DOH Monthly Briefing - May 2020

Carl J. Pucci in Finance & Reimbursement

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed:  

COVID -19 

NYSHFA raised the question of appropriate Medicaid reimbursement for the recent Executive Order mandating biweekly employee testing. DOH is presently discussing the issue internally and will communicate guidance when a decision has been reached. 

January 1, 2020 Rates 

DOH will initially release the 1/1/20 rates to include the updated capital, maintaining the existing case mix currently being paid via the July 1, 2019 rates. This would ensure that the capital rate would not be further delayed due to the MDS submission process described below. The rates would then require DOB approval, so most likely would not be issued until sometime next month. 

DOH will then move forward with an enhanced and simplified MDS collection process, which will be based on the July 31,2019 census picture date for case mix revisions to the 1/1/20 rate. A DAL and webinar will provide guidance related to this planned “streamlined” MDS collection process. The Jan. 1, 2020 rates will then be reissued to include the revised case mix adjustment utilizing the 7/31/19 census picture date. 

We stressed the importance of the rate issuance and subsequent update to the Benchmark Rates, as providers encounter difficulties with the MLTC plans paying retroactive rate adjustments, which will now approach six months.

The 2020/21 Executive Budget cuts, including the increase in the Medicaid claims payment cut from 1% to 1.5%, the 5% capital rate reduction and the loss of residual reimbursement (all effective 4/1/20) are still under review at DOB. NYSHFA will be addressing the cuts to residual reimbursement directly with DOH sometime next week. 

FFS Transition  

The implementation of the MLTC-FFS nursing home benefit limitation continues to be delayed. DOH has notified plans that June 1, 2020 implementation date will not occur for long-term nursing stay residents to disenroll from MLTC plans. Once the DOH-coordinated batch disenrollment occurs, residents meeting the three-month threshold going forward will be disenrolled by individual plans. 

DOH has indicated OHIP guidance will be released in the next few weeks and we have again requested a coordinated briefing with OHIP to discuss the transition implementation. Members should continue to forward questions and concerns to NYSHFA and/or MLTCNH@health.ny.gov

Medicaid Lag / CRA Suspension 

NYSHFA has requested that DOH suspend both the two-week Medicaid payment lag as well as the monthly CRA payment obligation due to the cash flow constraints caused by the pandemic. DOH recognizes this issue and is discussing at the department’s executive level. No additional information is available at this time.

2019 RHCF 

The RHCF process is being review across the entire LTC sector. No specific date on either the software release or the filing deadline was announced. Once issued, DOH will allow the same response time as in previous years for filing. 

NYSHFA will keep members updated on these rate-setting issues as they develop. 

NYSHFA/NYSCAL CONTACTS:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – January 2020

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed:

FFS Transition

CMS has approved the 1115 Amendment on limiting the MLTC partial plan nursing home benefits to three months (i.e., MLTC to FFS transition) for those that have been designated as long-term nursing home stay (LTNHS) residents, formerly described as “permanently placed” residents. 

DOH Division of Long Term Care is working with Maximus to notify LTNHS dual eligible residents who are seeking enrollment that they no longer need to enroll in a plan. Those residents who have already been scheduled to enroll will receive a notice that effective 2/1/20, their plan enrollment will end, and they will continue to receive services through regular Medicaid FFS. Mandatory enrollment of LTNHS dual eligible members has already been terminated to avoid unnecessary enrollments in light of this policy change. 30-day notices to all MLTCP enrollees will be mailed within the next week.

Members should refer to the attached DOH PowerPoint for specific timelines related to prospective enrollees (slide 3), as well as to the “Upstate/Downstate” implementation designation (slide 4.) Disenrollment information will be added to the existing Maximus form, to be distributed in late March (slide 5.)

DOH will be issuing a detailed DAL which will provide next steps. A Frequently Asked Questions (FAQ), as well as enrollee transition to the community guidance will also be developed. Initial questions should be forwarded to doh.sm.mltcnh@health.ny.gov. NYSHFA will closely monitor the transition back to FFS and provide regular updates over the coming weeks.

1% A-T-B Medicaid Cut 

As announced previously, the State has imposed a 1% Across-The-Board (ATB) cut to all non-exempt Medicaid providers. (See member mailing 1/2/20).

DOH will begin recouping 1% of FFS Medicaid claims via the EMEDNY system for dates of service 1/1/20 and forward. The CMS State Plan Amendment (SPA) will be modified accordingly. The MLTC’s will have their premium payments reduced 1%, also effective 1/1/20. DOH has not yet made a decision on whether the 1/1/20 benchmark rates will be adjusted for the 1% cut. 

Case Mix – July 1, 2019 Rates

DOH is presently processing the MDS certifications, which were due today (1/14/20). The 7/1/19 rates are expected to be recalculated next week. The rates will then move to DOB for approval. DOH will provide a payment cycle date as soon as possible. The Medicaid lag suspension will remain in place until the 7/1/19 rates are issued. Members should prepare for estimated resumption of the lag shortly after the rates are released, most likely mid to late February. 

January 1, 2020 Rates   

The 1/1/20 notice rates are under internal agency discussion as a result of our case mix litigation Preliminary Injunction. Further guidance regarding the 1/1/20 rates will be forthcoming once the 7/1/19 rates are issued. Subsequently, DOH will provide MDS data collection period guidance based on the 7/31/19 picture date in preparation for the 1/1/20 rates. Questions related to the notice rates should be emailed to DOH via the nfrates@health.ny.gov

2018 NHQI/1% Restoration 

The 2018 NHQI data results have been posted to the DOH website. DOH has indicated the 2018 NHQI and 1% Restoration are under final Executive review at DOB. DOH plans on again offsetting the NHQI adjustment with the 1% Restoration payments, similar to last year. DOH expects to release payment cycle dates in the very near future. 

2% QP Penalty 

The 2% Penalty rate package is also under final review at DOB. Facilities who are either coming off the 2018 2% QP Penalty or being added to the 2019 2% QP Penalty will have their 1/1/19 rates retroactively adjusted. DOH will share drafts of the respective rate calculations with the Associations in advance of issuance. The 2% QP will be issued separately, once the 2018 NHQI/1% restoration rate package noted above is released. 

2018 CRA Reconciliation 

The 2018 CRA Reconciliation has been approved by DOB. DOH should be finalizing the calculations in the upcoming weeks. 

Bedhold Revised Regulations 

The revised bedhold regulations were adopted, effective 5/29/19 (see member mailing). NYSHFA has been compiling members' bedhold questions and has forwarded them to DOH. DOH is formulating a Frequently Asked Questions (FAQ) document. Members should continue to email any bedhold questions to both nfrates@health.ny.gov as well as to NYSHFA. 

OMIG MDS Audits 

The 2016 final audit reports are in process. The 2017 field work will commence shortly in the Central Region. 

NYSHFA/NYSCAL CONTACT: 

DOH Monthly Briefing – Finance – December 2019

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed: 

Case Mix - July 1, 2019 Rates 

The 7/1/19 rates were issued on 10/9/19, utilizing an 8/8/18 through 3/31/19 MDS catchment period. The payment for these rates commenced with Medicaid cycle 2200 (check release date 11/6/19). Pursuant to our Preliminary Injunction, DOH will revert to the January 1, 2019 rates, (retroactive to July 1, 2019), which will go live in upcoming Medicaid Cycle #2207 (check release date 12/25/2019). All recoupments and/or shortages experienced by Providers will be adjusted in the system automatically upon implementation of the January 2019 rate. 

DOH has removed the two-week eMedNY lag for cycle #2207, as such, the targeted payment date will now be December 11, 2019. DOH remains on track with the December MDS collection process, (as outlined in the 11/21/19 DAL), to calculate the revised 7/1/19 rates. The lag will be reinstated once the 7/1/19 rates are recalculated. NYSHFA has requested that DOH give providers as much advance notice as possible as to the date the lag will be reinstated (expected to be sometime in January 2020) for cash flow planning. 

January 1, 2020 Rates 

The 1/1/20 notice rates are under internal agency discussion as a result of our Preliminary Injunction. Further guidance regarding the 1/1/20 rates and collection process will be forthcoming once the 7/1/19 rates are completed. Questions related to the notice rates should be emailed to DOH via the nfrates@health.ny.gov

Universal Settlement 

The fifth and final installment of the Universal Settlement has been transmitted to the Trustee’s (O’Connell and Aronowitz and Hinman Straub) accounts. The Trustees will reconcile Medicaid liabilities being applied to the payments prior to processing Provider checks. The Trustees expect to release the payments to Providers by the end of this month. 

FFS Transition 

DOH discussions with CMS have begun winding down. Specific guidance and next steps will be forthcoming from the Division of Long Term Care.

2018 NHQI/1% Restoration

The 2018 NHQI data results have been posted to the DOH website. DOH has indicated the 2018 NHQI and 1% Restoration are under final Executive review at DOB. DOH plans on again offsetting the NHQI adjustment with the 1% Restoration payments, similar to last year.

2% QP Penalty 

The 2% Penalty rate package is also under final review at DOB. Facilities who are either coming off the 2018 2% QP Penalty or being added to the 2019 2% QP Penalty will have their 1/1/19 rates retroactively adjusted. DOH will share drafts of the respective rate calculations with the Associations in advance of issuance. 

2018 CRA Reconciliation 

The 2018 CRA Reconciliation is under review at DOB. A timetable for finalization has not yet been established.

Advanced Training Initiative (ATI) 

The DOH ATI surveys have been completed by Providers, and DOH has funded both 2018/19 and 2019/20 to the MLTC plans who, in turn, have recently funded providers. NYSHFA continues to strongly advocate for an extension to the 3/31/20 ATI training deadline, and DOH has indicated extensions are likely to be granted. 

Bedhold Revised Regulations

The revised bedhold regulations were adopted, effective 5/29/19 (see member mailing). NYSHFA has been compiling members' bedhold questions and has forwarded them to DOH. DOH is formulating a Frequently Asked Questions (FAQ) document. Members should continue to email any bedhold questions to both nfrates@health.ny.gov as well as to NYSHFA.

OMIG MDS Audits

The 2016 audit field work is complete. OMIG has begun to distribute 2016 audit reports to Providers. The 2017 OMIG MDS field work has concluded in the Western and Northern Regions. OMIG will next begin MDS audits in the Long Island Region. 

NYSHFA/NYSCAL CONTACT: 

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing - Finance - November 2019

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed:  

Case Mix – Preliminary Injunction Granted 

Last Thursday, November 7, 2019, the Court granted our request for a Preliminary Injunction to halt the State’s implementation of its Medicaid case mix cut pending a final determination of our litigation on the merits. In its Order, the Court enjoined the State from implementing the new case mix methodology adopted for the 7/1/19 rates and directed the State to use the prior methodology for calculating Medicaid case mix rates. Consequently, DOH is going to begin the process of calculating the 7/1/19 rate pursuant to the prior methodology. Additionally, DOH is also beginning the process to determine its methodology to return funds to providers that were withheld pursuant to its new methodology. 

July 1, 2019 Rates 

The 7/1/19 rates were issued on 10/9/19, utilizing an 8/8/18 through 3/31/19 MDS catchment period. The payment for these rates commenced with Medicaid cycle 2200 (check release date 11/6/19). DOH is under internal agency discussion with regards to next steps in reaction to the recently issued preliminary injunction (see above). No immediate changes have yet been transmitted to EMEDNY regarding future rate payment adjustments, and the 7/1/19 benchmark rates currently posted will stay in effect until DOH establishes an operational plan. Any further action by the Court could also affect DOH’s plan of action. 

January 1, 2020 Rates 

The 11/1/19 notice rates, effective 1/1/20, have been issued. They include the initial 1/1/20 Capital Rate, the 1/1/20 Minimum Wage adjustment and a Case Mix adjustment which utilized the 4/1/19 through 9/30/19 MDS catchment period. As with the 7/1/19 rates, the 1/1/20 notice rates are under internal agency discussion as a result of the preliminary injunction. Questions related to the notice rates should be emailed to DOH via the nfrates@health.ny.gov

Universal Settlement 

DOH indicated that the fifth and final payment of Universal Settlement has been approved by DOB. The facility outstanding receivable calculation is being revised prior to MFM (Medicaid Financial Management) releasing the payment to the Trustees for facility distribution. 

2018 NHQI/1% Restoration 

The 2018 NHQI data results have been posted to the DOH website. DOH has indicated the 2018 NHQI and 1% Restoration are under Executive review. DOH also plans on again offsetting the NHQI adjustment with the 1% Restoration payments, similar to last year. 

2% QP Penalty 

The 2% Penalty rate package will be sent to DOB within the next few weeks. Facilities who are either coming off the 2018 2% QP Penalty or being added to the 2019 2% QP Penalty will have their 1/1/19 rates retroactively adjusted. DOH will share drafts of the respective rate calculations with the Associations in advance of issuance. 

