Nursing Home Reimbursement Update
(July 15, 2025) During a meeting with LeadingAge NY and other associations, the Department of Health (DOH) provided status updates on several nursing home Medicaid funding topics. The Department:
- reminded that 2024 Medicaid cost reports are due July 31st and encouraged providers to submit them along with required certifications by the deadline;
- reviewed recent rate releases and postings, which include January 2025 Medicaid rates as well as updates to the 2 percent quality penalty adjustments;
- reported that 2023 Cash Receipts Assessment (CRA) reconciliations were in final executive review;
- indicated that the posting of 2025 benchmark rates would occur after the 2023 CRA amounts were reconciled;
- revealed that 2024 rate appeals packages were under executive review;
- shared that DOH will work on processing the next batch of historic appeals (i.e., 2009 through 2021) over the summer with the hope to have it ready for review in late fall;
- said that no timeline had been established yet for processing the recently approved 2024-25 Intergovernmental Transfer (IGT) payments for public nursing homes;
- noted that internal conversations on case mix transition to Patient-Driven Payment Model (PDPM) were scheduled for the end of July, after which DOH intends to meet with associations to discuss and solicit input; and
- received a report from the Office of the Medicaid Inspector General (OMIG) that 2019 Minimum Data Set (MDS) audits were underway in Brooklyn and Queens, with audits in Rochester and Syracuse expected in the fall.
In June, the State submitted a State Plan Amendment (SPA) request with the Centers for Medicare and Medicaid Services (CMS) for 2025-26 downstate CINERGY funding as well as a SPA seeking federal approval for across-the-board Medicaid payment increases enacted in the 2025-26 State Budget. The SPA request specifies that $378.3 million would be distributed as uniform, per-day amounts, while $60 million would be distributed proportionately based on revenue. We are seeking some clarification from DOH regarding the language of the SPA and will share information with members. However, please note that the fate of these payments, especially in future years, is somewhat uncertain given the recently enacted federal Medicaid reductions.
Please note that the SPAs for both 2024-25 CINERGY and the 2024-25 nursing home funding increase continue to await federal approval. Because a different unit of DOH has jurisdiction of Vital Access Provider Assurance Program (VAPAP), Statewide Transformation Grants, staffing requirements and penalties, as well as minimum spending requirements, no new information was provided on these issues.
We remind members that Aug. 1, 2025 remains the due date for nursing homes to submit their off-cycle revalidations (info here). Please reach out with questions or concerns.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841