New York State recently froze Medicaid rates for payments to SNFs until a new case mix reimbursement system is implemented.  Welcome to limbo-land!  The big question around the industry is – just how long will we be living in limbo-land?

It is pretty clear that the answer is – no one knows for sure.

The retirement of Section G from the MDS effective October 1, 2023 was the impetus for change. States had the option to use an OSA – Optional State Assessment. However, New York decided against it resulting in the decision to freeze rates.

What does this mean for providers?  When your January 1, 2024 rate is published, expect it to last for a while. But no one knows how long or what is next.

Because MDS assessments aren’t producing a meaningful score, it is difficult for a SNF to know where they stand with a reasonable level of confidence.

States like neighboring Massachusetts are implementing a PDPM based system. NYS DOH has stated that they do plan on working with stakeholders to plan a new methodology.  One can also expect that a consultant will be brought into the process.

For SNF providers, this leaves more questions than answers.

  • How long will the “frozen” rate last?
  • What will happen next?
  • Will there be a PDPM based system?
  • Will a PDPM based system include rehab? Or just nursing?
  • Will the new system be similar to any other states?
  • What should I do in the meantime?
  • Should I stop delivering therapy to LTC patients because it won’t help my case mix?

Recent history such as the MDS 3.0 transition in 2010, has taught us that radical changes in patient care strategies based on reimbursement are frowned upon by CMS.  This could result in future audits. The purpose of providing therapy to long-term care patients helps them to prevent decline and restore function.

For now, give great care and document appropriately. Stay in touch with consultants and stakeholders who are truly connected in the industry.  Language Fundamentals is glad to be a resource if you have any questions.