2017 CRA Reconciliation 

The 2017 and 2019 CRA rates have been issued. Payments were processed in Medicaid cycles #2197 (10/16/19 check date) and #2198 (10/23/19 check date). 

2018 CRA Reconciliation 

The 2018 CRA Reconciliation is under Executive review. A timetable for finalization has not yet been established. 

Advanced Training Initiative (ATI)  

The DOH ATI surveys have been completed by Providers, and DOH has funded both 2018/19 and 2019/20 to the MLTC plans who, in turn, have recently begun funding providers. NYSHFA continues to strongly advocate for an extension to the 3/31/20 ATI training deadline. 

Bedhold Revised Regulations 

The revised bedhold regulations were adopted, effective 5/29/19 (see member mailing). NYSHFA has been compiling members' bedhold questions and has forwarded them to DOH. DOH is formulating a Frequently Asked Questions (FAQ) based on questions submitted by the Associations and Providers. Members should continue to email their bedhold questions to both nfrates@health.ny.gov as well as to NYSHFA.  

FFS Transition 

DOH is responding to CMS request for additional information (RAI) related to the transition back to FFS. DOH is still in discussions with CMS. No further updates were provided.   

OMIG MDS Audits 

The 2016 audit field work is complete. OMIG has begun to distribute 2016 audit reports to Providers. The 2017 OMIG MDS audit plan is currently being developed.  

NYSHFA/NYSCAL CONTACT: 

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – September 2019

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed: 

Case Mix

The Case Mix Workgroup recommendations were submitted to DOH on 6/28/19 (see member mailing). As the 7/1/19 rates are still under review, it is still uncertain as to DOH's response to the Workgroup recommendations. NYSHFA is actively opposing the State’s proposed changes in the Case Mix methodology and DOH acknowledged that opposition in today’s briefing. 

July 1, 2019 Rates 

The 7/1/19 rates are under Executive review. No further updates or timetables were given.

Universal Settlement 

DOH indicated that the fifth and final payment of Universal Settlement is on track to be issued during Fourth Quarter 2019. 

Capital Attestations 

The DAL outlining this years' capital attestation process has been issued. A reminder that all providers must file an attestation, regardless of whether their capital rate is correct or not. The due date is Wednesday, September 25, 2019. 

2017 CRA Reconciliation 

The 2017 Cash Receipts Assessment Reconciliation is under review with DOB and should be finalized during the next few weeks. The 2019 CRA rates are also under review with DOB. DOH will issue a corresponding DAL. 

2018 NHQI/1% Restoration/2% QP Penalty 

The 2018 NHQI data results have been posted to the DOH website. DOH has indicated it will prepare the 2018 NHQI, 1% Restoration, and 2% QP Penalty rate packages for submission to DOB by the end of September (following finalization of the 2018 RHCF data.) DOH also plans on again offsetting the NHQI adjustment with the 1% Restoration payments, similar to last year. Facilities who are either coming off the 2018 2% QP Penalty or being added to the 2019 2% QP Penalty will have their 1/1/19 rates retroactively adjusted. DOH will share drafts of the respective rate calculations with the Associations in advance of issuing. 

Bedhold Revised Regulations 

The revised bedhold regulations were adopted, effective 5/29/19 (see member mailing). NYSHFA has been compiling members' bedhold questions and has forwarded them to DOH. DOH is formulating a Frequently Asked Questions (FAQ) based on questions submitted by the Associations and Providers. The FAQs are close to finalization and should be released in the near future. Members should continue to email their bedhold questions to both nfrates@health.ny.gov as well as to NYSHFA. 

Advanced Training Initiative (ATI) 

DOH is finalizing the ATI surveys for both 2018 and 2019 and should release them within the next week. Additional training options have been added. DOH will prepare two separate calculations and fund two years to bring ATI to current status. Eligibility will be determined utilizing the respective 2017 and 2018 RHCF Sch P retention calculation. Since the MLTC to FFS transition has not yet been approved, ATI funding will once again flow through the MLTC plans. 

EO-38 Website

DOH is in discussions with their counsel regarding the EO-38 website updates. The form on the current website still requires a waiver for Executive salaries exceeding $199,000, despite the court ruling excluding non-Medicaid funds from the calculation (and this potentially negating the waiver requirement). NYSHFA continues to follow-up with DOH Legal seeking guidance related to the EO-38 filing. A separate member mailing will be issued once EO-38 guidance has been received. The State has proposed rule-making language which conforms to the court decision, and is found in the NYS Register.

FFS Transition 

DOH is responding to CMS request for additional information (RAI) related to the transition back to FFS. DOH is still in discussions with CMS. No further updates were provided.  

IGT Payments

IGT payment calculations are being finalized, and still await CMS SPA approval. As in prior years, the IGT funding will be split into two payments (tentatively September 2019/March 2020). 

OMIG MDS Audits 

The 2016 audit field work is complete. OMIG has begun to distribute 2016 audit reports to Providers. The 2017 OMIG MDS audit plan is currently being developed. 

NYSHFA/NYSCAL CONTACT: 

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – August 2019

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed:

July 1, 2019 Rates 

The 7/1/19 rates are under Executive review. No further updates were given. 

Case Mix Workgroup 

The Case Mix Workgroup recommendations were submitted to DOH on 6/28/19 (see member mailing). As the 7/1/19 rates are still under review, it is still uncertain as to DOH's response to the Workgroup recommendations. 

Bedhold Revised Regulations 

The revised bedhold regulations were adopted, effective 5/29/19 (see member mailing). NYSHFA has been compiling members' bedhold questions and has forwarded them to DOH. DOH is formulating a Frequently Asked Questions (FAQ) based on questions submitted by the Associations and Providers. The FAQs are close to finalization and should be released in the near future. Members should continue to email their bedhold questions to both nfrates@health.ny.gov as well as to NYSHFA. 

2017 CRA Reconciliation

The 2017 Cash Receipts Assessment Reconciliation is under review with DOB and should be finalized during early fourth quarter 2019. The CRA per diems will now reflect actual 2018 provider payments versus the previously announced plan to update the paid per diem from 2016 to 2017. The CRA per diem will again be updated to the 2019 rates, upon final approval. This process should minimize the reconciliation effect, as well as lead to more timely reconciliations going forward. 

2018 NHQI/1% Restoration/2% QP Penalty 

The 2018 NHQI data results have been posted to the DOH website. DOH has indicated it would prepare the 2018 NHQI, 1% Restoration, and 2% QP Penalty rate packages for submission to DOB in early September (following finalization of the 2018 RHCF data.) DOH also plans on again offsetting the NHQI adjustment with the 1% Restoration payments, similar to last year. Facilities who are either coming off the 2018 2% QP Penalty or being added to the 2019 2% QP Penalty will have their 1/1/19 rates retroactively adjusted. DOH will share drafts of the respective rate calculations with the Associations in advance of issuing. 

Advanced Training Initiative (ATI) 

DOH is finalizing the ATI surveys for both 2018 and 2019. Additional training options have been added. DOH will prepare two separate calculations and fund two years to bring ATI to current status. Eligibility will be determined utilizing the respective 2017 and 2018 RHCF Sch P retention calculation. Since the MLTC to FFS transition has not yet been approved, ATI funding may once again flow through the MLTC plans during 2019. 

EO-38 Website

DOH is in discussions with their counsel regarding the EO-38 website updates. The form on the current website still requires a waiver for Executive salaries exceeding $199,000, despite the court ruling excluding non-Medicaid funds from the calculation (and this potentially negating the waiver requirement). NYSHFA continues to follow-up with DOH Legal seeking guidance related to the EO-38 filing. A separate member mailing will be issued once EO-38 guidance has been received. 

FFS Transition 

DOH is responding to CMS request for additional information (RAI) related to the transition back to FFS. DOH is still in discussions with CMS. No further updates were provided. 

IGT Payments 

IGT payment calculations are being finalized, and still await CMS SPA approval. As in prior years, the IGT funding will be split into two payments (tentatively September 2019/March 2020). 

Universal Settlement (US) 

DOH indicated that the fifth and final payment of US could again take place as early as Fall 2019. 

OMIG MDS Audits 

The 2016 audit field work is complete. DOH/OMIG are resolving a data issue prior to issuing final audit reports. The 2017 OMIG MDS audit plan is currently being developed.

Capital Attestations 

A DAL outlining this years’ capital attestation process should be issued within the next week or so. Once issued, providers will have a 30-day response time to ensure timely issuance of the capital rates. 

NYSHFA/NYSCAL CONTACT: 

DOH Monthly Briefing – Finance – July 2019

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed: 

July 1, 2019 Rates 

The 7/1/19 rates are under Executive review. No further updates were given. 

Case Mix Workgroup 

The Case Mix Workgroup recommendations were submitted to DOH on 6/28/19 (see member mailing).As the 7/1/19 rates are still under review, it is uncertain as to DOH’s response to the Workgroup recommendations. 

Bedhold Revised Regulations 

The revised bedhold regulations were adopted, effective 5/29/19 (see member mailing). NYSHFA has been compiling members’ bedhold questions and has forwarded them to DOH. DOH is formulating a Frequently Asked Questions (FAQ) based on questions submitted by the Associations and Providers. Members should continue to email their bedhold questions to both nfrates@health.ny.gov as well as to NYSHFA. 

November 1, 2018 Rates 

The 11/1/18 rates which include the 1.5% transformation fund will be in Medicaid Cycle #2183 (check release date 7/10/19). Providers should see a positive retroactive adjustment from 11/1/18 forward through current billings. 

January 1, 2019 Rates 

The January 1, 2019 rates will be processed in upcoming Medicaid Cycle #2184 (check release date of 7/17/19). 

As noted in NYSHFA member mailing, the rates will be corrected for the Case Mix cap adjustment in upcoming Medicaid Cycle #2185 (check release date 7/24/19). 

2018 RHCF 

The 2018 RHCF filing deadline is Monday, July 29, 2019. Providers are urged to test the HCS/Gateway Portal for the proper authorization(s) to ensure timely filing of the RHCF. Members encountering any specific issues with the RHCF software should immediately email nfrates@health.ny.gov

2017 CRA Reconciliation

The 2017 Cash Receipts Assessment Reconciliation is under review with DOB and should be finalized during third quarter 2019. The CRA per diems will now reflect actual 2018 provider payments versus the previously announced plan to update the paid per diem from 2016 to 2017. The CRA per diem will again be updated to the 2019 rates, upon final approval. This process should minimize the reconciliation effect, as well as lead to more timely reconciliations going forward. 

2018 NHQI/1% Restoration 

The 2018 NHQI data results were posted to the DOH website last week. DOH has indicated it would implement the NHQI rate adjustments early Fourth Quarter 2019 (following the 2018 RHCF submissions). DOH also plans on again offsetting the NHQI adjustment with the 1% Restoration payments, similar to last year. 

EO-38 Website 

DOH is in discussions with their counsel regarding the EO-38 website updates. The form on the current website still requires a waiver for Executive salaries exceeding $199,000, despite the court ruling excluding non-Medicaid funds from the calculation (and this potentially negating the waiver requirement). NYSHFA expressed concerns given that the EO-38 filing date is rapidly approaching (7/29/19). 

Advanced Training Initiative (ATI) 

ATI funding was again included in the Enacted 2019/20 Budget. The ATI is currently under Executive review. No further timetables were given. Since the MLTC to FFS transition has not yet been approved, ATI funding may once again flow through the MLTC plans during 2019. 

FFS Transition

DOH is responding to CMS request for additional information (RAI) related to the transition back to FFS. DOH rate-setting will inquire internally as to the status of the RAI. No further updates were provided. 

Universal Settlement (US) 

DOH indicated that the fifth and final payment of US could again take place as early as Fall 2019. 

NYSHFA/NYSCAL CONTACT: 

DOH Monthly Briefing - Finance - May 2019

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed.

November 1, 2018 Rates

DOH will issue a separate 11/1/18 rate package (with DAL) containing the 1.5% Transformation Fund Increase, recently restored in the Enacted 2019/20 Budget. The rate package is under Executive review at DOH/DOB. The Associations requested that the benchmark rates be revised to include the 1.5% add-on as soon as possible.

January 1, 2019 Rates

The 1/1/19 rates are also currently in Executive review with DOH/DOB. It is expected that the Case Mix Adjustment will be updated for the July 2018 MDS, following past practice.

DOH did not specify current MDS upload periods, as has been the case since last Fall. DOH will be reviewing all acuity measures for the current period and will issue further information at the initial Case Mix Workgroup meeting.

Also included in the 1/1/19 rate is the initial 2019 Capital Rate, the 2019 Minimum Wage add-on, as well as the 1.5% Transformation Fund Increase. Additionally, various 2018 operating and capital rate corrections are also under review.

