Nursing Home Rate Updates
The Department of Health (DOH) met with LeadingAge NY and other associations last week to provide an update on nursing home Medicaid reimbursement issues. Highlights of the meeting are outlined below.
Medicaid Rate Timetable
July 1, 2016 Medicaid rates reflecting a Case Mix Index (CMI) based on the January 2016 picture date have been approved, and associated rate adjustments retroactive to July 1st are scheduled to be made in Medicaid payment cycle 2047, which has a check date of Nov. 14th with a Nov. 30th release date. The associated rate sheets are not yet posted on the Health Commerce System (HCS), but DOH is working on doing so. We expect DOH to notify homes when the rate sheets are available. We will echo any DOH notice or let members know when we confirm that they are posted.
DOH posted draft preliminary 2017 Nursing Home and ADHC rates on the Health Commerce Network in early November. This posting includes full 2017 Medicaid rate sheets and follows the posting of capital rate sheets in early October.
The draft rates reflect a Case Mix Index (CMI) calculated using the January 2016 picture date for most homes, which is then constrained to a 5 percent change from the prior period, if applicable.
Please note that providers who identify errors in the rates may address them as follows at this time:
- Nursing home capital – Homes may submit a corrected capital calculation along with required supporting materials and signed attestation to nfrates@health.ny.gov with the subject line reading "2017 Attestation of Capital Rate." Instructions and the attestation form are available here.
- Nursing home operating rate – Homes that identify a “significant” error in the operating component should notify DOH by email with a description of the error. The email should be sent to nfrates@health.ny.gov with the subject line reading “2017 Preliminary Operating Rate” and facility name.
- ADHC Rate – Corrections that affect only the ADHC rate should be submitted to nfrates@health.ny.gov with the subject line reading “ADHC – 2017 Preliminary Capital Rate” and facility name.
Whether a home submits a correction request or not, they will be able to file a formal appeal if they so choose once the final 2017 rates are published.
The state is targeting to publish the final 2017 rates, which will include minimum wage adjustments and reflect capital based on attested capital calculations for those homes that submit corrections, in mid-January. DOH will not process a separate capital correction schedule as it has done in the past and will not accept any capital attestations after Dec. 2, 2016. We urge members that have identified errors to file the attestation as early as possible and ensure that it meets the criteria outlined in the DOH guidance.
Case Mix Adjustment & Audits
Case mix related MDS audits performed by the Office of the Medicaid Inspector General (OMIG) for 2012 and 2013 rate periods have been finalized, and rate adjustments for homes with audit findings as well as the release of remaining CMI constraints for these time periods are being processed. We will publicize the Medicaid payment cycle that will contain these adjustments as soon as they are known.
Work on 2014 audits continues, but DOH is exploring other options for CMI audits beginning with 2015 data and has scheduled a dedicated meeting to discuss potential options. We continue to stress to DOH that the lengthy delays in lifting CMI constraints result in large retroactive rate adjustments that have cash flow implications, cause administrative headaches for both homes and managed care plans, and put reimbursement at risk in those cases where plans are not making retroactive rate updates.
DOH expressed concern that a number of homes did not upload their July census rosters during the October upload period and that homes have residents listed on submitted picture date census rosters who fail to match with an MDS in the CMS database. Historically, staff has reached out to homes in these situations to resolve problems and avoid defaulting residents to the lowest RUG category. However, this time, intensive process can cause delays in CMI calculations and rate updates. DOH is discussing strategies to alleviate this, which may include some type of penalty for failure to submit accurate and timely information.
After the meeting, DOH provided us with a listing of homes that still had outstanding submission issues. We have reached out to members on the list and are interested in hearing from any home whose submission delay or resident-to-MDS matching is due to circumstances beyond their control.
Other Medicaid Rate Issues
DOH has submitted the Medicaid State Plan Amendment (SPA) and regulations necessary to increase the Medicaid direct and indirect prices by 1 percent retroactive to April 2014. This will represent reinvestment of funds the state continues to collect from nursing homes through the 0.8 percent increase in the cash receipts assessment. The increased assessment was in lieu of a provider-wide Medicaid payment cut that expired for all other providers on April 1, 2014. DOH has also submitted the SPA and regulations to carve out the cost of non-emergency medical transportation from the Medicaid rate effective April 1, 2016. Both provisions require CMS approval.
Nursing Home Quality Initiative (NHQI) regulations have been approved, but NHQI rate adjustments for 2013, 2014, and 2015 continue to be on hold pending resolution of a legal challenge to the quality pool. DOH reports no progress in attempts to negotiate the lawsuit, but publication of the regulations may allow the legal process to move forward.
Other Funding Issues
DOH is working on reconciling 2015 Cash Receipts Assessment (CRA) payments and hopes to have that completed and processed by the end of the year. The assessment add-on will remain the same in 2017 as it is currently (i.e., based on 2014 CRA reconciled figures).
Advanced Training Initiative (ATI) applications from homes notified that they were eligible for funding were due in early November. DOH hopes to make year two payments in early 2017. This was a two-year initiative, and if it is to be continued in the coming year’s state budget, an evaluation of its effectiveness along with performance measures will need to be developed. DOH will schedule a dedicated meeting for that discussion.
Finally, DOH noted that a check of 2014 cost reports indicated that $124 million in equity withdrawals were made without seeking DOH authorization to do so. The requirement to seek DOH approval for such transactions, which include certain transfers not-for-profit homes may make, such as those from foundations, are provided in a 2009 Dear Administrator Letter available here.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841