DOH Monthly Update - March 2016

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly rate-setting update earliest this afternoon. The following agenda items were discussed:

1% Rate Restoration

DOH is moving forward with the 1% rate restoration, with draft payment methodology to follow in the upcoming weeks.

DOH indicated it will process the 2014/15 and 2015/16 payments (approximately $140M State and Federal share) into the 4/1/15 base rates.  An additional $70M (2016/17) would be funded prospectively into the 4/1/16 rates.  Final payment of the 1% restoration would be contingent on CMS SPA approval. NYSHFA has continuously advocated for the rate restoration.

Rate Packages

  • The July 2015 and January 2016 rates will be updated for the January 2015 MDS submission. The rates have been sent to EMEDNY for processing.
  • The 2014 CRA Reconciliation is being processed this week (cycle 2008), however, the 2014 per diem update into the 2016 rates is still pending.

OMIG Audits

As previously announced, DOH has reversed its’ position related to recoupments based on Draft OMIG Audit reports.  As such, DOH will batch outstanding OMIG adjustments once the 2012 and 2013 audits are finalized, and revise the rates accordingly. DOH expects audits for both rate years to be finalized by OMIG within 60-90 days.

Cost Reports

The RHCF-4 software is expected to be released on the HCS April 15, 2016.  Note:  The deadline for the 2015 RHCF has been changed to July 15, 2016 (vs. August 15, 2016). DOH had indicated the due date would be revised in briefings late last year.

DOH will also require a facilities PFI number to now be included in the configure section of the cost report.

Advanced Training Initiative (ATI)

DOH is confident of CMS approval following recent responses to their SPA questions.  Once approved, DOH will match the State share funding, which is being released this week (Cycle 2008).

2016 Benchmark Rates

DOH has indicated the 2016 Benchmark rates would be updated in the very near future. NYSHFA will continue to monitor the DOH website and keep members informed.

Energy Initiative

The Energy Workgroup will be reconvening in the next few weeks to discuss NYSERDA’s plan to provide in depth energy analysis of consumption data in an effort to better target potential nursing homes to initiate optional energy audits.

Transportation Cost Removal

DOH is reviewing providers’ transportation costs which were inadvertently included in the statewide pricing methodology. This will require regulatory change as well as CMS SPA approval.  Initial estimates call for a carve-out of approximately $0.30 - $0.40/day for medical transportation costs which currently are direct billed to FFS.

NYSHFA will provide further details on these issues as we receive updates from DOH.


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