Case Mix Workgroup 

The DOH Case Mix Workgroup members have been selected, with NYSHFA having five representatives on the Workgroup. The initial meeting will be on 5/22/19. The Statute calls for Workgroup recommendations no later than 6/30/19. The recommendations are expected to address the upcoming July 2019 CMI methodology. 

2018 RHCF Software 

The 2018 RHCF software is expected to be released in the next week or so, along with the respective DAL. The RHCF filing deadline will be 60 days after the software release date. No major reporting changes are anticipated. Providers are urged to test the HCS/Gateway Portal for the proper authorization(s) to ensure timely filing of the RHCF.

2017 CRA Reconciliation 

The 2017 Cash Receipts Assessment Reconciliation is in final review with DOB and should be finalized during second quarter 2019. The CRA per diems will now reflect actual 2018 provider payments versus the previously announced plan to update the paid per diem from 2016 to 2017. This should minimize the reconciliation effect, as well as lead to more timely reconciliations going forward.

2015 OMIG Case Mix Audits 

The 2015 OMIG Case Mix Audits are under Executive review. The 5% CMI Cap will be released for affected providers upon finalization. OMIG has completed their 2016 audit fieldwork and will be releasing draft reports in the next 30 days or so. The 2017 audits should be commencing over the summer months.

NHQI – 2018 Quality Scores 

DOH is nearing completion of the 2018 NHQI Quality Scores. CMS has approved the 2018 NHQI State Plan Amendment. DOH will issue additional information and guidance in the near future.

Advanced Training Initiative (ATI) 

ATI funding was included in the Enacted 2019/20 Budget. The ATI is currently under preparation by DOH. No further timetables were given. Since the MLTC to FFS transition has not yet been approved, ATI funding may once again flow through the MLTC plans during 2019.

2019 Upper Payment Limit (UPL) 

The 2019 UPL has been submitted to CMS for approval. The 2018 IGT/UPL payments have recently been completed.

FFS Transition

DOH is responding to CMS request for additional information (RAI) related to the transition back to FFS. No further updates were provided. 

Shared Savings 

A DAL is expected in the coming weeks regarding updates to the 50% shared savings initiative, which will include the applicable form and further guidance. The start date for refinancing submissions remains April 2015 and forward.

NYSHFA/NYSCAL CONTACT:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing - Finance - April 2019

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed. 

November 1, 2018 Rates 

DOH will issue a separate 11/1/18 rate package (with DAL) containing the 1.5% Transformation Fund Increase, recently restored in the Enacted 2019/20 Budget. The rate package is under Executive review at DOH/DOB. DOH did not give a timeline on the rate issuance. The Associations requested that the benchmark rates be revised to include the 1.5% add-on as soon as possible.

January 1, 2019 Rates

The 1/1/19 rates are also currently in Executive review with DOH/DOB. DOH reiterated that the Case Mix Adjustment will be updated for the July 2018 MDS, following past practice. Also included in the 1/1/19 rate is the initial 2019 Capital Rate, as well as the 1.5% Transformation Fund Increase. DOH stated that with the Budget now passed, the primary focus will be to issue the various rate packages still pending. DOH will email the Associations upon receiving DOB approval as a precursor to issuing the 1/1/19 rates.

Case Mix Workgroup

The selection process is underway seeking the appropriate mix of representatives of residential health care facilities, statewide associations and other CMI experts to comprise the Workgroup. The Statute calls for Workgroup recommendations no later than 6/30/19. The recommendations are expected to address the upcoming July 2019 CMI methodology. Further Workgroup updates are expected early next week. 

DOH did not specify current MDS upload periods, as has been the case since last Fall. DOH will be reviewing all acuity measures for the current period and will issue further information at the initial Workgroup meetng.

2017 CRA Reconciliation 

The 2017 Cash Receipts Assessment Reconciliation is in final review with DOB and should be finalized during second quarter 2019. The CRA per diems will now reflect actual 2018 provider payments versus the previously announced plan to update the paid per diem from 2016 to 2017. This should minimize the reconciliation effect, as well as lead to more timely reconciliations going forward.

2018 RHCF
 

The 2018 RHCF software is expected to be released in early May along with the respective DAL. The RHCF filing deadline (expected to be end of July) remains three months post software release. No major reporting changes are anticipated. Providers are urged to test the HCS/Gateway Portal for the proper authorization(s) to ensure timely filing of the RHCF. DOH will issue a separate reminder on HCS/Gateway access later this week.

NHQI - 2018

DOH is nearing completion of the 2018 NHQI Quality Scores. An email will be sent to the Associations in the next week or so prior to publishing. CMS has approved the 2018 NHQI State Plan Amendment.

2015 OMIG Audits 

The 2015 OMIG Audits are under Executive review. The 5% CMI Cap will be released for affected providers upon finalization.

Advanced Training Initiative (ATI) 

Although continued ATI funding is included in the Enacted 2019/20 Budget, DOH did not give timelines on the provider notification process. With the MLTC to FFS transition not yet approved, ATI funding may once again flow through the MLTC plans during 2019.

2018/19 IGT Payments 

The second payment for the 2018 IGT will be issued towards the end of April. DOH is in discussions with CMS regarding the 2019 IGT package and expects approval in the coming weeks.

FFS Transition

DOH is responding to CMS request for additional information (RAI) related to the transition back to FFS. No further updates were provided.

Shared Savings

A DAL is expected in the coming weeks regarding updates to the 50% shared savings initiative. The start date for refinancing submissions remains April 2015 and forward.

NYSHFA/NYSCAL CONTACT:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – February 2019

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed.

November 1, 2018 Rates 

DOH will issue a separate 11/1/18 rate package (with DAL) containing the 1.5% transformation fund increase, which is currently pending CMS SPA as well as DOB approval.

Please note: the 11/1/18 Benchmark rates have been updated to reflect the 1.5% rate add-on.

January 1, 2019

The 1/1/19 rates are currently in Executive review. DOH indicated the Case Mix Adjustment will be updated for the July 2018 MDS, following past practice. Also included in the Operating Rate is the initial 2019 Capital Rate, as well as the 1.5% Transformation Fund Cost of Living Increase.

MDS Case Mix 

As previously reported, DOH has analyzed data from both the April 25, 2018 and July 25, 2018 collection periods. DOH has not yet disclosed how the data from both picture dates will be blended but intends to utilize the July 2018 CMI update in the 1/1/19 rates (as noted above).

With respect to the upcoming July 1, 2019 rates, DOH will be examining all MDS data points within a specific six-month period (as one example of the upcoming process). Citing a 50% increase in case mix acuity over the past three years, DOH requested that the Associations provide direct input to the Medicaid Director as to reasons behind case mix fluctuations in rate-setting vs non-rate-setting census periods, as well as the complexities surrounding the capturing of information related to all MDS submissions. DOH is noncommittal to the establishment of a CMI stakeholder workgroup. 

NYSHFA is actively opposing the related CMI budget cut and will continue its efforts to communicate our message, including meeting with all health leaders of the Senate, Assembly, the Governor’s office and DOB. 

FFS Transition

The State is continuing its efforts to limit the Nursing Home Benefit in Partially Capitated MLTC Plans to Three Months.

  • DOH submitted request to amend the 1115 Waiver and limit the nursing home benefit in Managed Long Term Care Plans to three months.
  • After three months, the beneficiary will be involuntarily disenrolled and coverage for nursing home services will be covered by Medicaid fee -for- service IF individual qualifies for institutional Medicaid coverage.
  • Draft letter sent to CMS requesting amendment in September 2018.
  • DOH presently responding to CMS request for additional information (RAI).
  • When CMS approves amendment DOH will set up stakeholder meetings to discuss how to operationalize.
  • Once amendment is approved, members will receive a Medicaid Choice (MAXIMUS) notice as well as a notice that their benefit is being changed back to fee-for-service.

Timely Billing Issue 

The Associations again raised concern with recent EMEDNY enforcement of timely billing edits, which combined with Medicaid district office determination delays, has resulted in increasing billing denials. NYSHFA has been in contact with appropriate DOH staff and is seeking member specific examples of delayed ineligibility determination, resulting in denied claims.

CRA Reconciliation 

The 2017 Cash Receipts Assessment Reconciliation is in final review with DOB and is expected to be finalized during first quarter 2019. The CRA per diems will be updated to a 2017 base (from 2016) for inclusion in the 1/1/19 Rates.

Minimum Wage

DOH has collected the 2017 Minimum Wage Survey Reconciliations and is reviewing the data. No specifics on implementation of the reconciliation were released.

OMIG Audits

The 2015 OMIG Audits are now complete and are under executive review. The Associations requested results of the aggregate 2015 audit impact, noting its relevance in relation to ongoing CMI discussions.

NYSHFA/NYSCAL CONTACT:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – December 2018

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed.

1% Restoration/NHQI

The 1% Restoration and 5-year retro impact of the NHQI have been processed via Medicaid cycles #2152 (12/5/18 check date) and cycle #2153 (12/12/18 check date). Members are urged to access the DOH payment link to track and reconcile their payments to the DOH supporting files. Paper checks have been released for facilities whose 1% Restoration payments were used to offset negative Quality Pool adjustments for both cycles, with respective mailing dates of 12/5/18 and 12/12/18 (see DOH transmittal for further details). For further information related to either cycle #2152 or #2153, members are requested to contact CSRA directly at 1-800-343-9000, or email DOH at nfrates@health.ny.gov

In addition, NYSHFA has been contacting DOH on behalf of members who are expecting cash flow difficulties as a result of being subject to a 100% check recoupment in upcoming Medicaid cycle #2154 (12/19/18 check release). See DOH DAL.

1/1/19 Notice Rates

DOH released the 1/1/19 notice rates on 11/1/18, as scheduled. (Please reference NYSHFA EXTRA, dated 11/2/18 for details.) In addition to the initial 2019 capital rate, the notice rates contain a 1.5% transformation fund increase (effective 11/1/18) to the operating rate for all providers. (contained in Line 13 of the summary rate sheet.) 

DOH will issue a separate 11/1/18 rate package (with DAL) containing the 1.5% transformation fund increase, which is expected prior to the 1/1/19 rate issuance. The 1/1/19 published rate (expected mid-January 2019) will be updated for the July 2018 CMI (see below).

MDS Case Mix Picture Dates

As previously reported, DOH continues to analyze data from both the April 25, 2018 and July 25, 2018 collection periods. DOH has not yet disclosed how the data from both picture dates will be blended but intends to include the July 2018 CMI update in the 1/1/19 rates. DOH remains committed to the CMI Workgroup going forward to analyze MDS historical trends and provide input with respect to future Case Mix periods.

FFS Transition

Limit the Nursing Home Benefit in Partially Capitated MLTC Plans to Three Months

  • DOH submitted request to amend the 1115 Waiver and limit the nursing home benefit in Managed Long Term Care Plans to three months.
  • After three months, the beneficiary will be involuntarily disenrolled and coverage for nursing home services will be covered by Medicaid fee -for- service IF individual qualifies for institutional Medicaid coverage.
  • Draft letter sent to CMS requesting amendment in September 2018
  • Public comment period extended to November 23, 2018
  • When CMS approves amendment DOH will set up stakeholder meetings to discuss how to operationalize
  • Once amendment is approved, members will receive a Medicaid Choice (MAXIMUS) notice as well as a notice that their benefit is being changed back to fee - for -service. 

Timely Billing Issue

The Associations again raised concern with recent EMEDNY enforcement of timely billing edits, which combined with Medicaid district office determination delays, has resulted in increasing billing denials. DOH will review this issue and NYSHFA will follow-up accordingly.

CRA Reconciliation

The 2017 Cash Receipts Assessment Reconciliation is in final review with DOB and is expected to be finalized during first quarter 2019. The CRA per diems will be updated to a 2017 base (from 2016) for inclusion in the 1/1/19 Rates.

OMIG Audits

The 2015 OMIG Audits are now complete and DOH is presently analyzing audit results prior to issuing related rate adjustments. The 2016 audits continue throughout the Central and Northern regions of the State.

Minimum Wage

DOH is reviewing the 2019 survey data for inclusion in the January 2019 rates. The 2017 minimum wage reconciliation survey should be released to facilities by the end of December.

Shared Savings

DOH plans on releasing further guidance related to Shared Savings during the 1st quarter 2019.

NYSHFA will keep members posted on these important rate-setting issues going forward. 

NYSHFA/NYSCAL CONTACT:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – November 2018

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed.

1/1/19 Notice Rates

DOH released the 1/1/19 notice rates on 11/1/18, as scheduled. (Please reference NYSHFA EXTRA, dated 11/2/18 for details.) In addition to the initial 2019 capital rate, the notice rates contain a 1.5% increase to the operating rate for all providers. (contained in Line 13 of the summary rate sheet.) The 1/1/19 published rate (expected mid-January 2019) will be updated for the July 2018 CMI.

