Dear Administrator Letter

  • Letter is also available in Portable Document Format (PDF)

February 15, 2021

Dear Administrator:

This letter provides you with information regarding your Nursing Home Medicaid reimbursement rate effective January 1, 2021 for the treatment of COVID-19 persistently positive patients. To qualify for a rate enhancement for such patients, your Nursing Home must meet the following conditions:

  • Adhere to all terms of any Memorandum of Understanding (MOU) and/or other agreements your facility has entered with the DOH.
  • Bill the enhanced Medicaid rate only for residents that:
    • were discharged from a general hospital with a positive COVID-19 test, despite being beyond the CDC infectious period;
    • have received COVID-19 tests using a molecular test for SARS-Cov-2 RNA and received a positive result in accordance with State law and all applicable guidance, including but not limited to the DOH May 11, 2020 Directive titled “Hospital Discharges and Admissions to Nursing Homes and Adult Care Facilities´ and
    • consent to and require the services of a Nursing Home but based on COVID-19 molecular testing are otherwise unable to be admitted or returned to a NYS Nursing Home.
  • Once the resident tests negative, using an FDA approved or authorized test, for COVID- 19, the billing submission must revert to the traditional Medicaid rate, and discharge procedures should be implemented.
  • COVID-19 testing using a molecular test for SARS-COV2 RNA must be completed within 5 (five) calendar days post admission, and patients must be retested every 3 to 7 days thereafter.

The Medicaid rate add-on will be 50% of your current operating rate. This rate add-on reimburses Nursing Homes for the incremental and allowable costs associated with operating a COVID-Positive Only Facility, which include: physical plant modifications (e.g., airflow, ventilation design); deep cleaning; additional clinical care expenses; patient transport; increased staffing levels and associated worker support costs; procurement of additional personal protective equipment (PPE) and other supplies; and related administrative overhead and costs.

Attachment A includes six new rates codes and eMedNY billing guidance. If you have any questions regarding the rate information, please send an email to nfrates@health.ny.gov. If you have questions relating to the policies required for a COVID Nursing facility, please send an email to Covidnursinghomeinfo@health.ny.gov.