Medicaid Reimbursement Update

December 1, 2016

Presented by: Joseph F. Martello, CPA Managing Partner HMM, CPAs LLP

Intercounty Health Facilities Association

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Today’s Agenda… Reimbursement – Benchmark Rates Direct/Indirect Component Rate Add-Ons Capital Rate Streamlining Debt Refinancing / Shared Savings Initiative Energy Audits Rate Update Advanced Training Initiative Universal Settlement

Benchmark Rates

• Direct – Adjusted on Case Mix (with a cap over/under 5%) • Indirect – Price • Non Comparable – 2007 RHCF-4 • Rate Add-On Dementia, TBI, BMI • Property – 2015 RHCF-4, 2017 Rates

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Direct / Indirect Component

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DIRECT COMPONENT

RATE TRANSITION > 300 BED YEAR YEAR < 300 BEDS > 300 BEDS DIFFERENCE 2015 Year 4 114.32 124.46 10.14 2016 Year 5 114.85 125.03 10.18 2017 Year 6 115.37 125.59 10.22

INDIRECT COMPONENT

RATE TRANSITION > 300 BED YEAR YEAR < 300 BEDS > 300 BEDS DIFFERENCE 2015 Year 4 56.66 63.93 7.27 2016 Year 5 56.92 64.23 7.31 2017 Year 6 57.18 64.52 7.34

Rate Add-Ons

MDS * Dementia $ 8.00 Section I4200 CA, BA, PA, PB

Traumatic Brain Injury (TBI) $ 36.00 Section I5500

Bariatric (BMI) $ 17.00 Section K0200 * Changes twice a year (1/1 & 7/1) based on submission of MDS

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• Timeline o Early October – Initial 2017 Capital rate using automated

system and adjusted for known issues o December 2, 2016– Attestations for Corrections due o Initial 2017 rate, including capital with operator-certified

changes

• DOH involvement will be reduced with reliance upon a facility’s attestations; subject to OMIG audit

• Significant reduction in the number of capital appeals

Capital Rate Streamlining

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• Proposed Requirements o Closing date of refinancing must occur on or after 4/1/15

o Approved refinancing of previously approved financing

o Shared savings is 50% of interest savings only

o Only consider savings on o/s prior approved principal

NO closing costs

NO additional capital costs

o Written request to refinance is required as before

Debt Refinancing/Shared Savings Initiative

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• As part of the 2016-17 Executive Budget, DOH and NYSERDA (NYS Energy Research and Development Authority) working with energy audit firms to conduct energy audits.

• No cost to the facility receiving audit. • Facilities eligible are higher energy users. • Non Comparable – 2007 RHCF-4 • Call Tracey DeSimone at (518)-862-1090

x.3452 with questions.

Energy Audits

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Rate Update

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LATEST

TRANSITION DATE RATE DATE DATE PROCESSED

YEAR CMI EFFECTIVE DATE APPROVED 5%

OVER/UNDER Year 1 1/1/2012 7/1/2012 7/24/2013 7/29/2013

Year 2 7/1/2012 1/1/2013 3/7/2016 TBD

Year 2 1/1/2013 7/1/2013 1/15/2016 TBD

Year 3 7/1/2013 1/1/2014 1/15/2016 TBD

Year 3 1/1/2014 7/1/2014 8/3/2015 TBD

Year 4 7/1/2014 1/1/2015 8/3/2015 TBD

Year 4 1/1/2015 7/1/2015 2/2/2016 TBD

Year 5 7/1/2015 1/1/2016 9/7/2016 TBD Year 5 1/1/2016 7/1/2016 TBD TBD

Transition is Done 7/1/2016 1/1/2017 TBD TBD

2016/2017 Advanced Training Initiative

• $46 Million has been appropriated • Teach staff to detect early changes in

resident’s physical, mental or functional status that could lead to an avoidable hospitalization

• DOH using 2015 RHCF-4, Schedule P – Staff Turnover

• Per Diem add-on to rate if facility is above the State mean (78.8%) 10

• First and Second Installments paid in 2016. • Third Installment is due to be paid sometime

during the State Fiscal Year beginning 4/1/2017.

• The third installment could be paid sooner if room remains under the Medicaid Global Cap.

Universal Settlement

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Rate Sheet

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Rate Sheet

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Rate Sheet

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Rate Sheet

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Rate Sheet

* * = Goes on Rate Sheet

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Rate Sheet

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Rate Sheet

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Rate Sheet

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Information Not Presented on Slides

PPS Rates Tab 2 Page 1-2 Co-Insurance Bad Debts Tab 2 Page 6 Assessment Reconciliation Tab 2 Page 8-9 Nurses Aide Training Tab 2 Page 10 Flu Shots Tab 5 Page 12 Exclusions Under BBRA Tab 5 Page 1-11 Corporate Compliance Tab 7 Page 1-7 Record Retention Tab 8 Page 1-5

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Joseph F. Martello, CPA Managing Partner HMM, CPAs LLP Office: (631) 265-6289 E-Mail: jmartello@horanmm.com www.horanmm.com

THANK YOU - Questions?