Nursing Home Rate Adjustment Bonanza
With Department of Health (DOH) working to complete a number of rate updates before the end of the state’s fiscal year, nursing homes are facing several Medicaid payment adjustments that may require close tracking to understand. In a meeting with LeadingAge New York and other associations, DOH outlined the rate adjustments recently made as well as those currently being processed and provided updates on other reimbursement issues.
Medicaid Rate Adjustments
In recent weeks all nursing homes should have received rate adjustments related to the 2014 Cash Receipts Assessment (CRA) reconciliation and payment of the initial Jan. 1, 2016 Medicaid rate. While this initial rate contained updated prices and reflected 2016 capital, it was not updated for case mix index (CMI). This adjustment was made in Medicaid payments released in early March.
July 1, 2015 and Jan. 1, 2016 rates updated with more recent CMI data are scheduled to be paid in Medicaid payments released in mid to late March. As of today, the rate sheets containing the CMI updates are not yet posted. DOH reports that they continue to work on MDS roster submission issues for approximately 100 homes. CMI updates for these homes will be made several weeks later.
DOH is also updating the CRA per-day reimbursement amount used currently from the 2010-based amount, to the 2014 reconciled amount. This update will be retroactive to Jan. 1, 2016.
Several other rate updates impact only select homes. Homes eligible for Advance Training Initiative (ATI) funding received the state-share of their 2015-16 allocation in Medicaid payments released on March 2. The second half of this funding will be distributed upon federal approval.
Homes whose CMI change had been constrained to five percent and who did NOT experience an MDS audit of the assessments used to calculate that CMI should have received retroactive rate adjustments reflecting removal of the constraint. The release of the five percent constraint was reflected in several payment cycles and impacted rates with effective dates of 1/1/13, 4/1/13, 7/1/13 and 1/1/14. Note that the five percent CMI constraint impacts both increases and decreases.
Rate Adjustments Based on MDS Audits
DOH has determined that adjusting rates based on non-finalized OMIG audits is inappropriate. As a result, DOH will not make rate updates pursuant to any MDS audit that is not final and is also reversing any rate update made pursuant to an MDS audit that is not finalized. Few, if any, of the MDS audits performed by OMIG are final. This means that any home that has seen an MDS audit-related rate change will soon see that rate temporarily revert to its pre-audit level (including the re-imposition of any CMI constraint that may have been in place). Upon the issuance of a final audit report, the audit rate adjustments will be made again.
All rates for which an MDS audit was performed will revert to their pre-audit level, whether the audit resulted in a rate change or not. This means that even homes whose MDS audit resulted in no findings will have the five percent growth cap re-instated on the impacted rate period pending final audit report.
It is not yet clear in which payment cycle or cycles these changes will be made or how quickly OMIG will issue final audit reports.
|
Adjustment |
Medicaid Payment Cycle |
|
State share of ATI funding for eligible homes |
2008 |
|
2014 CRA Reconciliation |
2008 |
|
1/1/16 rates (no CMI update) |
2009 |
|
1/1/16 rates with CMI update (for all but about 100 homes) |
2010 or 2011 |
|
7/1/15 rates with CMI update (for all but about 100 homes) |
2010 or 2011 |
|
Update 1/1/16 CRA per-day reimbursement amount to 2014 |
2010 or 2011 |
|
CMI update to 7/1/15 and 1/1/16 rates for homes not yet updated |
? |
|
7/1/12 OMIG MDS audit adjustment |
1999 |
|
1/1/13 OMIG MDS audit adjustment & 5% CMI constraint release |
1999 |
|
4/1/13 OMIG MDS audit adjustment & 5% CMI constraint release |
2007 |
|
7/1/13 OMIG MDS audit adjustment & 5% CMI constraint release |
2007 |
|
1/1/14 OMIG MDS audit adjustment & 5% CMI constraint release |
2007 |
|
Reversal of OMIG audit adjustments and re-imposition of 5% constraint for impacted period(s). Only for homes with MDS audits for rates periods effective through 1/1/14 |
? |
Reinvestment of .8% Assessment and Quality Pool
The additional .8 percent assessment on nursing home cash receipts was imposed as an alternative to a two percent across-the-board Medicaid rate cut that other Medicaid providers experienced. The cut for other providers was repealed effective April 1, 2014, while the additional assessment continues for nursing homes. The state has committed to re-invest the assessment proceeds as a one percent supplement to the nursing home Medicaid operating rate retroactive to April 1, 2014. DOH has filed a Medicaid State Plan Amendment and has developed a methodology to increase the prices by one percent once federal approval is received. DOH is reviewing the request to provide something in writing that would allow providers to book this pending increase as revenue.
DOH has begun discussions with the Nursing Home Quality Initiative (NHQI) Work Group on the 2016 NHQI, but rate adjustments for the 2013, 2014 and 2015 quality pool remain on hold pending resolution of a legal challenge to the initiative.
Capital Streamlining & Rate Appeals
DOH sent an e-mail clarification that appeals to the 2016 capital component must be filed by June 10, 2016. The Department is waiting to see how many capital appeals are filed to complete their evaluation of the capital rate attestation process. DOH had stated previously that homes that attested to their capital but subsequently file a rate appeal would revert to their DOH-calculated rate. They are re-evaluating this position and will communicate any changes. A supplemental capital rate schedule addressing a small number of significant issues has been submitted to the Division of the Budget (DOB). The state did process $30 million worth of nursing home appeals during the fiscal year.
Cost Report Software
The 2015 RHCF Medicaid Cost Report software is salted for release on April 15th, and will be due on July 15, 2016. No major changes have been made, although schedule 10B has been eliminated and providers will need to enter their Permanent Facility Identifier (PFI) number. It is very important that members arrange Health Commerce System (HCS) access for those involved in filing and certifying the cost report in advance to ensure that the report is filed on time.
Universal Settlement
Please look for a separate communication regarding the Universal Settlement (US). We ask that those who have not completed the brief survey on prior ownership of their facility do so as soon as possible here. Recipients of Universal Settlement funds must complete and submit a W-9 form to the US Trustee via by e-mail to Michael Paulsen (mpaulsen@hinmanstraub.com).
Other Issues
The New York State Energy and Research and Development Agency (NYSERDA) is working with about ten homes to begin the energy audit process. DOH will reconvene dedicated meetings on the energy efficiency initiative to discuss other energy audit options available through NYSERDA.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841