DOH Medicaid Reimbursement Update: Frank Czernicki Bureau of Long Term Care Rate Setting Division of Finance and Rate Setting 1

Transcription

1 DOH Medicaid Reimbursement Update: Frank Czernicki Bureau of Long Term Care Rate Setting Division of Finance and Rate Setting 1

2 PROPOSED RATES PROCESSING SCHEDULE FALL/WINTER 2016 Initial 2016 Draft Notice Rates July 2012 AND January 2013 Audit Rate Revisions 2014 Cash Receipts Assessment Reconciliation July 2013 AND January 2014 Audit Rate Revisions July 2015 Nursing Home Rates (January 2015 MDS Collection) FINAL 2016 Rates, Including Capital Attestations. 2

3 Initial Draft 2016 Rates Released 11/2/2015 Currently use the July 2014 CMI Will Update for January 2015 CMI Facilities have until December 4, 2015 to submit attestations All acceptable attestations will become part of the 2016 Final Capital Attestations not accepted will become appeals is properly submitted to the EAS 3

4 PROPOSED RATES PROCESSING SCHEDULE FALL/WINTER CASE MIX AUDITS COMPLETED BY OMIG Month Description Rate Effective Date November 2015 Revision of the July 2012 & January 2013 Rates to include OMIG audit findings from the 2012 Audits July 2012 (retro) January 2013 (retro) To emedny 11/20/2015 Cycle 1997 Notes All case mix updates will be sent out paying up to 5.00% in accordance with , pending review of census date by OMIG 4

5 PROPOSED RATES PROCESSING SCHEDULE 2014 Cash Receipts Assessment Reconciliation Month Description Rate Effective Date December 2015 UPDATE FOR 2014 CRA 01/01/ /01/2014 To emedny Notes Mid-December Update CRA per diem Rebase state to 2013 beginning with the 2016 rates. 5

6 PROPOSED RATES PROCESSING SCHEDULE FALL/WINTER 2015 CASE MIX Month Description Rate Effective Date December 2015 UPDATE FOR 2013 Nursing Home Audits 07/01/ /01/2014 To emedny End of December Notes Release 5.00% Withhold and pay rates with audits impact included 6

7 PROPOSED RATES PROCESSING SCHEDULE FALL/WINTER 2015 CASE MIX Month Description Rate Effective Date January 2016 January 2015 CMI 07/01/ /01/2016 To emedny Publish with the processing of the Initial 2016 Rates Notes All case mix updates will be sent out paying up to 5.00% in accordance with , pending review of census date by OMIG 7

8 PROPOSED RATES PROCESSING SCHEDULE FALL/WINTER INITIAL DRAFT NOTICE RATES Month Description Rate Effective Date January FINAL To emedny Notes January 2016 Mid January Final rates ill include revised capital 2016 using the 2014 RHCF-4 and acceptable attestation adjustments Rates The FINAL January 2016 rates will include the January 2015 MDS 8

9 Initiatives Update NAMI Advanced Training Initiative Refinancing / Shared Savings Energy Universal Settlement 9

10 NAMI NAMI is being offset from the Medicaid Premium paid to the managed care plan. Per the NH Transition Policy paper the collection of the NAMI falls on the Managed Care Plan. Plans have the Option to: 1. Assume the responsibility to the Collect NAMI and administer the personal needs allowance or 2. Negotiate with the Nursing Homes leaving the responsibility to collect NAMI with the homes 10

11 NAMI NYSDOH in collaboration with industry representatives has drafted a proposal for the state to assume the responsibility of collecting the NAMI. This proposal is precedent setting and will require time to be developed to completion *. Currently the proposal has been submitted to CMS for review with a meeting scheduled for November 24 * Contingent on CMS s Approval of the Proposal 11

12 Advanced Training Initiative Applications have been received Review of Applications is Underway Review by Division of Residential Services (as needed) Meeting with CMS on 11/24/2015 Projecting payments December

13 Refinancing / Share Savings Implementation for refinancing closed on or after April 1, 2015 Shared savings is based upon tangible, aggregate savings from the refinancing Mortgage refinancing approval is based on the same historic approval parameters. Refinancing must be approved by DOH prior to the refinancing be eligible for shared savings. Meeting with CMS to discuss issues and concerns on 11/24/

14 Energy Pilot List of 30 Facilities Created Higher energy users Geographically Diverse Energy Audits are being completed to aid in the formation of an overall Energy Program Additional audits may be performed. 14

15 Universal Settlement Settlement packages are being finalized All negotiated changes are being made part of the packages Anticipate sending agreements to Counsel on 11/19/2015 Settlement Packages will include: Agreement List of Excluded Appeals Discontinued Audits Signing dates are to be determined In person signing is not required, but preferred 15

16 Capital Streamlining Streamlined Capital implemented for 2016 OPTIONS: Accept the DOH calculated capital per diem in total Facility attest to revised capital calculation Attestation must comply with all regulations and DOH policy Attestations which are not in compliance with regulation or policy will be rejected in total 16

17 Capital Streamlining Appeal rights are preserved for all items in a rejected attestation Accepted attestations are subject to OMIG audit The submission of an attestation DOES NOT constitute an appeal Rejected attestations issues must be appealed through the EAS 17

18 Questions: 18