1% Restoration/NHQI

The combined 1% Restoration/NHQI package has been approved by DOB and is currently slated for Medicaid cycle #2152 (expected release date 12/5/18). Note: The NHQI retroactive period will now encompass 2013 through 2017 (5 years to include the latest RHCF data). DOH will fund the earliest two fiscal years of the 1% Restoration ($140M) concurrently with the NHQI retroactive adjustment through 2021/22, then $70M going forward. The 1% Restoration is allocated based on an individual nursing home's Medicaid revenue divided by total Medicaid revenue. A DAL as well as a specific DOH website link will be posted with further details.

MDS Case Mix Picture Dates

As previously reported, DOH will be analyzing data from both the April 25, 2018 and July 25, 2018 collection periods. DOH has not yet disclosed how the data from both picture dates will be blended. The MDS data upload period (10/3 – 10/26/2018) has been completed, and the resulting data is now being analyzed. If members still have unmatched records, they should contact DOH via the primail@health.ny.gov address as soon as possible to resolve. DOH remains committed to the CMI Workgroup going forward to analyze MDS historical trends and provide input with respect to future Case Mix periods.

2% Quality Pool (QP) Penalty

The 2% QP Penalty, which is based on the 2016 and 2017 NHQI data, will be effective retroactive to the 7/1/18 rates (including the benchmark rates). The revised rates have been issued via Medicaid cycle #2145 (check release date 10/17/18). 92 providers are affected by the penalty and will absorb a 2% rate reduction. Those facilities that DOH deems financially disadvantaged (now updated to 2017 negative operating margin and negative fund balance) will be exempt from the initial penalty period. For recent ownership changes occurring during 2017 (as evidenced by a Part 1 RHCF filing), DOH may consider the previous owners 2016 RHCF data to determine the FD exemption. DOH may allow additional discretionary exemptions. The 2% QP reduction is also contained in line 13 of the summary rate sheet.

Gateway System

DOH has issued a DAL with details regarding their migration from the HCS System to the Gateway System, specifically for upcoming rate processing packages. Specific questions related to historical information access, and timing of future rate postings on the Gateway System have yet to be addressed.

2018 NHQI

NHQI data should be released by the end of 2018. Further details will be forthcoming.

FFS Transition

Limit the Nursing Home Benefit in Partially Capitated MLTC Plans to Three Months

  • DOH submitted request to amend the 1115 Waiver and limit the nursing home benefit in Managed Long Term Care Plans to three months.
  • After three months, the beneficiary will be involuntarily disenrolled and coverage for nursing home services will be covered by Medicaid fee –for- service IF individual qualifies for institutional Medicaid coverage.
  • Draft letter sent to CMS requesting amendment in September 2018
  • Public comment period extended to November 23, 2018
  • When CMS approves amendment DOH will set up stakeholder meetings to discuss how to operationalize
  • Once amendment is approved, members will receive a Medicaid Choice (MAXIMUS) notice as well as a notice that their benefit is being changed back to fee – for –service.

 CRA Reconciliation

The 2017 Cash Receipts Assessment Reconciliation has been sent to DOB for approval and is expected to be finalized during fourth quarter 2018. The CRA per diems will be updated to a 2017 base (from 2016) for inclusion in the 1/1/19 Rates.

OMIG Audits

The 2015 OMIG Audits are now complete and DOH is presently analyzing audit results. The 2016 audits have commenced in the Buffalo region.

Minimum Wage

DOH is reviewing the 2019 survey data for inclusion in the January 2019 rates. The 2017 minimum wage reconciliation should be released to facilities by the end of November.

NYSHFA will keep members posted on these important rate-setting issues going forward.

NYSHFA/NYSCAL CONTACT:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – October 2018

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed. 

MDS Case Mix Picture Dates

As previously reported, DOH will be analyzing data from both the April 25, 2018 and July 25, 2018 collection periods. DOH has not yet disclosed how the data from both picture dates will be blended but has confirmed that the statewide effect will not exceed the $15M savings per the Executive Budget. The MDS data upload period (10/3 – 10/26/2018) is underway, however DOH is currently experiencing technical issues which are expected to be resolved in the next few days. DOH will evaluate whether more time will be allotted to providers for MDS submissions. DOH remains committed to the CMI Workgroup going forward to analyze MDS historical trends and provide input with respect to future Case Mix periods. 

1% Restoration/NHQI

The combined 1% Restoration/NHQI package has been approved by DOB. The "Good Cause" waiver is now in place, which technically allows for retroactive funding beyond the two-year stipulation, as well as lump-sum funding vs. a per diem adjustment methodology. (Note: The NHQI retroactive period will now encompass 2013 through 2017 (5 years to include the latest RHCF data). DOH will fund the earliest two fiscal years of the 1% Restoration ($140M) concurrently with the NHQI retroactive adjustment through 2021/22, then $70M going forward. The 1% Restoration is allocated based on an individual nursing home's Medicaid revenue divided by total Medicaid revenue. DOH is finalizing the payment template and will provide the Associations with a draft DAL outlining both the 1% and NHQI calculations, as well as a summary of the combined 1%/NHQI effect upon each facility. For those facilities still owing moneys net of the 1%, a recoupment calculation (15% of weekly Medicaid check) and timeline will be provided. 

2% Quality Pool (QP) Penalty

The 2% QP Penalty, which is based on the 2016 and 2017 NHQI data, will be effective retroactive to the 7/1/18 rates (including the benchmark rates). The revised rates will be issued with Medicaid cycle #2145 (check release date 10/17/18). 92 providers are affected by the penalty and will absorb a 2% rate reduction. Those facilities that DOH deems financially disadvantaged (now updated to 2017 negative operating margin and negative fund balance) will be exempt from the initial penalty period. For recent ownership changes occurring during 2017 (as evidenced by a Part 1 RHCF filing), DOH may consider the previous owners 2016 RHCF data to determine the FD exemption. DOH may allow additional discretionary exemptions. 

Capital 

The 2019 Capital Attestation forms are required to be submitted by this Friday, October 12, 2018. The attestation filing is mandatory regardless if a facility is contesting its initial 2019 capital rate.

Universal Settlement (US) 

The fourth-year payment of the US has been approved by DOB for payment. DOH expects to release the payment to the trustees within the next week. The $10M special appeals fund (i.e., Bucket 9) is included. 

Gateway System

DOH will be issuing a DAL in the near future providing details regarding their migration from the HCS System to the Gateway System, specifically for future rate processing packages. Specific questions related to historical information access, and timing of future rate postings on the Gateway System have yet to be addressed.

FFS Transition

  • DOH is working to obtain CMS approval of the 1115 Amendment.
  • The Department has requested CMS expedite the process and plans to have regular contact with CMS to advance the initiative.
  • Once DOH confirms next steps and implementation dates with CMS, further guidance and additional stakeholder meetings will be scheduled.
  • The Department is considering options related to whether SNF's should continue involvement in various VBP levels in a FFS environment. NYSHFA will be providing further input to DOH. 

CRA Reconciliation

The 2017 Cash Receipts Assessment Reconciliation has been sent to DOB for approval and is expected to be released within the next 30 days. The CRA per diems will be updated to a 2017 base (from 2016) for inclusion in the 1/1/19 rates.

Transportation Adjustment

The duplicate transportation adjustment has been approved by CMS. The statewide prices will be adjusted accordingly, and the estimated impact is approximately $0.08/day for the under 300 bed peer group, and $0.18/day for over 300 beds. This adjustment has also been processed via Medicaid cycle #2145 (check release date of 10/17/18).

OMIG Audits 

The 2015 OMIG Audits are now complete. DOH expects to release the 5% cap for affected providers within the next 30 days. The 2016 audits have commenced in the Buffalo region. 

Shared Savings 

DOH will be issuing further communications related to the program, as well as more detailed filing instructions.

Minimum Wage 

DOH is reviewing the 2019 survey data for inclusion in the January 2019 rates. They continue to work on reconciliation methodology related to the 2018 payments.

Upper Payment Limit / IGT

The 2018 UPL ($225M) is at DOB for approval and will again consist of two payments (Fall 2018 and Spring 2019).

NYSHFA will keep members posted on these important rate-setting issues going forward.

NYSHFA/NYSCAL CONTACT:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – September 2018

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed:

MDS Case Mix Picture Dates

A DAL is expected to be released tomorrow which details the MDS case mix picture dates which will be utilized for the upcoming CMI adjustment to the 1/1/19 rates. DOH has announced two collection dates and their corresponding 92-day look back periods:

  • April 25, 2018                  (January 23rd look back)
  • July 25, 2018                   (April 24th look back)

DOH will then analyze and blend the two collection periods results prior to uploading the MDS data in early October. DOH continues to review historical MDS data prior to convening the Case Mix Workgroup, which will be established to discuss CMI streamlining per the Executive Budget. A start date for the Workgroup has not yet been announced.

1% Restoration/NHQI

The combined 1% Restoration/NHQI package has been approved by DOB. DOH has now filed a “Good Cause” waiver with CMS, which technically allows for retroactive funding beyond the two-year stipulation, as well as lump-sum funding vs. a per diem adjustment methodology. DOH anticipates a quick approval from CMS, which then clears the way for EMEDNY payment processing. Payments are now expected mid-October. (Note: The NHQI retroactive period will now encompass 2013 through 2017 (5 years to include the latest RHCF data). DOH will fund the earliest two fiscal years of the 1% Restoration ($140M) concurrently with the NHQI retroactive adjustment through 2021/22, then $70M going forward. The 1% Restoration is allocated based on an individual nursing home’s Medicaid revenue divided by total Medicaid revenue. DOH will issue a detailed DAL outlining both the 1% and NHQI calculations, as well as a summary of the combined 1%/NHQI effect upon each facility. For those facilities still owing moneys net of the 1%, a recoupment calculation (15% of weekly Medicaid check) and timeline will be provided.

2% Quality Pool (QP) Penalty

The 2% QP Penalty, which is based on the 2016 and 2017 NHQI data, will be effective retroactive to the 7/1/18 rates (including the benchmark rates). DOH has submitted to DOB this past week and has also received CMS SPA approval. 92 providers are affected by the penalty and will absorb a 2% rate reduction. Those facilities that DOH deems financially disadvantaged (now updated to 2017 negative operating margin and negative fund balance) will be exempt from the initial penalty period. For recent ownership changes occurring during 2017 (as evidenced by a Part 1 RHCF filing), DOH may consider the previous owners 2016 RHCF data to determine the FD exemption. DOH may allow additional discretionary exemptions.

Capital

DOH expects to issue the capital preview rates this coming Friday. The capital attestation is again due mid-October, and all facilities will be required to attest their capital rate. An upcoming DAL will outline parameters of the Capital Attestation and Refinancing/Shared Savings Program. A reminder the DOH capital methodology webinar is archived on the HCS for reference. DOH anticipates an on-time issuance of the 11/1/18 notice rates which will include the 2019 attested capital.

Universal Settlement (US) 

The fourth-year payment of the US has been approved by DOB for payment. DOH is expected to release payment to the Trustees by the end of September. The $10M special appeals fund (i.e., Bucket 9) is included. 

FFS Transition

  • DOH is working to obtain CMS approval of the 1115 Amendment.
  • The Department has requested CMS expedite the process and plans to have regular contact with CMS to advance the initiative.
  • Once DOH confirms next steps and implementation dates with CMS, further guidance and additional stakeholder meetings will be scheduled.
  • The Department is considering options related to whether SNF’s should continue involvement in various VBP levels in a FFS environment. NYSHFA will be providing further input to DOH. 

OMIG Audits

Approximately 90% of the 2015 audits have been finalized. DOH expects to release the 5% cap for affected providers within the next 30 days. OMIG is beginning the 2016 audits in the Buffalo area this week. The OMIG Audit Clarification and related DAL has been posted.

CRA Reconciliation

The 2017 Cash Receipts Assessment Reconciliation will be sent to DOB for approval by mid-September and is expected to be released in October. The CRA per diems will be updated to a 2017 base (from 2016) for inclusion in the 1/1/19 rates.

Minimum Wage Surveys

DOH has released the 2019 survey for both regular and contracted staff, in preparation for the 1/1/19 rate add-on. The due date has been extended until Friday, 9/21/18. No further extensions will be granted.

The 2017 Reconciliation survey to match requested funding with actual spending is in process and should be released by the end of September.

The surveys will include SNF’s and ALP’s.

Upper Payment Limit / IGT 

The 2018 UPL ($225M) is at DOB for approval and will consist of two payments (September 2018 and March 2019).

