State Updates Medicaid Rates to Reflect MDS Audits, Constraint Release

The Department of Health (DOH) has processed nursing home Medicaid rate adjustments related to 2012 Office of the Medicaid Inspector General (OMIG) MDS audits and has released the five percent Case Mix Index (CMI) constraint on Jan 1, 2013 rates. Nursing homes that experienced OMIG audits of their Jan. 2012 and/or July 2012 MDS assessments that resulted in findings will see their July 1, 2012 and/or Jan. 1, 2013 rates adjusted to reflect these findings.  DOH sent notification today that revised rate sheets have been posted to the Health Commerce System.  The DOH note is copied below.

Homes whose Jan.1, 2013 rate was constrained to a five percent CMI change will see the impact of the elimination of the constraint (i.e., the adjustment reflected on line 15 on the first page of their Jan. 1, 2013 rate sheet will be eliminated). These adustments should be included in Medciaid payment cycle 1999 which has a check date of Dec. 14th with a release date of Dec. 30th. Although the update includes both positive and negative adjustments, the net impact is a $14 million payment to homes.

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

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Dear Administrator:

The revised rates resulting from OMIG audit of 2012 MDS data are available on the HCS.   Please see the letter that accompanies the rates for further instructions and information regarding this posting.

Thank you.

To access the rates:

1.       Log into the HCS at

https://commerce.health.state.ny.us/hcs

2.       Under the MY APPLICATIONS heading, find NH Rate Sheets 4/2009 Forward

3.       Select either

July 2012 OMIG Audit Revised Rates

January 2013 OMIG Audit Revised Rates

4.       Select your facility

The DAL and all rate sheets are available from this link.