Preliminary Nursing Home Rates Available

The Department of Health (DOH) has posted draft preliminary 2017 Nursing Home and Adult Day Health Care (ADHC) rates on the Health Commerce System (HCS). This posting includes full 2017 Medicaid rate sheets and follows the posting of capital rate sheets in early October. Any capital corrections that providers may have submitted are not yet reflected in this posting. The DOH message used to notify homes was the text of the Dear Administrator Letter (DAL) that accompanies the rate sheets and is available here. 

Because 2016 was the final year of the 5-year phase-in of the Statewide Pricing Reimbursement Methodology, 2017 rates no longer have any stop-loss or stop-gain adjustment (line 11 of the rate sheet labeled "Transition Adjustment").  In 2016, the operating component was constrained to a 10 percent increase or decrease relative to a home’s July 2011 operating component (compared on a case mix neutral basis).

The draft rates reflect a Case Mix Index (CMI) calculated using the January 2016 picture date for most homes, which is then constrained to a 5 percent change from the prior period, if applicable, by applying a constraint adjustment which appears on line 15 of the rate sheet. Members may validate their case mix date by reviewing the date on their “Current Facility MDS Summary” schedule (p. 5 of the rate sheet packet for most homes). The nursing home Medicaid rate build-up starts with a statewide direct and indirect price. These starting prices are slightly higher (direct by $0.50 to $0.60, indirect by $0.25 to $0.30) in 2017 than in 2016. Attachment 1 of the DAL contains a table that lists the direct and indirect prices for 2017. Members can download the LeadingAge NY Pricing Template available here to model CMI changes.  

Please note that providers who identify errors in the rates may address them as follows at this time:

1. Nursing home capital – Homes may submit a corrected capital calculation along with required supporting materials and signed attestation to nfrates@health.ny.gov with the subject line reading "2017 Attestation of Capital Rate." Instructions and the attestation form are available here. Capital corrections must be received by DOH by Dec. 2, 2016.  

2. Nursing home operating rate – Homes that identify a “significant” error in the operating component should notify DOH by email with a description of the error. The email should be sent to nfrates@health.ny.gov with the subject line reading “2017 Preliminary Operating Rate” and the facility name.

3. ADHC Rate – Corrections that affect only the ADHC rate should be submitted to nfrates@health.ny.gov with the subject line reading “ADHC – 2017 Preliminary Capital Rate” and the facility name.

Whether a home submits a correction request or not, they will be able to file a formal appeal if they so choose once the final 2017 rates are published.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841