Nursing Home Rate Adjustments

Rate adjustments reflecting case mix updates to the July 1, 2014 nursing home Medicaid rates should be included in payment cycle #1944 due for release on Wed., Dec. 10, while retroactive adjustments to 2013 rates related to the 2013 quality pool are expected to be in the last Medicaid payment released this calendar year. DOH sent the 2012 cash receipts assessment reconcilition calculations to the Division of Budget and hopes to make those rate adjustments in January. The July 1, 2012 and Jan. 1, 2013 rates have been finalized to reflect MDS audit results, lift the five percent constraint and will be sent to e-MedNY for payment/recoupment at the end of the year. Homes that experienced OMIG audits of their January or July 2012 MDS assessments should be receiving letters from OMIG officially reporting the audit findings.

Please keep in mind that Mon., Dec. 1 is the final day to report 2015 capital or operating rate errors to DOH (NFRATES@health.ny.gov for operating rate, BVAPR@health.ny.gov for capital rate) without utilizing the formal appeals process.

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