Validating the Assessment Reconciliation Calculation
The Department of Health (DOH) has posted a spreadsheet with information that will allow nursing homes to better understand and validate the 2016 cash receipts assessment reconciliation calculation. To avoid delays, instead of posting facility-specific calculation sheets on the Health Commerce System (HCS) as in previous years, DOH has prepared a spreadsheet that can be downloaded by clicking here. It displays the data DOH used to calculate the reconciliation:
- the per-day assessment reimbursement amount that each facility received through fee-for service Medicaid in 2016;
- assessment payments made in 2016;
- 2016 non-Medicare days;
- the per-day reimbursement amount calculated based on 2016 assessment payments; and
- the difference between the two per-day amounts.
The file includes a “CRA Revision Form” that homes can complete and email to nfrates@health.ny.gov to request a correction should they identify any errors. We recommend that members review the calculation and underlying data for accuracy and submit any correction requests without delay.
Medicaid payment adjustments related to the reconciliation were included in payment cycle 2106 (check dated Jan. 1, 2018, to be released on Jan. 17th). The adjustment may be positive or negative based on each home’s individual circumstances.
Please note that the reconciliation impacts assessment reimbursement made through fee-for-service Medicaid only. Assessment reimbursement amounts reflected in the benchmark rate paid by managed care plans are based on a two-year lag (i.e., 2017 rates contained 2015 reconciled assessment reimbursement amounts) and are updated annually, but not reconciled.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841