One More Change to Assessment Reimbursement
Last week, the Department of Health (DOH) notified nursing homes that the assessment reimbursement amount paid through Medicaid fee-for-service (FFS) was being updated for the second time in two months. The amount is being updated from a DOH-estimated figure to the 2018 reconciled amount (i.e., based on actual 2018 assessment payments). The update is retroactive to Jan. 1, 2019, with the adjustment scheduled to be reflected in Medicaid payment cycle 2201, which has a check release date of Nov. 13th. Adjustments will be positive or negative based on individual home circumstances.
With multiple updates to the assessment reimbursement being made, we strongly recommend that members track assessment-related payment adjustments and verify that adjustments reflect correct amounts.
FFS Assessment Per-Diem: The first mid-year update to the assessment reimbursement amounts being paid through FFS in 2019 became effective with Medicaid payment cycle 2197 (released Oct. 16th) or 2198 (released Oct. 23rd). These per-diem amounts were based on DOH estimates and were retroactive to Jan. 1st. The second mid-year update (described above) uses the 2018 reconciled amounts and will be reflected in payment cycle 2201 (released Nov. 13th). Note that these reimbursement amounts used in FFS are placeholders that will eventually be reconciled to actual assessment payments and reimbursements (as was recently done for 2017).
Managed Care Benchmark List Assessment Per-Diem: Two weeks ago, DOH notified providers that the assessment reimbursement in the managed care benchmark list was being updated from DOH estimates to 2018 reconciled amounts. Note that managed care assessment reimbursement is not subject to further reconciliation.
Assessment Reconciliation: DOH reconciles the assessment reimbursement that a home received in a past year to that year’s actual assessment payments and reimbursements after that year’s data becomes available. This has most often been done on a two-year lag. DOH reconciled the 2017 assessment earlier this year and made payment adjustments in Medicaid payment cycle 2197 (Sept. 30th check date, released on Oct. 16th). The associated Dear Administrator Letter (DAL) is posted here, and the back-up calculations are here.
DOH has completed the 2018 assessment reconciliation calculation and will use it as the basis of the assessment per-diem in both managed care and FFS for the remainder of the year. However, 2018 payment adjustments based on the reconciliation have not yet been made; those adjustments are awaiting approval of the Division of the Budget (DOB). No back-up calculations have been posted yet.
Please let us know if you encounter discrepancies. DOH is fielding questions at nfrates@health.ny.gov (indicate “CRA” in the subject line).
LeadingAge NY Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841