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Long Term Care Medicaid Reimbursement Update

During the first quarter of 2021, the NYS Department of Health (DOH) was very busy issuing numerous rate batches impacting reimbursement to the Long Term Care industry. Current 2021 Medicaid cycles are impacting current and prior year revenues with updates to the Medicaid operating and capital rates. See summary and details below.

2021 Medicaid Cycles

Cycle # 2262, Check Release Date: January 13, 2021

2019 Nursing Home Quality Pool
– An annual budget-neutral pool of $50 million that was created to incentivize nursing homes across NYS to improve the quality of care for their residents, and to reward homes for quality, based on their performance.

2020/2021 1% Supplemental Payment – $140 million paid across all nursing facilities.

2019 Reconciled 1% Supplemental Payment – A portion of prior year’s 1% supplemental calculation was reconciled to incorporate the submitted 2019 cost report days.

Cycle # 2268, Check Release Date: February 24, 2021

January 1, 2020 & April 2, 2020 Rates:

  • Operating & Casemix Components: Both rates were updated to reflect the July 2019 MDS and may contain an adjustment to limit the impact for any facility that reported a casemix change of greater than plus or minus 5% when compared to the January 2019 MDS. These rates have also been updated to reflect the 2020 Minimum Wage, as well as updated 2% Penalty on poor performing nursing homes for NHQI years 2018 & 2019. The miscellaneous per diem line also includes the 5% cut to capital in the April 2, 2020 rate.
  • Capital Component: 2020 capital reimbursement rate that is based on 2018 certified cost report and approved attestations. The April 2, 2020 rate reflects a capital component that eliminates residual equity payments.

July 1, 2016 & January 1, 2017 Rates – Updates to these rates result from the review of the Minimum Data Set (MDS) data performed by OMIG for MDS periods of January 2016 & July 2016. The impact to the rates will reflect any audit adjustments and removal of the 5% casemix cap withhold for all facilities.

Cycle # 2269, Check Release Date: March 3, 2021

2019 Cash Receipt Assessment (CRA) – 2019 CRA per diem rates have been reconciled using the actual assessment liability and have been applied to 2019 and forward dates of service.

Cycle # 2271, Check Release Date: March 17, 2021

July 1, 2020 Rates – These rates have been updated to include a casemix adjustment for the January 2020 MDS collection. These rates contain an adjustment to limit the impact for any facility that reported a casemix change of greater than plus or minus 5% from the July 2019 MDS collection.

Cycle # 2272, Check Release Date: March 24, 2021

2020-2021 Advanced Training Initiative (ATI) & Cinergy Payments – Only eligible facilities to receive funds. Programs primary focus is training CNA’s to identify early signs of resident decline. Both very similar programs, except Cinergy is through the Vital Access Provider (VAP) program.

Cycle # 2273, Check Release Date: March 31, 2021

January 1, 2021 Rates:

  • Operating and Casemix Components: The components of the rates remain unchanged from the July 2020 rate and will be updated in a future action. The miscellaneous per diem line also includes the 5% cut to capital in the April 2, 2020 rate.
  • Capital Components: Reflects 2021 capital reimbursement rate that is based upon the facilities’ 2019 certified cost report and reflects approved attestations.

October 26, 2020 Residual Rates – Updated to include the Jan 2020 MDS collection period. Note: this rate only impacts facilities that are plaintiff-petitioner providers covered by the Order to reinstate residual equity payments.

Cycle # 2275, Check Release Date: April 14, 2021

October 26, 2020 Residual Rates – Updated to include the 2020 minimum wage and 2% penalty updates (if applicable). The miscellaneous per diem line includes the 5% capital cut, but it is incorrectly based on the capital rate without the residual. The DOH has been notified of the error.

Cycle # 2276, Check Release Date: April 21, 2021

2017-2019 Rate Appeal Correction Rates – Includes both operating and capital rates. The applicable calculations, summaries of affected appeals and the rate sheets have been posted on the Health Commerce System (HCS) for applicable facilities.

**DOH is allowing rate appeals to be filed within 30 days from the March 30, 2021 date on the Dear Administrator Letter (DAL).

If you are interested in knowing the impact of these items for your facility or for additional information, please contact us.

The information and advice we are providing for this matter relates to COVID-19 legislative relief measures. Because legislative efforts are still ongoing, we expect that there may be additional guidance and clarification from regulators that could modify some of the advice and information provided to you, after the conclusion of our engagement. We, therefore, make no warranties, expressed or implied, on the services provided hereunder.