Nursing Home Rate Updates

DOH anticipates several of the outstanding nursing home Medicaid rate adjustments to be reflected in August Medicaid payments. These include a reissuance of Medicaid rates for the first six months of 2015 to reflect the July 2014 Case Mix Index (CMI) and a reconciliation of 2013 cash receipts assessment payments. Homes will see retroactive payments or recoupments based on their individual circumstances.  While the CMI update is a net increase in payments, the assessment reconciliation is a net recovery. Two other rate adjustments will impact only selected homes:  DOH has processed an additional capital correction schedule impacting about a dozen homes and will reissue 7/1/14 rates correcting the miscalculated five percent case mix change constraint for homes whose rates were subject to the constraint.  

The quality pool rate adjustments will be made after regulations are adopted as described here.  Finally, rate adjustments based on 2012 MDS audits as well as the release of the five percent CMI constraint on 7/1/12 and 1/1/13 Medicaid rates are being sent to the Division of the Budget for review this week.  We continue to stress the importance of more timely rate updates as the state moves into managed care and received assurance that DOH will share the 2014 quality pool rate adjustment amounts as soon as they are available.  

DOH continues work on posting determinations regarding facility-submitted universal settlement exclusions. The initial posting attempt was abandoned due to technical difficulties and a reposting is anticipated this week.   We will forward the announcement to member facility CFOs when it is issued.

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