Reimbursement Update

Carl J. Pucci in Finance & Reimbursement

The DOH “Nursing Home Rates” webpage now reflects recent updates for the following rate setting items:

July 1, 2019 Revised Rates

  • Utilizes the January 30, 2019 MDS census picture date
  • Reflects the updated 2% QP penalty (for those affected)
  • Will be processed in Medicaid cycle #2217 (revised check release date 2/26/19) 

As noted in the DAL, the two-week Medicaid lag will be reinstated in two increments:

  • 2/19/20
  • 3/11/20

Thus, Providers will receive no Medicaid FFS payments for those weeks. 

2018 NHQP / 2019/20 1% Supplemental (i.e., Restoration) Payments 

  • Specific data for both calculations are now available.
  • Note: the NHQP funding is subject to the cash receipts assessment, while the 1% supplemental payment is not. 

Benchmark Rates 

DOH has notified MLTC’s that the Benchmark rates have been updated for the July 2019 revised rates. The July 2019 Benchmark letter to MLTC’s as well as the facility specific calculations are posted. 

2018 CRA Reconciliation 

Payment adjustments for the 2018 CRA Reconciliation were included in Medicaid cycle #2215 (check release date 2/19/20). The related facility back-up data is now posted. 

Members are urged to carefully review the DOH webpage for specific details on these issues.


Carl J. Pucci
Chief Financial Officer
518-462-4800 x36