DOH Monthly Update

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly rate-setting briefing earlier this afternoon.  The agenda items discussed included the following:

Rate Packages

  • 2013 CMI audited rates are back from DOB and should be sent to EMEDNY for processing next week.  The July 2013 and January 2014 affected rates will have the 5% CMI cap constraint removed.
  • 2014 CRA Reconciliation is also back from DOB and will be released in the next few weeks.  It is an estimated $14M statewide positive impact to providers.
  • The July 2015 and January 2016 rate updates are expected to be issued in early February.  Note: January 2016 rate will be updated to reflect the  2014 CRA billing per diem, as previously announced.

Advanced Training Initiative (ATI)

The ATI rates are at DOB, and will initially reflect the state share of the funding ($23M) as the state awaits CMS SPA approval.  DOH will fund the payments (approximately ½ of the est. $3.78/day) via a compressed Medicaid rate calculation (12/1/15 through 12/31/15 Medicaid days) in order to approximate the lump-sum payment to providers.

2015 NHQI (Quality Pool)

The 2015 Quality Pool results have been posted to both the DOH and MRT websites.  Attached is the link which depicts the various quintile scoring.  The 2013 and 2014 Quality Pool rate adjustments remain held due to litigation proceedings.

Universal Settlement (US)

Members should have received a separate US mailing, including revised Appendix A ($ allocation to facilities) and B (DOH Account Receivable Balance), together with Attachment A (election of special appeals fund process) this past weekend.

OMIG Audits

NYSHFA raised member questions regarding DOH rate revisions from draft OMIG audits (vs. final audits).  DOH acknowledged that very few facilities were affected, but that they would review the process internally and with OMIG.  DOH would correct any successful audit challenges in subsequent rate issues.  NYSHFA will continue to pursue this issue with DOH on behalf of affected members.

Energy Efficiency Initiative

NYSERDA and DOH provided updates on the initial Stage II audit notifications.  They are seeking 10 -15 providers short-term (out of 30 selected) to respond.  First steps for providers would be to contact Scott Smith at NYSERDA, (518) 862-1090 x3344, with initial interest and/or questions.  DOH has met with contractors who will be allowing 30 -60 days post audit for billing, thus providing NYSERDA and DOH adequate time to fund the total audit cost of the audits.

NYS Budget Update

  • DOH is reviewing the effects of year one funding of the minimum wage proposal on providers.  No details were provided, as further research continues.  NYSHFA and other statewide provider associations are aggressively advocating the legislature and Governor’s office for adequate Medicaid funding to cover costs associated with any minimum wage increases, if it occurs.
  • DOH will be eliminating transportation costs from the FFS pricing rates (approximately $0.43 and $0.54/day for facilities with less than 300 and greater than 300 bed’s respectively).  These costs should be direct billed to Medicaid and subsequently not part of the pricing methodology.

Capital Streamlining

DOH continues to view the Capital Attestation process as successful, with all but 40 facilities attestations being accepted.  Members are reminded that capital appeals need not be filed if providers attested to request capital rate corrections.

Shared Savings/Refinancing

DOH continues to respond to CMS questions, which are extensive in their scope.

NYSHFA will provide further details on these issues (including rate cycle numbers and respective dates) when they are made available from DOH.


Carl J. Pucci
Director, Finance & Reimbursement
518-462-4800 x36