NHTD and TBI 2% Rate Cut Provider Letter

August 20, 2012

Dear NHTD/TBI Provider:

The NYS 2011-12 Enacted Budget required a two percent (2%) across the board reduction in most Medicaid (MA) payments. This reduction remains in effect until March 2013.

On November 3, 2011, the Department posted an informational letter concerning the Medicaid payment reduction on the eMedNY general update site at listserv/emednygeneralupdates/all_provider_types_11-3-11.pdf.

To meet the savings target, all payments for services provided through the Nursing Home Transition and Diversion (NHTD), and Traumatic Brain Injury (TBI) 1915(c) MA waivers will now be reduced by two percent (2%) for dates of service beginning on or after April 1, 2012 and will remain in effect through March 31, 2013.

These reductions will be reflected in the MA check or electronic funds transfer (EFT) beginning with Cycle 1829 (check date 09/10/2012). However, this date is subject to change depending upon DOH system priorities.

In order to recover funds already paid to you from 4/1/2012 through the present, the reprocessing of these claims will occur automatically via the eMedNY retro rate process. When these claims process, an "accounts receivable" will be established for your MA provider identification number. Each cycle (week), the system will reduce your weekly payment check by 15 percent (15%) until the receivable has been satisfied. Similarly, because the reduction is being handled retroactively, there will be a separate remittance generated at the time of processing showing every claim involved and the exact amount by which it was reduced. Each subsequent week, the 15% is subtracted to offset the account receivable, and itwill be identified on the paper remittance by Financial Reason Code "RR1".

For information regarding the 2% Across the Board Reduction, go to the DOH Redesigning New York's Medicaid Program.

If you have questions regarding the reductions, please direct them to following electronic mailbox: 2PercentAcrosstheBoard@health.state.ny.us. Include your provider name and Medicaid number on the email so that questions can be reviewed. If you have questions regarding the NHTD or TBI Programs, call 518-474-5271 or email them to mailboxes nhtdwaiver@health.state.ny.us or tbi@health.state.ny.us, respectively.