Nixon Peabody LLP

  • People
  • Capabilities
  • Insights
  • About

Trending Topics

    • People
    • Capabilities
    • Insights
    • About
    • Locations
    • Events
    • Careers
    • Alumni

    Practices

    View All

    • Affordable Housing
    • Community Development Finance
    • Corporate & Finance
    • Cybersecurity & Privacy
    • Environmental
    • Franchising & Distribution
    • Government Investigations & White Collar Defense
    • Healthcare
    • Intellectual Property
    • International Services
    • Labor & Employment
    • Litigation
    • Private Wealth & Advisory
    • Project Finance
    • Public Finance
    • Real Estate
    • Regulatory & Government Relations

    Industries

    View All

    • Cannabis
    • Consumer
    • Energy
    • Entertainment
    • Financial Services
    • Healthcare
    • Higher Education
    • Infrastructure
    • Manufacturing
    • Non Profit
    • Real Estate
    • Technology

    Value-Added Services

    View All

    • Alternative Fee Arrangements

      Developing innovative pricing structures and alternative fee agreement models that deliver additional value for our clients.

    • Continuing Education

      Advancing professional knowledge and offering credits for attorneys, staff and other professionals.

    • Crisis Advisory

      Helping clients respond correctly when a crisis occurs.

    • DEI Strategic Services

      Providing our clients with legal, strategic, and practical advice to make transformational changes in their organizations.

    • eDiscovery

      Leveraging law and technology to deliver sound solutions.

    • Global Services

      Delivering seamless service through partnerships across the globe.

    • Innovation

      Leveraging leading-edge technology to guide change and create seamless, collaborative experiences for clients and attorneys.

    • IPED

      Industry-leading conferences focused on affordable housing, tax credits, and more.

    • Legal Project Management

      Providing actionable information to support strategic decision-making.

    • Legally Green

      Teaming with clients to advance sustainable projects, mitigate the effects of climate change, and protect our planet.

    • Nixon Peabody Trust Company

      Offering a range of investment management and fiduciary services.

    • NP Capital Connector

      Bringing together companies and investors for tomorrow’s new deals.

    • NP Second Opinion

      Offering fresh insights on cases that are delayed, over budget, or off-target from the desired resolution.

    • NP Trial

      Courtroom-ready lawyers who can resolve disputes early on clients’ terms or prevail at trial before a judge or jury.

    • Social Impact

      Creating positive impact in our communities through increasing equity, access, and opportunity.

    1. Home
    2. Insights
    3. Alerts
    4. Seeking over $179 million in cost saving measures, New York proposes reduced reimbursement for multiple OPWDD services Alerts

    Alert / Health Care Alert

    Seeking over $179 million in cost saving measures, New York proposes reduced reimbursement for multiple OPWDD services

    June 4, 2020

    Share

    By Jéna Grady and Jennifer Greco

    This alert was co-authored by Meredith LaMaster.

    On Wednesday, May 27, 2020, the New York State Department of Health (“DOH”) issued two (2) public notices proposing to amend the New York Medicaid State Plan and 1915(c) Home and Community-Based Services Comprehensive Waiver (“HCBS Waiver”) to effectuate certain rate setting provisions in the approved 2020–2021 New York State Budget. If submitted and approved by the Centers for Medicare and Medicaid Services (“CMS”), such amendments will in part significantly affect OPWDD provider agency reimbursement for Intermediate Care Facilities (“ICFs”) and Supervised Residential Habilitation services. New York seeks to annually save for Medicaid expenditures around $75.2 million for the adjustments to intermediate care facilities and other OPWDD services (e.g., health home reimbursement) and $103.8 million for adjustments under the HCBS Waiver.

    Proposed reimbursement cuts and rate-setting changes

    Under the current proposed HCBS Waiver application, DOH and OPWDD will amend the HCBS Waiver to provide rate-setting changes that either reduce or eliminate the “occupancy adjustment” for Supervised Residential services and implement other limits to reimbursement when an OPWDD member is not in residence. Occupancy Adjustments permit an adjustment to the calculated daily rate of an OPWDD provider agency that provides Supervised Residential services to account for days when Medicaid billing cannot occur (e.g., an OPWDD member is absent due to hospitalization). Nonetheless, DOH and OPWDD proposed in the HCBS Waiver application that effective on or after October 1, 2020, the occupancy adjustment shall be 0%.

    Additionally, during the COVID-19 pandemic, OPWDD provider agencies have relied on reimbursement for “retainer days.” Retainer days are days of medical leave or an associated day where other in-patient Medicaid payment is made for providing services to an OPWDD member. DOH and OPWDD propose that effective on or after October 1, 2020, retainer days will be reimbursed at a rate of fifty percent (50%) of the provider’s established rate. DOH and OPWDD also propose that reimbursement for “therapy days,” where an OPWDD member is away from the supervised residence for the purpose of visiting with family or friends, will be reimbursed at a rate of fifty percent (50%) of the agency’s established rate and that such agency will also be limited to only ninety-six (96) therapy days per rate year per person.

    DOH and OPWDD also intend for the New York State Medicaid State Plan to address the rate setting methodology for calculating occupancy adjustments for ICFs by either completely removing or reducing any adjustment to address vacancies effective on or after October 1, 2020. The agencies also propose to “impose a limit on the amount of administration that is recognized in the rate methodology, as well as consider other actions to limit reimbursement where individuals are not in residence.” Further details on the proposed amendment to the State Plan are not yet publically available.

    The above proposed rate adjustments under the HCBS Waiver and the Medicaid State Plan will have a significant impact in reimbursement for OPWDD provider agencies that have already faced substantial vacancies and lack of provided services in their facilities during the COVID-19 pandemic.

    Next steps

    DOH and OPWDD are seeking public comments on these proposed changes. More information can be found in the New York State Register.

    Public comments for the amendment to the HCBS Waiver must be submitted by July 1, 2020. Once DOH and OPWDD review the comments, DOH will submit the amended HCBS Waiver to CMS for approval.

    Healthcare

    Locations

    AlbanyLong IslandNew York CityRochester

    Practices

    HealthcareBehavioral HealthHealthcare Regulatory & ComplianceMedicare & Medicaid and Other Government Payors

    Industries

    Healthcare

    Insights And Happenings

    • Alert

      New York’s OPWDD releases interim COVID-19 guidance regarding community habilitation and care planning activities

      May 11, 2020
    • Alert

      New York Medicaid Redesign Team II issues proposals that include emphasis on Long Term Care

      March 23, 2020

    Subscribe to stay informed of the latest legal news, alerts, and business trends.Subscribe

    • People
    • Capabilities
    • Insights
    • About
    • Locations
    • Events
    • Careers
    • Alumni
    • © 2023 Nixon Peabody. All rights reserved
    • Privacy Policy
    • Terms of Use
    • Statement of Client Rights
    • Supplier Diversity Program
    • Nixon Peabody International LLC
    • PAL