It was a-coming: http://www.northjersey.com/community...ing_homes.html

Nursing homes that care for the sickest of patients should have been paid more this year under a new Medicaid reimbursement formula. But because of state budget cuts, it didn't turn out that way.

Instead, some nursing homes that had been slated for a substantial boost in reimbursements were warned last summer to brace for a 3 percent cut — only to be told in the autumn that their rates would be slashed by more than twice that proportion.

Like all things related to nursing-home finances, the reason is complicated — so much so that long-term center operators and their advocates were themselves caught off guard by the realization that a change meant to protect some nursing homes' bottom lines jeopardized others.

"Everyone had been told to expect a 3 percent cut, but some of our members suffered as much as an 8 percent cut," said Paul Langevin, president of the Health Care Association of New Jersey, which represents more than 300 long-term care centers. "That's a pretty dramatic difference, especially when you learn about it after you've already planned your budget and staffing levels for the year."

Here's what happened, in a nutshell: New Jersey officials had decided in July to move to a reimbursement system that would allow homes that care for the patients with greater medical needs to be paid at a higher daily Medicaid reimbursement rate.

But officials recognized that some of the facilities that care for healthier patients would be subject to an abrupt drop in revenue if the new rates weren't phased in more slowly, Langevin said. So the new reimbursement rules contained a provision that prevented any one nursing home's rates from going up or down by more than $10 a day.

But before that new rate system could go into place, the budget signed by Governor Christie called for a $75 million reduction in Medicaid spending on long-term care, which was supposed to be spread across all facilities in the form of a 3 percent cut. Because some facilities were already going to lose more than the amount called for in the new rate system, the state instead cut rates to those that hadn't already experienced a loss.

As a result, nursing homes such as Christian Health Care Center in Wyckoff, which three years ago opened a 68-bed, post-acute care unit to accommodate sicker patients, saw its daily per-Medicaid-patient reimbursement rate drop from $198 to $187, although the new rate system had previously promised to raise that figure to $225.

"It was really disillusioning to find that instead of moving to a rate system that would bring us closer to the actual costs of providing care, we would instead be taking a step backwards," said Douglas Struyk president and chief executive officer of Christian Health Care Center. He estimates his facility's actual cost of caring for Medicaid patients at between $250 and $260 a day.

The state notified nursing homes of the revised Medicaid rates in early October, more than three months into the current fiscal year, meaning some facilities would have to pay back a portion of reimbursements already received.