Nursing Home Reimbursement Update
In a meeting with LeadingAge NY and other associations representing nursing homes, the Department of Health (DOH) shared that the Division of the Budget (DOB) has signed off on the distribution of $140 million in supplemental payments for the 2023-24 State Fiscal Year. These payments represent the reinvestment of funds collected from nursing homes through the 0.8 percent portion of the cash receipts assessment. While no Medicaid payment cycle has been assigned, the expectation is that these lump sum payments will be in a Medicaid payment cycle released by mid-March, if not earlier.
Members will recall that the 0.8 percent assessment was originally enacted as an alternative to an across-the-board cut imposed on Medicaid providers in 2011. Even though the cut was restored, nursing homes continue to pay the additional assessment subject to an agreement with the State that the proceeds would be reinvested into nursing home reimbursement. Providers can estimate the amount of their supplemental payment by multiplying their annual Medicaid revenue for 2022 by 2 percent.
The Department has also posted the results of the 2022 Nursing Home Quality Initiative (NHQI). It seems like final score sheets are not being posted on the Health Commerce System (HCS), but rather, providers are being directed to the Health Data NY website, where they can access the overall quintile assignment as well as the performance rates and resulting scores for each individual measure. Note that the 2022 NHQI is primarily based on facility performance on quality measures in 2021, so the 2022 NHQI measures are identified in the Health Data NY posting as Measurement Year 2021. For those just seeking their overall quintile ranking, they can be accessed easily on the DOH website here, which is also where the scoring methodology document is posted.
LeadingAge NY members tend to outperform their peers each year, with this year being no exception: 80 percent of non-profit and public homes score in the top three quintiles, while the rate is 50 percent for for-profit facilities. More than a third (36 percent) of non-profit homes in the state achieved the highest ranking. Of the homes that achieved the highest ranking in each of the past three years, 60 percent are public or non-profit providers, despite the fact that these sponsors represent less than a third of the facilities receiving NHQI scores. Continuing care retirement communities (CCRCs) and specialty facilities are not part of the NHQI.
The results are used to redistribute $50 million in Medicaid funding: facilities in the top three quintiles will receive a graduated positive payment adjustment based on their quintile, while those scoring in the fourth and fifth quintiles will see a negative adjustment. Although exact percentages vary each year, past experience suggests that the payment for those in the top quintile is likely to be about 1.2 percent of annual Medicaid revenue, while those in the second quintile can expect approximately 0.8 percent. Those in the third quintile will see a nominal positive amount, while those in the bottom two quintiles will see a negative adjustment equaling approximately 0.8 percent of annual Medicaid revenue. The Department is working on the adjustments, but it is not yet known in which Medicaid payment cycle they will be reflected.
No new information is available regarding outstanding payments that are awaiting federal approval. These include the remaining 1 percent of the 7.5 percent rate increase retroactive to April 2023, the federal share of safe staffing funding, the federal share of 2023-24 CINERGY funding, and the 2023-24 Intergovernmental Transfer (IGT) payments for public nursing homes. The Department is working on January 2024 Medicaid rates as well as the reconciliation of the 2022 cash receipts assessment payments, but no estimated release dates are available.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841