Transportation Adjustment

The duplicate transportation adjustment has been approved by CMS. The statewide prices will be adjusted accordingly, and the estimated impact is approximately $0.08/day for the under 300 bed peer group, and $0.18/day for over 300 beds. Reduction in rates are expected to be implemented in September (effective date of 7/1/18). DOB approval is expected this week.

NYSHFA will keep members posted on these important rate-setting issues going forward. 

NYSHFA/NYSCAL CONTACT: 

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – August 2018

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed: 

1% Restoration/NHQI

The combined 1% Restoration/NHQI package is going to DOB this week for approval. DOH will fund the earliest two fiscal years of the 1% Restoration ($140M) concurrently with the NHQI retroactive adjustment. (Note: The NHQI retroactive period will now encompass 2013 through 2017 (5 years) to include the latest RHCF data). Once DOB approval is received, DOH will issue a detailed DAL outlining both the 1% and NHQI calculations, as well as a summary of the combined 1%/NHQI effect upon each facility. For those facilities still owing moneys net of the 1%, a recoupment calculation (15% of weekly Medicaid check) and timeline will be provided. 

2% Quality Pool (QP) Penalty 

The 2% QP Penalty, which is based on the 2016 and 2017 NHQI data, will be effective retroactive to the 7/1/18 rates (including the benchmark rates). DOH is submitting this package to DOB this week, and still awaits CMS SPA approval, which is expected in the near future. 92 providers are affected by the penalty and will absorb a 2% rate reduction. Those facilities that DOH deems financially disadvantaged (2016 negative operating margin and negative fund balance) will be exempt from the initial penalty period. DOH may allow additional discretionary exemptions. 

Capital 

DOH will be issuing the capital preview rates in early September. The attestation timeline will again be during October, and all facilities will be required to attest their capital rate. An upcoming DAL will outline parameters of the Refinancing/Shared Savings Program, which again will be available to providers. 

Universal Settlement (US) 

The fourth year payment of the US has been sent to DOB for approval. DOH’s goal is to release the payment by the end of September. The $10M special appeals fund (i.e., Bucket 9) is included. 

FFS Transition 

  • DOH is sending notice to amend the 1115 Waiver to CMS in the near future.
  • The Department has requested CMS expedite the process and plans to have regular contact with CMS to advance the initiative.
  • Once DOH confirms next steps and implementation dates with CMS, further guidance and additional stakeholder meetings will be scheduled.
  • The Department is considering options related to whether SNF’s should continue involvement in various VBP levels in a FFS environment. NYSHFA will be providing further input to DOH. 

To keep abreast of the most current VBP information, please review the following link: 

https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_library/2018/2018-jul_mltc_lev2_contracting.htm

Case Mix Workgroup

DOH continues to review MDS data prior to convening the Workgroup, which will be established to discuss CMI streamlining per the Executive Budget. A start date has not yet been announced.

OMIG Audits

Final draft report letters have been issued for the 2015 audits. Following a 30-day response period, final reports will be issued. OMIG anticipates starting the 2016 audits in September. 

CRA Reconciliation 

The 2017 Cash Receipts Assessment Reconciliation will be sent to DOB for approval by mid-September. 

Minimum Wage Surveys 

DOH is in the process of finalizing two surveys over the next month:

  • 2019 survey for both regular and contracted staff, in preparation for the 1/1/19 rate add-on
  • 2017 Reconciliation survey to match requested funding with actual spending. 

The surveys will include SNF’s and ALP’s. 

Upper Payment Limit / IGT 

The 2018 UPL ($225M) is at DOB for approval and will consist of two payments (September 2018 and March 2019). 

Transportation Adjustment 

The duplicate transportation adjustment has been approved by CMS. The statewide prices will be adjusted accordingly, and the estimated impact is approximately $0.08/day for the under 300 bed peer group, and $0.18/day for over 300 beds. 

NYSHFA will keep members posted on these important rate-setting issues going forward. 

NYSHFA/NYSCAL CONTACT: 

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing - Finance - July 2018

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed.

7/1/18 Rates

DOH has posted the 7/1/18 rates to the HCS. The rates, updated for the January 2018 MDS collection period, will be processed in Medicaid cycle 2131 with a check release date of 7/11/18. The Cash Receipts Assessment (CRA) billing per diem has also been updated to reflect 2016 (from 2014). Attached is the related DAL with further details.

RHCF Deadline

The RHCF deadline is Monday, July 16, 2018. Members are urged to test their HCS networks prior to the deadline to ensure timely compliance. Due to intermittent software “run-time error” issues, DOH recommends saving data changes to an additional location (i.e., flash drive) to avoid loss of work. In addition, DOH requests that HCS access for operator and CPA certifications be submitted to RHCF-hcs@health.ny.gov by COB Thursday, July 12, 2018 to ensure timely submission of the cost report on July 16th.

ATI

DOH funded year three of the ATI to the MLTC plans in mid-May. Most plans have yet to distribute lump-sum payments to eligible providers. DOH is reviewing the timetable for MLTC distributions and indicated ATI payment letters to eligible providers are imminent. NYSHFA has obtained the master list of ATI funding by MLTC for member reference.

1% Restoration

DOH has received State Plan Amendment (SPA) approval from CMS for the 1% restoration and is verifying CMS SPA approval of the retroactive portion of the Quality Pool. The combined package will then go to the Division of Budget for approval. The target date at this point is early September for processing. DOH will fund the earliest two fiscal years of the 1% restoration ($140M) concurrently with the NHQI retroactive adjustment. As reported previously, DOH will "double up" the 1% Restoration payments over the next four state fiscal years (2018-2021) until current. Payments will be made via lump-sum through eMedNY in a Medicaid cycle, and again will incorporate both FFS and MLTC days.

Quality Pool Implementation (NHQI)

As reported in the June DOH Briefing update, the NHQI implementation will consist of a retroactive adjustment for years 2013 - 2016, followed by a prospective adjustment for 2017 and forward. (Note: should CMS SPA approval occur later in the year, the potential for a five-year retroactive adjustment exists, as the 2017 RHCF data will have been submitted and received.)

  • Retroactive Adjustment:
    DOH will calculate the retroactive effect of the NHQI for providers receiving monies, and lump-sum adjustments will be processed through eMedNY. For providers owing monies, DOH will first offset the initial 1% Restoration payment (as noted below). DOH has shared the NHQI retroactive rate run (which includes the 1% Restoration offset) with NYSHFA for review.
  • Prospective Adjustment:
    Going forward, DOH will match the respective year's Quality Measure (QM) and Medicaid days (i.e., 2017 QM x 2017 days applied to 2018 rates). This will necessitate a change to the CMS SPA on file, which currently calls for a subsequent reconciliation of the Medicaid days.

    Once the 2017 Medicaid days are reported (via the 2017 RHCF filing), DOH will finalize the adjustment to the 1/1/18 rates for the 2017 NHQI.

    Both the retroactive and prospective NHQI adjustments will incorporate both FFS and MLTC Medicaid days, so as not to involve the MLTC plans in the NHQI Reconciliation process.

2% QP Penalty

  • DOH will base the initial QP Penalty on the 2016 and 2017 quality data. A 2% rate reduction will be applied to the combined total rate (operating and capital) going forward for affected facilities. Per the Executive Budget, Financially Distressed (FD) facilities shall be exempted from the penalty. NYSHFA provided comments related to both the FD criteria, as well as exclusion of Medicaid specialty days (and associated Medicaid revenue) from the calculation. Once the FD criteria has been finalized, DOH will file the CMS SPA.

FFS Transition

  • At this time, there is no update from DOH on the movement of enrollees to Fee for Service. The Department is still working through the administrative process and is still awaiting CMS SPA approval. NYSHFA will be attending a health plan meeting on Thursday, July 12 and will seek further updates at that time.

Case Mix Workgroup

Per the 2018/19 Executive Budget, a Case Mix Workgroup will be established to discuss CMI streamlining in an effort to achieve $15M in savings. DOH is not committing to a July 25, 2018 census picture date. DOH is working internally with an outside contractor to analyze MDS data submitted over the past few years. Once this work is finalized, the Workgroup will convene to review and discuss.

OMIG Audits

DOH will be distributing the 2015 draft audit reports in the next few weeks. Following a 30-day response period, DOH will review provider comments prior to releasing the final reports. The 2016 audits for both census periods will commence once the 2015 audits are finalized. NYSHFA will be meeting with DOH to review our suggested MDS audit criteria in the next few weeks.

Universal Settlement

The Division of Budget will be reviewing DOH's submission on Universal Settlement this summer. Once DOB approves, the funds could be released as early as September.

Upper Payment Limit / IGT

DOH is awaiting CMS approval and still expects to remit two payments slated for this Fall and early Spring 2019.

Bedhold

DOH will respond to comments raised by the Associations during the recent allotted comment period. The Department will continue to pay the existing bedhold rate until further direction is obtained from the Governor's office and DOB. These discussions will continue after the conclusion of legislative session.

Minimum Wage

DOH is still working on a survey to providers to match minimum wage requested funding with actual spending. Providers will be asked to attest to funds that were included in the minimum wage adjustment.

NYSHFA will keep members posted on these important rate-setting issues going forward.

NYSHFA CONTACT:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing - Finance – June 2018

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed. 

Quality Pool Implementation (NHQI)

As reported in the May DOH Briefing update, the NHQI implementation will consist of a retroactive adjustment for years 2013 - 2016, followed by a prospective adjustment for 2017 and forward. (Note: should CMS SPA approval occur later in the year, the potential for a five-year retroactive adjustment exists, as the 2017 RHCF data will have been submitted and received.)

  • Retroactive Adjustment:
    DOH will calculate the retroactive effect of the NHQI for providers receiving monies, and lump-sum adjustments will be processed through eMedNY. For providers owing monies, DOH will first offset the initial 1% Restoration payment (as noted below). DOH has shared the NHQI retroactive rate run (which includes the 1% Restoration offset) with NYSHFA for review.
  • Prospective Adjustment:
    Going forward, DOH will match the respective year's Quality Measure (QM) and Medicaid days (i.e., 2017 QM x 2017 days applied to 2018 rates). This will necessitate a change to the CMS SPA on file, which currently calls for a subsequent reconciliation of the Medicaid days.

    Once the 2017 Medicaid days are reported (via the 2017 RHCF filing), DOH will finalize the adjustment to the 1/1/18 rates for the 2017 NHQI.

    Both the retroactive and prospective NHQI adjustments will incorporate both FFS and MLTC Medicaid days, so as not to involve the MLTC plans in the NHQI Reconciliation process.

1% Restoration

DOH will fund the earliest two fiscal years of the 1% restoration ($140M) concurrently with the NHQI retroactive adjustment. As reported previously, DOH will "double up" the 1% Restoration payments over the next four state fiscal years (2018-2021) until current. Payments will be made via lump-sum through eMedNY in a Medicaid cycle, and again will incorporate both FFS and MLTC days. DOH is currently awaiting State Plan Amendment (SPA) approval of the 1% restoration.


2% QP Penalty

DOH will base the initial QP Penalty on the 2016 and 2017 quality data. A 2% rate reduction will be applied to the combined total rate (operating and capital) going forward for affected facilities. Per the Executive Budget, Financially Distressed (FD) facilities shall be exempted from the penalty. NYSHFA provided comments related to both the FD criteria, as well as exclusion of Medicaid specialty days (and associated Medicaid revenue) from the calculation. Once the FD criteria has been finalized, DOH will file the CMS SPA. 

ATI 

DOH funded year three of the ATI to the MLTC plans in mid-May. Most plans have yet to distribute lump-sum payments to eligible providers. DOH is reviewing the timetable for further MLTC distributions to eligible providers. NYSHFA has obtained the master list of ATI funding by MLTC for member reference.

Case Mix Workgroup

Per the 2018/19 Executive Budget, a Case Mix Workgroup will be established to discuss CMI streamlining in an effort to achieve $15M in savings. DOH is not committing at this time to a July 25, 2018 census picture date pending CMI Workgroup discussions which are slated to take place in the upcoming weeks. DOH is keeping their options open and may not disclose specific biannual dates in advance, as per past practice. We will continue to advocate for transparency on the dates of assessment periods. 

OMIG Audits 

DOH will be distributing the 2015 draft audit reports in the next few weeks. Following a 30-day response period, DOH will review provider comments prior to releasing the final reports. The 2016 audits for both census periods will commence once the 2015 audits are finalized. 

Universal Settlement

The Division of Budget will be reviewing DOH’s submission on Universal Settlement this summer. Once DOB approves, the funds could be released as early as September.

Bedhold

DOH will respond to comments raised by the Associations during the recent allotted comment period. The Department will continue to pay the existing bedhold rate until further direction is obtained from the Governor's office and DOB. These discussions will continue after the conclusion of legislative session.

RHCF Deadline

DOH is seeking comments regarding recent changes to the cost report certifications. NYSHFA Payment for Services Committee has been alerted and will provide input. Reminder that the filing deadline is Monday, July 16, 2018.

