Why is My Medicaid Payment Amount Different?
Nursing homes are likely to see retroactive adjustments in Medicaid payment cycle 2056 with a check release date of Feb. 1st and/or cycle 2057 with a check release date of Feb. 8th. Homes that call ahead for their Medicaid payment amounts can see that adjustments are being made, but the rate and calculation sheets that would help identify each adjustment and its amount are not yet available.
The following adjustments are included in one or both of these cycles:
- Reconciliation of the 2015 cash receipts assessment.
- Rate adjustments related to OMIG MDS audits for rate periods beginning July 1, 2013 and Jan. 1, 2014 as well as the release of any remaining 5 percent CMI constraints for these periods.
- Year two Advanced Training Initiative funding for eligible facilities.
An update to the Jan. 1, 2017 rate is expected in a subsequent cycle but may be included in one of these cycles as well.
Please note that not all adjustments impact all homes and that some may be positive or negative depending on a home's specific circumstance. The Department of Health (DOH) hopes to post relevant rate sheets, calculation documents, and "Dear Administrator" letters before the check release dates. While it may be necessary to wait until DOH posts the explanatory documents in some cases, please let us know if you need assistance deciphering the adjustments.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841