DOH Outlines Timing of 1.5% Across the Board (ATB) Medicaid Reductions

Final 2020-21 state budget extended the 1% ATB cut implemented on all providers and plans effective January 1, 2020 and included an additional .5% ATB cut effective April 1, 2020.

As reported in an alert to members on Wednesday, eMedNY, the state’s web-based Medicaid claims-processing system, has announced the implementation schedule of the anticipated across-the-board (ATB) Medicaid payment reductions. These reductions were included in the most recently enacted state budget.

The reductions begin for dates of service on or after April 2, 2020 and each state fiscal year (SFY) thereafter. All non-exempt Department of Health (DOH) state Medicaid payments will be uniformly reduced by 1.5%. This follows a 1.0% reduction effective from January 1, 2020 through April 1, 2020.

For services subject to the 1.5% reduction, all fee-for service payments will receive a decrease to Medicaid checks and/or Electronic Funds Transfers (EFT) for dates of services on or after April 2, 2020. In addition, managed care payments to health plans will be reduced through a 1.5% reduction to premium rates effective April 2, 2020.

Remittances will reflect the prospective 1.5% reduction (appearing as an “FC2” recoupment) starting in Medicaid Cycle 2231, which has a check release date of June 10, 2020. Retroactive adjustments will be made at a future date for previously submitted claims with dates of service spanning April 2, 2020 through May 13, 2020.

HCA will notify the membership when DOH provides additional information on this retroactive adjustment.

Some exceptions to the ATB reduction include: hospice services; the Traumatic Brain Injury waiver; and the Nursing Home Transition and Diversion waiver.

eMedNY’s entire announcement can be downloaded here.

These reductions were approved at a time when the Administration was already forecasting major Medicaid fiscal imbalances, well before the COVID-19 health emergency took a further toll on state finances. The Administration has warned of yet further cuts across a variety of state programs and services at the very moment when home and community-based providers are likewise struggling with the financial toll of COVID-19 response, including the rising cost of personal protective equipment, changes in referral patterns, surge capacity impacts and other effects. Federal relief aid is paramount, and HCA, in our outreach to Congress, is pressing for direct funds to support home and community-based providers struggling with COVID-19-related costs. We are also seeking funds to stabilize Medicaid- and Medicare-funded programs and services.