Minimum Wage

DOH is still working on a survey to providers to match minimum wage requested funding with actual spending. Providers will be asked to attest to funds that were included in the minimum wage adjustment.

NYSHFA will keep members posted on these important rate-setting issues going forward. 

NYSHFA CONTACT: 

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – May 2018

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed: 

Quality Pool Implementation (NHQI) 

The NHQI implementation will consist of a retroactive adjustment for years 2013 – 2016, followed by a prospective adjustment for 2017 and forward.

  • Retroactive Adjustment:

DOH will calculate the four-year retroactive effect of the NHQI for providers receiving monies. A lump-sum adjustment will be processed through eMedNY sometime in late August or early September. For providers owing monies, DOH will first offset the initial 1% Restoration payment (as noted below). DOH will share the NHQI retroactive rate run (which will include the 1% Restoration offset) with NYSHFA for review in the near future.

  • Prospective Adjustment:

Going forward, DOH will match the respective year’s Quality Measure (QM) and Medicaid days (i.e., 2017 QM x 2017 days applied to 2018 rates). This will necessitate a change to the CMS SPA on file, which currently calls for a subsequent reconciliation of the Medicaid days.

Once the 2017 Medicaid days are reported (via the 2017 RHCF filing), DOH will finalize the adjustment to the 1/1/18 rates for the 2017 NHQI.

Both the retroactive and prospective NHQI adjustments will incorporate both FFS and MLTC Medicaid days, so as not to involve the MLTC plans in the NHQI Reconciliation process.

1% Restoration

DOH will fund the earliest two fiscal years of the 1% restoration ($140M) concurrently with the NHQI retroactive adjustment. As reported last month, DOH will “double up” the 1% Restoration payments over the next four state fiscal years (2018-2021) until current. Payments will be made via lump-sum through an eMedNY in a Medicaid cycle, and again will incorporate both FFS and MLTC days.

2% QP Penalty

DOH will base the initial QP Penalty on the 2016 and 2017 quality data. A 2% rate reduction will be applied to the combined total rate (operating and capital) going forward for affected facilities. Per the Executive Budget, Financially Distressed (FD) facilities shall be exempted from the penalty. At the Department’s request, NYSHFA is working with the DOH to establish FD exemption parameters.

Benchmark Rates

DOH expects the 1/1/18 Benchmark Rates to be posted later this week. Note: neither the NHQI or 2% QP Penalty adjustments will be included in this update to the Benchmark Rate. DOH anticipates including both adjustments in the Benchmark Rate once finalized.

Bedhold

DOH will respond to comments raised by the Associations during the recent allotted comment period. The Department will continue to pay the existing bedhold rate until further direction is obtained from the Governor’s office and DOB. 

ATI

Year three payments of the ATI are being funded through the MLTC plans, who, in turn, will have 30 days to distribute a lump-sum payment to eligible providers. A DAL is being drafted with further instructions, and payments to providers are expected by the end of second quarter. 

DOH indicated that next year’s ATI funding (assuming continued CMS SPA approval) will revert back to direct payments from DOH to eligible providers (as in years one and two).

RHCF Deadline

Reminder that the filing deadline is Monday, July 16, 2018.

MDS Look-Back Period

DOH is not committing at this time to a July 25, 2018 census picture date. They are keeping their options open and may not disclose specific biannual dates in advance, as per past practice. We will continue to advocate for transparency on the dates of assessment periods.

NYSHFA will keep members posted on these important rate-setting issues going forward. 

NYSHFA CONTACT: 

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – April 2018

Carl Pucci and Lauren Pollow in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed. 

2018-19 Executive Budget

Return to Fee-For-Service (FFS)

NYSHFA continues to have fluid discussions with DOH regarding the limit of MLTC Long Term Care Nursing Home Benefit to three months. The State is enacting a “Three Prong Approach” that will cease the auto enrollments of new long-term care nursing home enrollees, limit the Nursing Home Benefit to three months for long term care enrollees once Medicare or other Third-Party insurances are maximized, and finally transition Nursing Home enrollees from MLTC back to Fee for Service. DOH will be providing further guidance to both plans and providers. Target events and dates are as follows: 

    • DOH sent out a March 28 letter to plans notifying them of the 3-month change to FFS;
    • MLTC plans must continue to enroll beneficiaries until May 3rd, when auto-enrollment of beneficiaries will be turned off; and
    • DOH is awaiting CMS approval to change the nursing home benefit for long-stay placements to FFS, they are on track for a July 2018 timeframe.

The Department intends to reconvene meetings with the plans and provider associations on the transition of the benefit back to FFS. They are working on the invitee list and the agenda, which will be primarily focused on the above transition issues. 

1% Restoration 

DOH has finalized the 1% Restoration payment methodology and is awaiting CMS SPA approval prior to funding. The initial lump sum payment should include the first two fiscal years due providers (2014 and 2015), totaling $140M. DOH plans to “double up” payments over the next three state fiscal years (2019/20/21) until the 1% restoration is current. Funding will then continue at $70M going forward in state fiscal year 2022.

2% Quality Penalty 

Since there is no existing methodology to calculate this penalty, DOH will need to gather data, submit a State Plan Amendment (SPA) on the cost-savings, and seeking association input on how to assess a penalty for lower performing nursing homes. DOH is attempting to gather information for a mid-May submission to CMS. Once approved, the 2% penalty would be retroactive to 4/1/18.

DOH has been examining how to define “financially distressed” nursing homes for exemption within the new NHQI quality penalty impacting providers in the lower two quintiles.

Case Mix Index Streamlining 

As a result of increased OMIG audit findings over the last three years, a proposal to streamline CMI and achieve a $15 million gross savings is contained within the Enacted Budget. DOH will be looking to create a workgroup and examine reasonable changes to the case mix process. This will likely involve reviewing information from providers with negative audits, creating a list of best practices, and assisting providers in achieving fewer errors moving forward. 

January 1, 2018 Rates 

The 1/1/18 rates have been posted on the HCS. They include the July 2017 MDS update, the attested 2018 capital rates and the minimum wage adjustment for both employees and contracted staff. DOH has committed to updating the benchmark rate in a timely manner. Attached is the NYSHA member mailing regarding the recent rate posting.

Quality Pool (NHQI)

NYSHFA and the other statewide associations continue to work with DOH regarding the implementation of the four-year retroactive impact of the nursing home quality pool. It is DOH’s intention to first recoup from those providers in the 4th and 5th quintiles. Once the retroactive monies have been recouped, DOH will release funding to facilities in the first three quintiles. No specific timeline for initiating recoupments has yet been provided by DOH. NYSHFA continues to advocate for the 1% restoration funding concurrently with the NHQI to alleviate cashflow concerns.

Bedhold 

Although not discussed at today’s briefing, DOH recently proposed regulations to modify the policy on reserved bed days for residents of nursing homes ages 21 and over. The proposed regulations would require nursing homes to hold the same room and same bed without payment. On April 16, NYSHFA submitted a formal response to the Department of Health’s (DOH) proposed regulations. NYSHFA has continually opposed the requirement to reserve the same room/same bed when Medicaid does not reimburse the facility for a resident who is temporarily hospitalized.

As it stands, the 2017 DAL suggested that implementation of new bed hold reimbursement policies would be delayed until the adoption of regulations. It is our understanding that providers will continue to be reimbursed until that time.

Advanced Training Initiative (ATI)

The ATI Application Surveys have been completed and approved by DOH in advance of the anticipated $46M funding. The payment calculations for 223 facilities (all approved), are currently awaiting DOB approval. DOH is expected to adjust rate premiums for MLTC plans, who, in turn, would issue lump-sum payments to eligible providers within 30 days. DOH indicated that a VBP-one contract addendum must be in place to receive ATI funding.

2017 RHCF Deadline

The deadline for submission of the 2017 RHCF is July 31, 2018. DOH anticipates releasing the RHCF software in early May.

Nursing Home Remittance Reports 

With the discontinuance of the FMG FoxPro Reports, DOH is seeking an alternative software solution and has put such a request into EMEDNY. No further timetable has yet been provided by DOH. Although the weekly remittance report includes recoupment detail, the Associations again stressed the unavailability of retroactive adjustment details during this time. Members should contact EMEDNY with specific concerns at emednyfinancialsupport@csra.com

NYSHFA/NYSCAL CONTACT:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36 

Lauren Pollow
Director, Government Affairs
518-462-4800 x25

DOH Monthly Briefing – Finance – January 2018

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed. 

2018-19 Executive Budget Proposals 

  • Care Management - DOH confirmed the Executive Budget that proposes to allow a long term care enrollee in the nursing home be disenrolled from the managed long term care plan and placed in fee-for-service after a consecutive period of six months or more. Among other things, NYSHFA will be following up with membership regarding the next steps once enrollees revert back to fee-for-service. Additionally, inquiries will be sent to DOH on the administrative, payment and contracting process for the nursing facility. This will be discussed further with DOH next week at a subsequent meeting.
  • Capital Streamlining Rate Reduction – This proposal establishes a Capital Workgroup which will review capital regulations and rate methodology to achieve a proposed 1% reduction in capital expenditures to hospitals and residential nursing facilities (est. at $7.6M for SNF’s) in capital payments for state fiscal year 2018/19. Absent a coordinated plan by the workgroup to reduce capital expenditures, the Commissioner of Health is authorized to reduce capital rates by 1%, during the state fiscal year.
  • Quality Penalties – This proposal imposes an additional 2% penalty on facilities which fall into the fourth and fifth NHQI quintiles over a two-year period. Therefore, if a SNF falls into quintile 5 two years in a row, or drops from quintile 4 to quintile 5 over a two year period, they will be affected by the penalty. The estimated $20M budget savings would affect approximately 92 SNF’s. DOH will share the impacted provider list with the Associations. A subsequent meeting with DOH is being scheduled for next week to further discuss. 

Case Mix – This proposal would result in an estimated $15M in budget savings related to increases in case mix. DOH compared annual increases under the PRI system (2004-06) with the MDS system (2012-17) and noted significant annual increases (2%/year PRI vs 5%/year MDS). In addition, they noted OMIG MDS audit recoupments more than doubled ($30M in 2014 vs $12M in 2012) which raised concerns with respect to the case mix validity. DOH’s goal is to achieve half of the 2014 OMIG recoupment ($15M) over the state fiscal year 2018/19. According to DOH legal, legislation is not necessary to implement this reduction (nor was it part of the 2018/19 Executive Budget.)

1% Restoration 

Although no timeline for payment was given, DOH outlined a proposed payment plan for the four-year cumulative $280M owed for the 1% Restoration. DOH would remit $140M in the first fiscal year approved, followed by $70M in payments each of the next two fiscal years.

Quality Pool

DOH is beginning implementation of the Nursing Home Quality Pool (NHQP), enacted in the 2010/11 State Budget as a consequence of the recent State Supreme Court decision favoring the State. DOH recognizes the challenges associated with four years’ worth of NHQP retroactivity, and is offering possible implementation options. The Department stressed that since the NHQP is budget neutral, and cannot impact the Global Cap, any monies paid out to providers must be equal to monies recouped. NYSHFA has just received the facility-specific impacts of the four-year period and will provide input to DOH at the separately scheduled Quality Pool meeting referenced above. Attached is the DOH Quality Pool outline with more details. 

January 1, 2018 Rates

The 1/1/18 rates are still with DOB, and should be released in the near future. They include the July 2017 MDS update, the attested 2018 capital rates and the minimum wage adjustment for both employees and contracted staff. DOH committed to updating the benchmark rate in a timely manner.

Advanced Training Initiative (ATI)

The ATI Application Surveys have been completed and approved by DOH in advance of the anticipated $46M funding. The payment calculations for 223 facilities (all approved), are under DOH review, then must go for DOB approval. DOH is expected to adjust rate premiums for MLTC plans, who, in turn, would issue lump-sum payments to eligible providers within 30 days. The goal is to fund the ATI by 3/31/18. DOH indicated that a VBP-one contract addendum must be in place to receive ATI funding. Since the target date for lump sum payment is March 31, 2018, applicants will be given a full 12 months to complete training (i.e., 3/31/19).

2016 CRA Reconciliation

DOH has posted CRA facility-specific data on its website (under “Nursing Home Rates”). The respective payment adjustment is in cycle #2106 (check date 1/1/18 and release date 1/17/18).

Nursing Home Remittance Reports

With the discontinuance of the FMG FoxPro Reports, DOH is seeking an alternative software solution and has put such a request into EMEDNY. No further timetable has yet been provided by DOH. Although the weekly remittance report includes recoupment detail, the Associations again stressed the unavailability of retroactive adjustment details during this time. 

