Nursing Home Rate Updates Scheduled for Payment

The Department of Health (DOH) has forwarded three rate adjustments to e-MedNY. Nursing home providers should see the 2013 cash receipts assessment reconciliation in Medicaid payment cycle 1981 with a check release date of Aug. 26th. Payment cycle 1983 (check release date of Sep. 9th) will contain adjustments to 1/1/15 rates to reflect the July 2014 MDS-based Case Mix Index (CMI). Homes with a six month CMI change exceeding five percent will have their CMI change temporarily capped at five percent pending Office of Medicaid Inspector General (OMIG) audits of July 2014 MDS submissions.

Also included in payment cycle 1983 will be a correction to the five percent temporary CMI constraint imposed on 7/1/14 rates. An error in that calculation resulted in some homes seeing constraint reductions higher than warranted. The corrected constraint will remain in effect until OMIG completes audits of Jan. 2015 MDS submissions which are the basis of the CMI used in the 7/1/14 rates.

We have requested that DOH post the assessment reconciliation calculation sheets as well as the updated 1/1/15 rate sheets to the Health Commerce System as quickly as possible and will let members know when they are available. 

Rate adjustments for homes that had OMIG audits of their 2012 or 2013 MDS submissions as well as the release of the five percent CMI growth constraint on 2012 and 2013 Medicaid rates for affected providers are in process. The Medicaid payment cycle is not yet known. The 2013 and 2014 quality pool rate adjustments remain on hold pending issuance of emergency regulations.

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