DOH Update – Finance - September 2016

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly update meeting late yesterday.  The following is a brief summary of issues that were discussed:

Minimum Wage

DOH reported on the provider minimum wage survey conducted last month.  610 facilities responded (95%), with 348 facilities demonstrating a need for reimbursement to offset the mandatory increases for minimum wage levels beginning in 2017.  Approximately $5.1M (after benefits) for wage increases, and an additional $4.0M (after benefits) for contracted staff was reported.  The total of $9.1M represents total dollars, and would be adjusted to reflect statewide Medicaid payor mix (approximately 76%). In addition to increasing the minimum wage dollar pool from $4M (initial RHCF averaging methodology) to $9M, the number of eligible facilities has now increased from 60 to 348. DOH, along with the associations, are now in discussions regarding allocation methodology in order to ensure appropriate rate implementation. The goal remains to have a rate methodology in place within the next few weeks in order to allow sufficient time for CMS and DOB approvals in order to process effective rates on or around 1/1/17.

OMIG Audits

The 2012 and 2013 OMIG Audits have been drafted and should be finalized in the near future. The 2012 audited rates should reach EMEDNY within the next 4 – 6 weeks, with 2013 audited rates following. DOH is in active discussions with OMIG to develop an audit streamlining process to review past audit findings and attempt to reduce the amount of time necessary to complete MDS audits going forward.

Rate Packages

Updates to the following rate packages were noted by DOH:

  • Cash Receipts Assessment – update the 2010 per diem to 2014, retroactive to 1/1/16 – cycle 2031 – check release date 8/10/16
  • Capital – DOH is planning on issuing a “preview rate” for 2017 Capital as early as next week. This is in advance of the normal 11/1/16 notice rate for capital, and will allow additional time for facilities to attest their capital rates in advance of the 12/2/16 attestation deadline.  DOH does not plan on issuing a capital correction schedule in 2017, given the success of last years’ attestation process, as well as the additional time granted this year via the “preview rate” issuance. A DAL is upcoming with more details.
  • 2016 Capital corrections – cycle 2039 – check date 10/5/16
  • July 2015 MDS census affecting January 2016 rates – cycle 2040 – check date 10/12/16
  • January 2016 MDS censusaffecting July 2016 rates are being finalized and are heading to division review prior to moving on to DOB for final approval.
  • 4/1/13 Cap release – still pending
  • 1% Restoration – DOH is still responding to CMS RAI’s (Request for Additional Information) prior to SPA approval.
  • Transportation Carve-out – DOH will hold the recoupment and match against the 1% restoration (upon approval) to ease the cash flow effect.
  • Advanced Training Initiative (ATI) – DOH has scheduled a meeting next week to discuss year 2 of funding.  (Details to follow.)
  • Upper Payment Limit (IGT) – 2014 funding has been approved by CMS and payment allocation schedules are en-route to affected provides.

NYSHFA will keep members appraised of further developments with respect to these issues.


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