NYSHFA/NYSCAL CONTACT:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – December 2017

Nancy Leveille and Lisa Volk Carl Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following is a brief summary of the topics discussed:

January 2018 Initial Rates

The 1/1/18 rates are expected to be issued in early January, and will include the July 2017 MDS update, the attested 2018 capital rates and the minimum wage adjustment for both employees and contracted staff. DOH committed to updating the benchmark rate in a timely manner.

Advanced Training Initiative (ATI)

The third year of the ATI is underway, as eligible facilities were notified late last week via email to the Administrator-of-Record on the HCS. NYSHFA also notified its member facilities, alerting them to the 12/20/17 application survey deadline. As in previous years, $46M in funding is available to approximately 230 SNFs who exceeded the direct-care staff median retention level, which for 2016, was .78125. DOH is expected to fund the ATI sometime in late February, and is discussing premium rate adjustments to major MLTC plans, who, in turn, would then issue lump-sum payments to eligible providers. This change is part of DOH’s incentive for providers to enter into Value Based Payment (VBP) contract addendums with their respective MLTC plans. Questions regarding ATI funding should be directed to Carl Pucci and questions related to ATI educational training should be directed to either Nancy Leveille or Lisa Volk, here at NYSHFA.

Managed Care 

  • Value Based Purchasing – DOH has directed the Managed Long Term Care Plans (MLTCs) to partner with Skilled Nursing Facilities for VBP Level 1 upside only risk. Some health plans have already sent out amendments to providers with a deadline up to 12/31 to sign or agree to the terms and conditions of the amendments. The measurable outcome for facilities is the “potentially avoidable hospitalization (PAH).” DOH has set 12/31 as a deadline for partnership between plans and providers to meet a CMS qualification and not lose federal dollars to the state.
  • Managed Care Rate Cells – DOH continues discussions with CMS to create single rate cells for High Cost / High Need, HARP and The Nursing Home populations. Although CMS has no current objection to creating single rate cells, there is a concern if a single rate cell will negatively affect The Olmstead Act. As a result, DOH continues to gather information from other states and have further discussions with stakeholders.

Quality Pool (QP)

DOH announced implementation of the Quality Pool in early 2018, noting that final regulations have been passed. The QP implementation had been long delayed pending litigation issues. DOH will compile the rate data from 2013 through 2016 to assess the financial impact to nursing home providers, and will share this data with the Associations to further discuss.

The Quality Pool is a $50M annual budget neutral reallocation of funds which provides rate per diem add-ons to providers in the 1st and 2nd NHQI quintiles, is neutral to providers in the 3rd quintile, and imposes a negative per diem adjustment for providers in the 4th and 5th quintiles.

The Associations raised potential provider cash flow issues which may stem from a four-year retroactive (2013-16) rate impact for providers in the lower quintiles. DOH will work with the Associations to address these concerns prior to actual implementation. The January 2018 DOH Briefing should include additional detail regarding the upcoming QP implementation.

Bedhold

A potential resolution to the $10M funding gap derived from the 2016/17 Executive Budget is in discussion with the Governor’s office.

2012 Cash Receipts Assessment (CRA) Reconciliation

The 2016 CRA is complete and should be at EMEDNY for processing later this month. DOH indicated it is adding additional information to the calculation sheet to assist providers, and will soon be posting this to the HCS.

2015 OMIG Audits

The 2015 MDS Audits have commenced in Western New York. OMIG will issue regional audit reports rather than waiting for the entire statewide audits to conclude, which should help expedite the audit process. In addition, DOH and OMIG will discuss potential combination of 2016/17 audits in order to bring the audit process current.

1% Restoration

Approval of the State Plan Amendment remains on hold, as DOH continues working through issues with CMS.

MDS Educational Trainings

2018 MDS educational training dates have been announced, and details will be distributed by DOH in the very near future. The training module will be shared with the Associations prior to implementation. NYSHFA will issue a separate member mailing once the training locations and dates have been finalized.

NYSHFA CONTACTS:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

Deanna Stephenson
Director, Managed Programs
518-462-4800 x16

Nancy Leveille, RN, MS
Executive Director
518-462-4800 x20

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services\
518-462-4800 x15

DOH Monthly Briefing - Finance - November 2017

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following is a brief summary of the topics discussed:

Minimum Wage Survey – Contracted Staff

DOH is finalizing contracted staff survey data, and related facility per diem add-ons will be included in the January 1, 2018 rates. DOH will share the statewide minimum wage impacts for both non-contract and contracted staff with the Associations once finalized. DOH is formulating the 2017 minimum wage payment reconciliation to facilities, and will initiate this process sometime during the First Quarter 2018. A further survey and/or attestation by providers may be required.

Capital Attestation

DOH reported that 587 facilities attested their 2018 capital rate with 23 still outstanding. The 1/1/18 rate package containing the attested capital rates will proceed to DOB the first week in December, as planned. Seventeen facilities have had their attestations denied, and all have been notified by DOH.

Advanced Training Initiative (ATI)

The third year of ATI funding is slated for early 2018. NYSHFA remains in active discussions with DOH related to various funding methods currently under consideration. The SNF eligibility methodology centered around statewide median employee retention rates remains unchanged.

2014 OMIG Audits

The 2014 OMIG audits have been finalized, and retroactive adjustments made via cycle #2097. The respective rates (7/1/14 and 1/1/15) have been posted to the HCS.

Nursing Home Remittance Reports

With the discontinuance of the FMG FoxPro Reports, DOH is seeking an alternative software solution and has put such a request into EMEDNY. No further timetable has yet been provided by DOH. Although the weekly remittance report includes recoupment detail, the Associations again stressed the unavailability of retroactive adjustment details during this time.

2016 CRA Reconciliation

The 2016 Cash Receipt Assessment Reconciliation is expected to be finalized during Fourth Quarter 2017. The Associations continue to advocate for an update to the 2014 billing per diem.

NYSHFA will keep members updated on these issues going forward.

NYSHFA CONTACT:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – October 2017

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following is a brief summary of the topics discussed:

Minimum Wage Survey – Contracted Staff

NYSHFA’s efforts to advocate for inclusion of contracted staff with DOB was successful, as DOH will be issuing a separate survey to capture contracted staff cost information. The survey is expected to be released in the next week or so, and will have a two-week turnaround. It is vital that any facility utilizing direct care contracted staff respond by the applicable due date in order to ensure proper reimbursement in their 1/1/18 rates.

Capital Attestations

The 2018 Capital Attestation’s are due this Friday, October 13, 2017A reminder that the attestation filing is mandatory for all nursing homes! DOH does not plan on any capital supplemental rate packages during 1st Qtr 2018; as such, this remains the only opportunity (short of a lengthy appeal process) to verify and correct the accuracy of your 1/1/18 capital rate.

Case Mix

The July 2017 census date and roster submissions concluded on September 29, 2017. DOH reported that all facilities successfully submitted their MDS rosters. They fully anticipate the 7/1/17 MDS update to be included in the 1/1/18 initial rates. Optimally, the MDS update could even be reflected as early as the 11/1/17 notice rates, but no guarantees were given.

OMIG Audits

The 2014 MDS audits have been approved by DOB. The revised 7/1/14 and 1/1/15 rates, including release of the 5% CMI cap, will be forwarded to EMEDNY for payment within the next two Medicaid rate cycles. The corresponding rate revisions will be posted concurrently with the EMEDNY payments.

The 2015 MDS audits are being initiated by OMIG in the next few weeks. OMIG anticipates approximately 200 facilities will be audited (down from 250 in 2014) beginning in the western part of the state. OMIG will again combine the January and July 2015 MDS submission periods for audit. OMIG noted an increase in audit findings and related dollar impact from the 2014 audit results (over 2013), primarily in therapy increases and related documentation issues. Discussions then centered on further MDS education based on historical OMIG audit findings. DOH will contact the School of Public Health for possible MDS webinar training to assist providers going forward with respect to OMIG MDS audit preparation.

Nursing Home Remittance Reports

As previously noted, the FMG/Medical Financial Management FoxPro Reports were discontinued recently. NYSHFA has advocated for restoration of the reports, and DOH is meeting internally this week to further discuss.

2016 CRA Reconciliation

The 2016 Cash Receipt Assessment Reconciliation is expected to be finalized during 4th Qtr 2017. The Associations once again advocated for an update to the 2014 billing per diem.

NYSHFA will keep members updated on these issues going forward.

NYSHFA/NYSCAL CONTACT:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – September 2017

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following is a brief summary of the topics discussed:

Minimum Wage Survey

DOH reported approximately 94% of SNFs completed the survey. They will utilize RHCF data for those who did not respond. NYSHFA and other associations have strongly advocated for the inclusion of contract staff in the upcoming reimbursement methodology. NYSHFA met with Division of Budget recently to explain the importance of adequate reimbursement for contracted direct care staff and have compiled DOB requested documents to further support this effort. DOH is meeting with DOB and the Governor’s office and indicated that reimbursement for contract staff is still “on the table.”

1% Restoration

DOH’s CFO (John Ulberg) acknowledged a CMS SPA backlog of over 125 requests. He noted that the Department has not prioritized the 1% SPA due to the pricing litigation that has been filed against the State. The now four-year effect of reimbursing the 1% restoration is approximately $280M (2014-17). DOH stated that they are holding these funds to protect the Medicaid Global Cap from any losses as a consequence of this litigation. Mr. Ulberg further noted that the Department is open to discussions with the Associations to seek possible solutions to this matter.

Case Mix

DOH has posted the July 2017 census date and roster upload period, which is Monday, September 11, 2017 through Friday, September 29, 2017Attached is the DAL with further details. Members are urged to complete their roster uploads in a timely manner to avoid delays in their 1/1/18 rate.

OMIG Audits

The 2014 MDS audit rate package has been sent for DOH executive review. The goal is to incorporate the revised 7/1/14 and 1/1/15 rates into the initial 1/1/18 rate package. NYSHFA reiterated the urgency of timely OMIG audits in relation to the benchmark rates in order to mitigate the retroactive effect of the 5% withhold as it pertains to Managed Care contracts. NYSHFA also requested an update for the 2015 OMIG audit timeline, which will be added to the October DOH briefing agenda.

Capital Attestations

DOH recently requested confirmation of existing mortgage debt in an effort to finalize their database in advance of this year’s capital attestation process. Note: DOH will require all facilities to attest their initial 2018 capital rate. DOH anticipates initiating the Capital Attestation process by the end of September.

Nursing Home Remittance Reports

NYSHFA has received a number of member complaints regarding the sudden discontinuance of the recoupment history report from FMG/Medicaid Financial Management. We alerted DOH accordingly, and this issue was added to this month’s briefing agenda. DOH recognizes the issue across all sectors, has received numerous email inquiries, and will prioritize this issue internally to seek resolution.

2016/17 UPL Payments

The 2016 Upper Payment Limit (UPL) payments were recently released to county SNF's, and approximated $198M statewide.

The 2017 UPL payments are going to DOB for approval this week. The statewide total of $168M will be split into two payments: one later this month, and the other in March 2018. (DOH is now current with UPL and thus cannot release the entire 2017 amounts prior to year-end, per CMS).

NYSHFA will keep members updated on these issues moving forward.

NYSHFA CONTACT:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – August 2017

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following is a brief summary of the topics discussed:

Rate Package Update 

  • 7/1/17 Rates – updated for the 1/1/17 case mix collections, have been approved by DOB are scheduled to be paid in Medicaid cycle 2084, with a check release date of 8/17/17. The estimated statewide impact of the 1/1/17 CMI increase approximates $30M.
  • 2018 Notice Rates – are expected to be posted by 9/1/17, which would allow additional time for this year’s capital attestation process.
  • Benchmark Rates – DOH has acknowledged the importance of prompt updates to the benchmark rates. They indicated the July 2017 benchmark rates would be updated within the next two weeks, so as to parallel processing of the 7/1/17 rates by EMEDNY (see above).
  • 2014 MDS Audits – Final reports have been issued, closing the OMIG 2014 audit process.

Equity Withdrawal

DOH is consulting with its’ internal legal staff regarding questions raised concerning the Department’s revised draft Equity Withdrawal form, including the treatment of income tax payments. Among other things, NYSHFA is strongly advocating for the exclusion of income tax payments from the equity withdrawal requirements, citing recent legal decisions. DOH and DLA (Division of Legal Affairs) are in process of redrafting the DAL and accompanying Equity Withdrawal form and again will share with NYSHFA and the other Associations prior to release.

Minimum Wage Survey

DOH reviewed the Associations edits and recommendations to the draft minimum wage survey which they hope to release by week’s end. DOH estimates giving providers 2 – 3 weeks for completion, with no extensions being allowed.

Universal Settlement (US)

The third Universal Settlement installment package is at DOB. No timeline for approval and subsequent payment was given.

