Nursing Home Should Watch for Rate Update Notice
Nursing home members should be on the lookout for announcements regarding Medicaid rate updates. In a recent meeting with LeadingAge New York and other associations, the Department of Health (DOH) reported that the 2014 Cash Receipts Assessment (CRA) reconciliation has cleared necessary approvals and should be included in one of the next two Medicaid payment cycles. The same is true for July 2013 and Jan. 2014 rates that are being re-issued to reflect MDS audits and/or the release of the five percent Case Mix Index (CMI) constraint. DOH should notify providers by e-mail when revised rates sheets or the CRA calculation sheets are posted on the Health Commerce System. We will echo these announcements to members.
DOH also provided updates on various other Medicaid payment-related issues:
2016 Initial Rates have been sent to the Division of the Budget (DOB) for review. Once they are published and the state begins paying them, the cash receipts assessment reimbursement add-on will be updated from the current 2010-based amount to the amount based on the 2014 reconciliation. DOH expects to issue July 2015 rates (reflecting a January 2015 CMI) at the same time as 2016 rates.
The Universal Settlement continues to move forward. Although 98 percent of the state’s homes executed the settlement paperwork, a number of homes are required to submit a corrected release which is due Jan. 28th. This resubmission has only impacted for-profit homes and appears to be proceeding on schedule. Nursing homes received updated Universal Settlement information earlier this month that detailed individual litigation a home was settling and provided final figures for the 240 homes eligible to apply for the special appeals fund because they are receiving minimum payment funding. More information, including an outline of the special appeals process, can be accessed here.
2015 Nursing Home Quality Initiative quintile rankings are now posted on the DOH Medicaid Redesign Team (MRT) Web page. Facility-specific detailed score sheets have been available on the Health Commerce System since fall and will eventually be released on the state’s HealthData page. When DOH calculates 2015 NHQI rate adjustments they will be posted on the Medicaid benchmark rate schedule here. NHQI rate adjustments for 2013, 2014 and 2015 remain on hold as the state seeks to resolve litigation.
The one percent increase in reimbursement for nursing homes to reinvest into nursing home care funds collected by the continuation of the .8 percent assessment is awaiting federal authorization and resolution of the NHQI litigation. The .8 percent assessment was enacted in lieu of an across the board cut on other Medicaid providers but continues even after the cut was eliminated on April 1, 2014. The state intends to make the rate increase retroactive to April 2014.
Advanced Training Initiative initial payments are pending state Division of the Budget (DOB) approval. All homes that were eligible and applied for this funding will receive it. The initial payments represent the state-share (i.e., approximately half) of the allocations and are being made while the state awaits federal approval.
Other issues discussed, included the Webinar DOH held for homes invited to participate in the initial stage of the energy efficiency initiative. Homes that were invited to participate should contact NYSERDA if they have not yet done so and homes not invited, but interested in participating should contact DOH to express their interest. DOH reported that the removal of transportation costs from the Medicaid rate pursuant to proposals to consolidate transportation with the state’s centralized transportation brokers will reduce Medicaid rates between 40 and 60 cents effective April 1, 2016.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841