amount currently paid through fee-for-service (FFS) Medicaid to the 2018 reconciled figure, but the actual reconciliation of 2018 payments remains outstanding.
The largest outstanding question remains when and how the State will update the Medicaid rate effective July 1, 2019. This is the rate that incorporates the case mix index (CMI) cut, which was the subject of last week’s injunction from the State Supreme Court. Because the July rates were already loaded into the payment system by the time the injunction was granted, providers saw the cut reflected in the payments released last week. It is likely that homes will be paid on those rates for several more payment cycles before they are updated.
The injunction and forthcoming litigation put the fate of the CMI calculation in the recently issued January 2020 notice rates in question as well. However, we recommend that members contact DOH at nfrates@health.ny.gov if they have questions or identify discrepancies in the assessments used in the CMI calculation. While the Department has incorporated most of the acceptable 2020 capital rate correction requests that they received, any provider that was asked to submit additional documentation associated with a correction request should do so no later than Nov. 15th.
Advanced Training Initiative (ATI) recipients should have received their full payments from the Managed Long Term Care (MLTC) plan(s) with which they were paired. We ask that you let us know if the payment amount you received varies from the amount listed on the distribution list posted on the Health Commerce System (HCS). DOH continues to work on answers to Frequently Asked Questions on bed hold as well as updating the 2 percent penalty on homes with low NHQI scores.
Finally, we remind members about the Medicaid spending concerns expressed by DOB and the Governor’s Office. While their magnitude and form are uncertain, the State has signaled that some type of Medicaid funding reductions will likely be needed in this state fiscal year.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841