Uncollectable NAMI

The Department of Health and provider associations are working collaboratively to collect information related to Net Available Monthly Income (NAMI). New York State is interested in using this information to advance its current proposal for the state to assume responsibility for collecting NAMI. We appreciate your assistance in providing information requested below.

Please note that all individual responses to this survey will remain confidential and only aggregate data will be shared with outside parties.

Please complete a separate survey for each licensed nursing facility. The deadline to complete the survey is January 21.

Question Title

* 1. Please provide the following information:

Respondent Name:

Facility Name:

Opcert #:

Facility County:

E-mail:

Telephone:

Question Title

* 2. What local social services district (i.e., county or NYC HRA) is responsible for the greatest number of Medicaid recipients in your facility?

Question Title

* 3. What was the estimated total annual dollar value of NAMI you were supposed to collect for your facility for calendar year 2012?

Question Title

* 4. What was the estimated total annual dollar value of uncollected NAMI for calendar year 2012?

Question Title

* 5. In your estimation, what percentage of your annual uncollected NAMI is attributable to each factor below (your responses should add to 100).

Eligibility Lag

Noncompliance - Legal

Noncompliance - Pension

Noncompliance - Refusal to Pay/Funds Otherwise Spent

Question Title

* 1. Please provide the following information:

Question Title

* 2. What local social services district (i.e., county or NYC HRA) is responsible for the greatest number of Medicaid recipients in your facility?

Question Title

* 3. What was the estimated total annual dollar value of NAMI you were supposed to collect for your facility for calendar year 2012?

Question Title

* 4. What was the estimated total annual dollar value of uncollected NAMI for calendar year 2012?

Question Title

* 5. In your estimation, what percentage of your annual uncollected NAMI is attributable to each factor below (your responses should add to 100).

Question Title

* 6. Please provide any necessary comments below: