Nursing Home Waiting Game
The Department of Health (DOH) is finalizing a capital rate schedule that will update 2017 capital for homes that filed capital correction attestations, but whose attestations were unable to be reviewed prior to issuance of 2017 rates. The correction schedule is expected to be sent to the Division of the Budget (DOB) for approval this month. DOH provided this information as well as status updates on other reimbursement issues in a meeting with associations last week. Items discussed are outlined below.
Hospitalization Bed Hold: The 2017-18 enacted State Budget eliminates hospitalization bed hold payments effective April 1, 2017 while retaining therapeutic leave bed hold payments at 95 percent of the Medicaid rate. DOH is reviewing questions submitted by LeadingAge NY and other associations and has indicated that it will issue guidance to nursing homes as well as to hospitals and managed care plans. We continue to urge DOH to provide guidance on the most immediate questions as soon as possible. While we are uncertain as to the details of the guidance that will be issued, a reasonable expectation is that hospitalization bed holds that are billed on or after April 1, 2017 will be rejected or, if paid, will be recouped.
Reinvestment of the .8 Percent Assessment Proceeds: DOH intends to reinvest proceeds derived from the .8 percent non-reimbursable assessment to supplement nursing home rates by $70 million per year and filed a Medicaid State Plan Amendment (SPA) in September 2015 seeking approval from the Centers for Medicare and Medicaid Services (CMS) to do so. The assessment was implemented in lieu of a 2 percent cut that was imposed on most Medicaid providers. For other provider types, that cut was eliminated effective April 1, 2014, but nursing homes have continued to pay the assessment. Most recently, CMS posed several additional questions to the state on the SPA, which DOH indicated would be addressed quickly. DOH reports that they continue working on regulations and are having discussions on the issue with the Governor’s Office, DOB, and CMS.
Capital Attestation Webinar: DOH is preparing a webinar to address issues that they have observed in the capital attestation process. DOH will be issuing advance 2018 capital calculations in the fall and providing homes the opportunity to identify any errors and submit corrections. Unless DOH identifies an issue with the correction that violates regulation or policy, the calculation will be used as the basis for the home’s 2018 capital and be subject to review and audit by the Office of Medicaid Inspector General (OMIG).
DOH intends to require all homes, both those that submit a correction request as well as those who agree with the state’s calculation, to provide an attestation verifying that the submitted correction, or the capital calculated by DOH, is accurate. The webinar date is not yet set, but DOH expects to hold it in late June or early July. We urge members who have encountered difficulty with the attestation process or have capital rate questions to submit them to us or to the Bureau of Long Term Care Reimbursement mail log at nfrates@health.ny.gov so they can be addressed during the webinar. DOH is also planning to reconstitute a capital workgroup to address potential changes to the capital rate setting methodology, including issues such as residual capital and useful life.
Refinancing Shared Saving: CMS approved the state plan amendment that authorizes the state to share savings that accrue from mortgage refinancing with the provider in November 2016. DOH continues to work on finalizing and releasing guidance. Refinancing arrangements that closed in April 2015 or later will be eligible for consideration.
Nursing Home Quality Initiative: Rate adjustments pursuant to the Nursing Home Quality Pool for payment years 2013, 2014, 2015, and 2016 continue to be on hold pending resolution of litigation challenging the initiative.
Return to the Medicaid Lag: Medicaid providers receive their Medicaid payment two weeks after the check issuance date, a statutory requirement referred to as the "Medicaid lag." Providers under financial stress have had the opportunity to request to be “removed from the lag,” and DOH reports that over the years, a number of nursing homes have made this request. DOH is making it a priority to reinstate the lag for these homes and recently sent a communication to affected providers asking whether there was a compelling reason why that should not be done. DOH is evaluating the responses they received and will make case-by-case determinations for extending lag waivers for six months. In deciding whether to approve lag waiver requests, DOH will be looking for an indication that the need for the waiver is temporary and that the provider has a reasonable expectation to be able to return to the lag after six months.
DOH intends to put those homes that did not respond to the communication back on the lag, meaning providers would not receive Medicaid checks for two consecutive payment cycles. If Medicaid payments to your home are not subject to the two-week lag and you have not responded to the DOH request for information, you should do so as soon as possible.
Equity Withdrawal: Nursing homes are required to seek DOH approval when transferring more than 3 percent of a facility’s total reported annual revenue for patient care services. While such transfers are more common in for-profit organizations, they can include certain transfers that not-for-profit homes may make, such as those from a foundation. DOH included a reminder of this requirement in Appendix G of the 2017 Rate DAL and has sent a letter requesting a response to homes that they have identified as possibly having made an unauthorized transfer. If any members receive these letters, they should respond promptly. DOH is finalizing a new, simplified transfer authorization form, but until that work is completed, the old form should be used.
Transportation Carve-out: The carve-out of transportation from the nursing home rate retroactive to April 1, 2016 has been approved by CMS. DOH has not indicated when the rate adjustments, which are expected to reduce Medicaid payments by approximately $6 million per year, will be made.
Universal Settlement: While DOH provided verbal assurance during a Medicaid State Budget/Global Cap presentation that the third of five payments of the Universal Settlement is included in the 2017-18 state spending plan, no payment date has been announced. Based on the agreement, the third payment must be made to the trustees prior to the end of the 2017-18 State Fiscal Year (i.e., March 31, 2018).
2015 Cash Receipts Assessment (CRA) Reconciliation: DOH reports that it believes that all of the remaining issues related to the 2015 CRA reconciliation have been resolved. If you believe that your home’s reconciliation is incorrect or if you continue to experience unwarranted recoupment related to this issue, please let us know.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841