DOH Monthly Update - April 2016

Carl J. Pucci in Finance & Reimbursement

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

1% Rate Restoration

DOH has updated the regulations related to the changes to the statewide prices, and most work has been completed on the rate package.  The two years (2014/15 and 2015/16) will be rolled into the 4/1/15 base rates, with the 4/1/16 rate prospectively adjusted going forward.  NYSHFA inquired whether DOH would pay the state share prior to CMS SPA approval. DOH responded that it would discuss internally.  DOH may combine the medical transportation carve-out (est. to be $0.30 - $0.40/day) to this rate package, once finalized.

Minimum Wage

DOH will be working together with NYSHFA/NYSCAL and other associations to develop a work plan over the summer, detailing issues related to funding and CMS approval.  Meetings with the Associations will commence in May.

Rate Package’s

  • As announced in last week’s member mailing, the July 2015 and January 2016 rates were updated to include both the January and July 2015 MDS submissions.  DOH continues to work with approximately 100 facilities on their 2015 MDS submissions, and will adjust those rates accordingly once they are complete.  In addition, the July 2012 – July 2014 audited rates were “unwound”, pending final OMIG audits for that time period (see below).
  • DOH continues to make 2016 capital corrections on a facility-specific basis.
  • The outstanding 4/1/13 quarterly rates have gone to DOB for approval.
  • Benchmark rates have been updated to reflect the 1/1/16 rates (DOH website)
  • Cash Receipts Assessment billing per diem will be updated to 2014 (effective for the 2016 rates) in the very near future, as DOH internal approvals have been obtained.
  • DOH is constructing a rate chart for all outstanding and upcoming rate packages.  The chart will soon be shared with the Associations prior to being posted on the DOH website.  The goal is to provide nursing homes with key rate information (including cycle numbers and check dates) in a timely manner via the DOH website.

OMIG Audits

DOH is meeting with OMIG on a regular bi-weekly basis in efforts to streamline the MDS audit process.  It is expected that OMIG will begin finalizing the draft MDS audits by the end of May.  Once completed, DOH will make every effort to revise audited rates as soon as possible, thus removing the existing 5% cap constraint, where applicable.

Cost Reports

The RHCF software (and related DAL) will be released this Friday, 4/15/16.  The deadline will be 7/15/16, with no time extensions granted.

Advanced Training Initiative (ATI)

CMS has approved the SPA for the ATI, and providers should be seeing the federal match of funds possibly as soon as cycle #2014 (check dated 3/28/16, with check release 4/13/16). DOH will conduct upcoming meetings to measure the success of year one ATI funding, as well as discuss the ongoing issue of contracted staff prior to initiation of year two funding this fall.

Energy Initiative

DOH and NYSERDA are working with an energy consultant to review energy data on a statewide basis.  If approved, statewide provider data would allow for a larger targeted group of facilities to opt for energy audits.  The energy workgroup will be re-convening to discuss further.


Although nothing new to report regarding CMS discussions, DOH did indicate it may explore a regional approach (ie: county pilot program).

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


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