DOH Monthly Update - May 2016

Esq. Stephen B. Hanse and Carl J. Pucci in Finance & Reimbursement

The Department of Health (“DOH”) held its monthly update meeting this afternoon. The following is a brief summary of issues that were discussed:

Rate Packages

  • As previously reported by NYSHFA, the DOH posted its rate package inventory on its website. This inventory is inclusive of all anticipated rate packages that will be processed by the Department this year. Among other things, the inventory sets forth respective payment dates as well as expected payment cycle numbers. While acknowledging that certain dates may be aggressive and changes may need to be made, the Department’s stated goal is to meet the dates and payment cycles listed within the inventory. 
  • DOH continues to work with approximately 100 facilities on their 2015 MDS submissions and will adjust those rates accordingly once complete.

Case Mix Proposal

  • The DOH presented the attached draft proposal for revising their current methodology for collecting and finalizing the data that it uses to produce the case mix index for provider reimbursement purposes. Among the revisions included in the Department’s proposal is moving from a bi-annual collection period to an annual collection period which would result in a 10% case mix cap constraint as opposed to the current 5% cap constraint. The DOH has requested NYSHFA and other associations to review the draft proposal for future discussion.

Minimum Wage

  • The DOH is working internally on methodologies to include funding for the minimum wage in provider rates. The Department will commence meetings in June with NYSHFA/NYSCAL and other stakeholders to work through the methodology and attendant issues.

OMIG Audits

  • OMIG recently forwarded the 2012 audit data to the DOH. The Department is processing this data in an effort to revise audited rates as soon as possible and remove the current 5% cap constraint where applicable.

Transportation Costs

  • The Department recently completed the removal of transportation costs from pricing rates. However, as a consequence of insufficient data, there is a concern that certain non-medical transportation costs may have been incorrectly removed. In an effort to address this concern, the Department is going to circulate a draft provider transportation survey to NYSHFA and other associations for review and comment.

Optional Cost Report Requirements for New Owners

  • The DOH noted that certain recent purchasers of a nursing home have the option to file an off-year cost report and the Department will go back to the date of the sale and recalculate the capital component. The DOH plans on issuing a DAL to explain this matter in greater detail.

Capital Correction Schedule

  • The DOH is working with approximately 15 facilities on certain “catastrophic” capital issues which it anticipates completing by June 2016.

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


Stephen B. Hanse
Vice President & Counsel
518-462-4800 x25 

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