Nursing Homes
Nursing Homes
SFY 2017-18 Final State Budget Nursing Homes
While the Executive Budget included only one provision specifically affecting nursing homes , the final budget includes other provisions of interest . Major components of the budget affecting multiple providers ( e . g ., capital funding , VAP , etc .) are covered in the Overview section of this report . Provisions impacting nursing homes are detailed below .
Bed Hold Benefits
The Executive Budget included a proposal to eliminate Medicaid coverage and payment for all nursing home bed holds . For Medicaid beneficiaries aged 21 +, the final budget eliminates hospitalization bed hold payments entirely , while maintaining 10 days of therapeutic leave per 12-month period reimbursable at 95 percent of the Medicaid rate . The final budget also makes permanent a bed hold-related cut already reflected in current Medicaid rates that results in $ 18 million in annual savings . These changes are effective April 1 , 2017 .
We understand that for hospitalization situations on or after April 1 , 2017 , the relevant state regulations would apply to the facility . Specifically , the current requirements in the nursing home code [ 10 NYCRR 415.3 ( h )( 3 )] require that a home offer the first available semi-private room to a returning resident , consistent with its bed hold policy .
Nursing Home Benchmark Rate Requirement
Under existing DOH policies , Medicaid managed care plans have been required to reimburse nursing homes in their networks at the “ benchmark ” ( i . e ., fee-for-service ) rate or an alternative rate methodology for the first three years following the beginning of the transition to managed care . This means that the benchmark rate requirement was set to expire Feb . 1 , 2018 in New York City ; April 1 , 2018 in Nassau , Suffolk and Westchester Counties ; and July 1 , 2018 in the rest of the State .
The final budget requires Medicaid managed care plans to continue to reimburse nursing homes in their networks at the benchmark rate through at least Dec . 31 , 2020 . The benchmark rate requirement may be continued beyond that date , but DOH may require as a condition of continuation that total payments from Medicaid managed care plans to nursing homes must meet the value-based payment ( VBP ) requirements agreed to with the Centers for Medicare and Medicaid Services . The applicable requirement at present is that by April 1 , 2020 , 80-90 percent of all payments from managed care plans to providers must incorporate VBP Level 1 features ( i . e ., FFS with upside-only shared savings ), and 15 percent of payments from partially capitated plans ( e . g ., MLTC ) must be contracted at Level 2 ( i . e ., FFS with shared savings / losses ) or higher . DOH may waive this requirement for purposes of extending benchmark rates if it presents a financial hardship or threatens access to care .
An existing law already requires Medicaid managed care plans to pay nursing homes at the benchmark rate indefinitely for all out-of-network placements .
LeadingAge New York / April 2017 Page 18