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Long-Term Care 2022 Medicaid Reimbursement Update

Over the course of the last few months, NYS Department of Health (DOH) issued numerous rate packages impacting Medicaid reimbursement for the long-term care industry. As we look to close year-end and prepare for upcoming 2022 audits, the below Medicaid cycles will impact current and prior year revenues. Updates include operating rates, capital rates and Medicaid Programs. See summary and details below:

Cycle # 2362, Check Release Date: December 14, 2022

  • 2% Across the Board Supplemental Payment:
    • 2022/2023 2% Supplemental Payment (4/1/22 – 3/31/-23) – $140 million paid across all nursing facilities.
    • 2021/2022 Reconciled 2% Supplemental Payment (1/1/21 – 12/31/21) – A portion of prior year’s 2% supplemental calculation was reconciled to incorporate the submitted 2021 cost report days.
  • July 1, 2022, Operating Rates – These rates were updated to include a case mix adjustment which was calculated using all assessment data submitted to CMS for the time period October 1, 2021, through March 31, 2022.
  • 2022-2023 Advanced Training Initiative (ATI) – Only eligible facilities received funds to offer training programs aimed at early detection of patient decline in order to reduce avoidable hospital admissions. The initiative recognized nursing home providers who have shown an ability to retain quality direct care staff and are willing to make a commitment to provide direct care staff the tools to help lower resident hospitalization rates.

Cycle # 2355, Check Release Date: October 26, 2022

  • Corrected 2022 January and April Operating Rates – DOH issued corrected rate sheets due to an error in the miscellaneous per diem (line 13). This rate package is titled “2022 Corrected Jan and April Rates” and can be found on the Healthcare Financial Data Gateway.

Cycle # 2350, Check Release Date: September 21, 2022

  • January 1, 2022, Initial Capital & Operating Rates:
    • `Operating & Case Mix Components: The January 1, 2022, rates remained unchanged from the previously issued rates provided in the DAL dated July 7, 2022.
    • Capital Component: 2022 capital reimbursement rate that is based on 2020 certified cost report and approved attestations. The capital component is also reduced by an overall five-percent cut. This five-percent cut is reflected on line 13 of the operating rate sheets as part of the Miscellaneous Per Diem Adjustment. NOTE: The deadline to file appeals on the Health Commerce System is December 23, 2022.
  • April 1, 2022, Operating Rates – A 1% operating increase that was included as part of the State Fiscal Year 2023 Enacted Budget. Additionally, these rates contained updates to the 1.5% Transformation Fund add-on.

Cycle # 2349, Check Release Date: September 14, 2022

  • Release of 5% Case Mix Index Cap – Due to an amended State regulation, the 5% case mix cap language was eliminated. As a result, DOH released funds held and recouped funds owed pursuant to the 5% case mix cap, for the rate periods July 1, 2017, through January 1, 2021.
  • Recalculation of the 1.5% Across the Board Investment Annually – The 1.5% increase was applied to the November 1, 2018, rates and not recalculated each year when initial (i.e., January) rates were released. The 1.5% increase for the initial rates in effect for the rate periods January 1, 2019, through January 1, 2022, are now recalculated.

There are multiple rate packages in the pipeline that DOH is currently working on and should be released in the near future: 2021 Reconciled Cash Receipt Assessment Per Diem, 2023 Initial Capital Rate, January 1, 2023, Operating Rate with updated case mix and the 2021 Nursing Home Quality Pool.

If you have any questions or are interested in learning about what impact these items may have on your facility, we’re here to help. Please do not hesitate to reach out to Chelsea Murray at cmurray@bonadio.com for additional information.

This material has been prepared for general, informational purposes only and is not intended to provide, and should not be relied on for, tax, legal or accounting advice. Should you require any such advice, please contact us directly. The information contained herein does not create, and your review or use of the information does not constitute, an accountant-client relationship.