What's That Retro Adjustment in the Nursing Home Medicaid Payment?

Many nursing home members checking on the amount of future Medicaid payments are seeing a sizable adjustments in Medicaid payment cycle number 1981.  This represents the reconciliation of 2013 cash receipts assessment payments and will be included in Medicaid checks dated August 10th and scheduled for release on August 26.  While the net impact of this reconciliation is a gain for the State, providers will see negative or positive adjustments based on their specific circumstances.

The Department of Health (DOH) intends to post the assessment reconciliation calculation sheets on the Health Commerce System (HCS) in early August. Additionally, the State intends to update the assessment reimbursement per-diem effective 1/1/16 to the 2013 reconciled amount and homes will be able to see what that amount will be on their calculation sheets.  Current assessment reimbursement amounts are still based on 2010 figures.  

Shortly after this, homes should see rate adjustments for two other outstanding issues: an update to the Jan. 1, 2015 rates to reflect the July 2014 roster-based Case Mix Index (CMI) and a correction to July 1, 2014 rates for those homes that are subject to the five percent CMI change constraint.  It is not yet clear how quickly after the assessment reconciliation those adjustments will follow. The constraint to the July 1, 2014 rates was calculated incorrectly for some homes resulting in a larger rate reduction for some than was warranted.  This correction will correct the constraint amount for the second half of 2014.  Eventually when OMIG has completed audits of those homes selected for audit for that time period, homes that had audit finding will have their rates reclaculated based on audit findings and the constraint will be removed.  

We will let members know as soon as the timing for these rate adjustments are known.  

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