Nursing Home Reimbursement Update
Nursing home members should monitor their Medicaid payments closely for retroactive adjustments as the Department of Health (DOH) processes several payments prior to the end of the State’s fiscal year. Payment adjustments made this year are listed below. Please note that while in most cases payments are made in the Medicaid payment cycles listed, occasional payments may slip to the following cycle.
January 2021 Medicaid Rates. On March 9th, homes should have received notification that Jan. 1, 2021 rates have been posted on the Healthcare Financial Data Gateway section of the Health Commerce System (HCS). These rates contain an update to the capital component but still reflect the same case mix index (CMI) used in July 2020 rates. Please note that the capital component is subject to the 5 percent cut enacted last year. The associated Dear Administrator Letter (DAL) is available here. Payment adjustments will be reflected in Medicaid payment cycle 2273 (checks dated March 15th, released on March 31st).
Rate Appeals. DOH is also reporting that many outstanding rate appeals from 2017 through 2019 have been approved by the Division of the Budget (DOB) and are being processed for payment. The Department indicated that providers whose rate appeals have been processed will be notified. We will share the Medicaid payment cycle number in which they will be reflected when it is assigned.
ATI and CINERGY. For those providers receiving Advanced Training Initiative (ATI) and CINERGY funding, those payments should be reflected in Medicaid payment cycle 2272 (checks dated March 8th, released on March 24th).
July 2020 Medicaid Rates. DOH posted July 2020 nursing home Medicaid rates on Feb. 19th. Payment of these rates retroactive to July 1, 2020 was made in Medicaid payment cycle 2271 (check release date of March 17th). The rates updated the CMI based on Minimum Data Set (MDS) data from November 2019 through January 2020 using a Jan. 29, 2020 picture date. The DAL that accompanies the rates is available here. DOH also posted the July 2020 benchmark rate list used by managed care plans on their website.
Reconciliation of 2019 CRA Payments. DOH has reconciled Cash Receipts Assessment (CRA) payments made and reimbursement received in 2019 to actual amounts. Depending on the facility’s circumstances, the adjustment may have been positive or negative and was reflected in Medicaid payment cycle 2269 (check date of Feb. 15th, released on March 3rd). The assessment reimbursement amount currently paid has been updated to reflect the reconciled amount. The associated DAL is available here, and the back-up calculations are here.
January and April 2020 Rate Update. In late January, DOH posted January and April 2020 nursing home Medicaid rates on the HCS. The rates incorporate the CMI calculated using MDS data tied to the July 31, 2019 picture date and apply a 5 percent constraint if the CMI has changed by more than 5 percent relative to July 2019 rates. They also update the basis of the 2 percent quality penalty to 2018 and 2019 Nursing Home Quality Initiative (NHQI) results. The only difference between the January and April 2020 rates for member homes should be a 5 percent reduction to the capital component. (For-profit facility rates may also reflect a residual capital cut.) The payment adjustments were included in Medicaid payment cycle 2268 (check date of Feb. 8th, released Feb. 24th). DOH also updated the nursing home benchmark rate list used by managed care plans to reflect these rates.
2016 MDS Audit Results and Constraint Release. The Office of the Medicaid Inspector General (OMIG) completed its work on 2016 MDS audits, and DOH updated rates for those homes that may have had audit findings in January 2021. Along with that update came the release of the 5 percent CMI constraint for those homes subject to the constraint. The audit rate adjustments and removal of the constraint for July 2016 and January 2017 rates were reflected in Medicaid payment cycle 2267 (check date of Feb. 1st, released Feb. 17th). Rate sheets and the associated DAL were posted on the HCS.
NHQI and Assessment Reinvestment. The 1 percent supplemental payment representing reinvestment of .8 percent assessment and payment adjustments related to the 2019 NHQI were included in Medicaid payment cycle 2262 (checks released Jan. 14th). The back-up calculations for these adjustments are available here under the Nursing Home Quality Pool section.
As DOH looks to begin the census collection and MDS verification cycle that will be used to finalize the January 2021 rates, we will be reaching out to see whether members believe that the public health emergency and related waivers may have impacted their MDS submissions in a way that may skew the accuracy of the case mix calculation for their home. Please contact us if you have questions or concerns.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841