1% Restoration

NYSHFA continues to work with AHCA in efforts to securing approval by CMS of New York’s State Plan Amendment which would provide a 1% increase in Medicaid reimbursement rates for SNFs, retroactive to 4/1/14. DOH provided no further update regarding status of the 1% restoration at today’s briefing.

Capital Webinar

Following the Capital Webinar last month, draft FAQ’s will be sent to the Associations in advance of posting, with the goal of releasing to providers later this month.

NYSHFA will keep members updated on these issues going forward.

NYSHFA/NYSCAL CONTACT:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing - Finance - July 2017

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following is a brief summary of the topics discussed:

Capital Webinar

The capital webinar is scheduled for this Thursday, July 13, 2017 from 1:00 to 4:00 p.m. The goal is to clarify issues and provide answers to common questions raised regarding DOH capital policy. A complete review of the upcoming capital attestation process, owner’s equity withdrawal, shared savings and all significant capital expense reimbursement issues will be discussed. Attached is the related PowerPoint. All members are strongly encouraged to participate. Registration details are expected early tomorrow morning. (NYSHFA will post via a separate member mailing). FAQ’s will be developed and the webinar will be archived for later viewing.

1% Restoration

Attached, for your information, is a July 6th letter from NYSHFA to AHCA seeking AHCA’s assistance in securing approval by CMS of New York’s State Plan Amendment that would provide a 1% increase in Medicaid reimbursement rates for skilled nursing facilities retroactive to April 1, 2014.

Rate Package Update 

  • Capital Corrections – the corrections to the 1/1/17 initial capital rates have been processed and are at EMEDNY for payment. The expected Medicaid cycle number is 2083, with a check release date of 8/10/17.
  • 7/1/17 Rates – updated for the 1/1/17 case mix collections, have been approved by DOB and are scheduled to be paid in Medicaid cycle 2084, with a check release date of 8/17/17.
  • 2018 Notice Rates – are expected to be posted by 9/1/17, which would allow additional time for this year’s capital attestation process.
  • Benchmark Rates – DOH has acknowledged the importance of prompt updates to the benchmark rates. They indicated the July 2017 benchmark rates would be updated in August, so as to parallel processing of the 7/1/17 rates by EMEDNY (see above).

2016 RHCF

As noted in NYSHFA member mailing from 6/22/17, DOH has extended the 2016 RHCF filing deadline until July 31, 2017. Note:  there will be no further filing extensions beyond that date.

Equity Withdrawal

DOH is consulting with its’ internal legal staff regarding questions raised concerning the Department’s revised draft Equity Withdrawal form, including the treatment of income tax payments. Among other things, NYSHFA is strongly advocating for the exclusion of income tax payments from the equity withdrawal requirements, citing recent legal decisions.

OMIG Audits

The MDS audit procurement process still has not been resolved between DOH and OMIG. Due to the extended period of time that has now elapsed, OMIG will be auditing both 2015 MDS cycles. OMIG is gathering information currently in an effort to start the 2015 audit schedules.

Minimum Wage Survey

DOH expects to release a minimum wage survey in the next few weeks. It will be similar to last year’s survey, and will be used to assist in reconciling the 2017 minimum wage adjustment. A DAL will accompany the survey outlining the specific requirements. DOH has not yet established the survey due date.

NYSHFA will keep members updated on these issues going forward.

NYSHFA/NYSCAL CONTACT:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – June 2017

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following is a brief summary of the topics discussed:

Bed Hold

As previously reported in NYSHFA member mailing, DOH is delaying the 4/1/17 bed hold cut until emergency regulations are enacted. NYSHFA and other statewide associations have provided legislative language (introduced by Senator Hannon) to restore bed hold provisions that were removed as a result of the Executive Budget.

Rate Package Update 

  • 7/1/17 Rates - updated for the 1/1/17 case mix collections, are at DOB and are expected to go to EMEDNY for processing in early July. DOH reported 100% provider compliance with respect to the January MDS collection.
  • 2018 Notice Rates – DOH expects to issue these rates on or around 9/1/17 with the goal being timely processing of the initial January 2018 rates.
  • Benchmark Rates – DOH has acknowledged the importance of prompt updates to the benchmark rates. They indicated the July 2017 benchmark rates would be published in early July, so as to parallel processing of the 7/1/17 rates by EMEDNY.

2016 RHCF

The software patch has been posted to the HCS. Providers should download the 5/23/17 update line (which includes the patch correcting the Sch. 17 mortgage amortization issue). Previously submitted RHCF data will be automatically saved. A reminder that the submission deadline is Monday, July 3, 2017.

Capital Reimbursement Webinar

DOH is in final stages of preparing a capital reimbursement webinar which will address the following issues: 

  • 2018 nursing home rate timeline
  • Overview of the attestation process
  • Complex attestation issues
  • Review of capital expense reimbursement
    • Real property rent & insurance
    • Return on and of equity
    • Land/leasehold improvement amortization
    • Real estate taxes/pilot
    • Moveable equipment depreciation, interest and rental payments
    • Mortgage principal amortization
    • Working capital interest & income offset
    • Organization/start-up costs and sales tax

The webinar is expected to be presented in late June and will be archived for later viewing.

The Capital Workgroup will then reconvene to address long standing capital rate issues.

ATI

The ATI Workgroup is meeting this week to focus on the DOH survey results, as well as evaluating metrics going forward.

Medicaid Lag Reinstatement

DOH has agreed to delay the Medicaid lag reinstatement until other rate-setting issues are resolved (i.e., 1% restoration). This will help minimize the resulting cash flow effects upon providers affected by the lag reinstatement.

Energy Workgroup Update

DOH is currently reviewing the final data analysis report issued by Enerlife Consulting. Once reviewed, DOH will develop an operational plan moving forward. 

NYSHFA will keep members updated on these issues moving forward.


NYSHFA/NYSCAL CONTACT:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – May 2017

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following is a brief summary of the topics discussed:

Bed Hold

With the elimination of the 50% reimbursement for hospital bed hold effective 4/1/17, numerous provider questions have arisen. NYSHFA and other statewide and regional associations have compiled a listing of questions which were presented to DOH last week. DOH is working on guidance (i.e. DAL) for both financial as well as programmatical issues raised, including a FAQ in response to the many operational questions raised by members.

A separate meeting on bed hold is tentatively being scheduled for this Friday between DOH rate-setting, DOH legal and provider associations to clarify the bed hold regulations and statute. DOH will stop all bed hold billings and remove the bed hold rate code in the very near future. They recognize that cross over claims billed and paid post 4/1/17 will be subject to recoupments, which also will be addressed in upcoming guidance.

2016 RHCF Software

The final software edits are being uploaded today, with the software expected to be released this week. The due date for the RHCF filing is expected to be 7/1/17.

Equity Withdrawal

The revised Equity Withdrawal form is expected to be finalized and posted within the next two weeks. DOH indicated the form has been simplified and will not require any additional information from providers seeking equity withdrawal approval.

Advanced Training Initiative (ATI)

DOH reported that 200 out of 229 eligible facilities completed the ATI survey, due yesterday 5/1/17. DOH will share the list of facilities who have not yet submitted the survey with the associations for further follow-up. The survey results will be reviewed at an upcoming ATI Workgroup meeting which will be scheduled later in May.

1% Restoration

DOH is in discussion with DOB, the Governor’s office and CMS with respect to the 1% restoration. They hope for some resolution later this month, but are not yet prepared to issue written guidance.

Medicaid Lag Reinstatement

DOH will share a listing of providers who are coming off the two-week Medicaid payment lag with the associations. All members should respond to any notifications received from DOH with respect to the lag, as they continue to evaluate providers on a case-by-case basis.

Universal Settlement (US)

DOH reiterated that year three funding of the US is included in the budgeted global cap, and that their intention is to pay this installment by 3/31/18, as per the settlement agreement.

Capital Webinar/Workgroup

DOH will conduct a capital webinar during late June, in advance of this year’s capital attestation period to address issues and concerns related to the 2016 attestation process. On a separate track, DOH will reform the Capital Workgroup to discuss capital methodology issues going forward. NYSHFA will utilize its Payment for Services Committee to bring capital issues forward in advance of both the webinar and the Capital Workgroup meeting.

NYSHFA will continue to keep members updated on these issues moving forward.

NYSHFA/NYSCAL CONTACT:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

DOH Monthly Briefing – Finance – April 2017

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following is a brief summary of the topics discussed:

Advanced Training Initiative (ATI)

DOH is finalizing the ATI survey, which will be sent to all eligible facilities, possibly as soon as tomorrow. NYSHFA provided input related to the survey document, which DOH is utilizing to access information related to the training requirements. DOH will allow for two-week turnaround for survey completion. DOH will then begin submission of a CMS State Plan Amendment requesting continuation of the ATI into 2018.

Equity Withdrawal

Letters have been sent to those facilities in violation of the equity withdrawal requirements. The revised equity withdrawal form is still with DOH Legal.  There is still no decision from DOH as whether retroactive penalties will be assessed.  Members who disagree with DOH determinations still have opportunity to send supporting documentation to DOH for further review.

2016 Cost Report Software

The RHCF software is undergoing final testing, and is expected to be released in the next few weeks. DOH anticipates the RHCF filing date to be 7/1/17 (two weeks earlier than last year).  DOH plans on issuing 2018 notice rates as soon as 9/1/17, vs. the normal 11/1 notice date used in past years.

Medicaid Lag Reinstatement

Letters have been sent to specific facilities who may be placed back on the two-week lag. DOH is evaluating facility responses accordingly. All members should respond if notified in order to prevent automatic placement on the lag. DOH will share a list of non-respondents to the Associations.

Case Mix

DOH reported that all but thirty or so facilities have successfully transmitted their MDS data, a vast improvement over last cycle. Facilities with missing data will have until Friday, April 14, 2017 to submit in order to avoid delays in their upcoming CMI rate package.

1% Restoration

As previously reported, DOH is still awaiting CMS approval. NYSHFA continues to strenuously lobby both DOH officials and the Legislature to release the state share portion of the funding.

Quality Pool

The 2013-15 Quality Pool distribution continues to be delayed pending litigation. Note:  Both the 2016 NHQI results and the 2017 NHQI program and methodology have been posted on the HCS.

Capital Attestations

Work continues to approve remaining capital attestations.  5/1/17 is the anticipated deadline for final review.

Refinancing/Shared Savings

DOH expects to release its’ Policy & Procedures in the next few weeks. All approved refinancings after 4/21/15 are eligible to be considered for shared savings. DOH indicated it is current with all refinancing applications and anticipates a 30-day turnaround on future refinancing applications.

NYSHFA/NYSCAL will continue to keep members updated on these issues moving forward.

NYSHFA/NYSCAL CONTACT:

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

DOH Monthly Briefing – Finance – March 2017

Carl J Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following is a brief summary of the topics discussed:

Rate Packages

  • January 2017 Rates:

The rates were issued in late January, and include the updated July 2016 Case Mix, approved 2017 Capital Attestations, Minimum Wage adjustment and fully-implemented pricing methodology. DOH has also updated the benchmark rates accordingly.

Minimum Wage

Minimum wage adjustments were incorporated into the initial 1/1/17 rates (line 13). NYSHFA has received the statewide facility data file and will review member impacts as compared to their wage survey data in order to address any discrepancies.

OMIG Audits

OMIG has issued the 2014 draft audit reports. DOH announced that, effective with the January 2015 submissions, OMIG will no longer audit the MDS. DOH is drafting an RFP to determine a new audit contractor going forward. They will be seeking general Association input, clarification points and overall audit process improvements prior to going out to bid. NYSHFA will utilize its Payment for Services and Clinical & Quality Committees to gather the appropriate information requested.

Cash Receipts Assessment Reconciliation (CRA)

According to DOH, the 2015 CRA Reconciliation is now close to 100% correct. DOH is examining remaining provider recoupment issues on a case-by-case basis, and anticipates outlier issues to be corrected no later than cycle 2064 (check release date 3/29/17).

Equity Withdrawal

DOH has revised the Equity Withdrawal letter in the 2/23/17 DAL. It is anticipated DOH will be enforcing the notification requirements related to Equity Withdrawal, and letters will be sent out to those in violation over the next few weeks. DOH will share the draft letter with the Associations prior to sending, as well as a listing of facilities currently in violation. DOH has indicated it will not impose retroactive penalties at this time for those facilities found in violation of the notification requirement. The Equity Withdrawal form has been revised and will be posted to the HCS.

1% Restoration

As previously reported, DOH is still awaiting CMS approval. NYSHFA continues to strenuously lobby both DOH officials and the Legislature to release the state share portion of the funding.

Medicaid Lag Reinstatement

Letters have been sent to specific facilities who may be placed back on the two-week lag. DOH is evaluating facility responses accordingly. All members should respond if notified in order to prevent automatic placement on the lag.

Case Mix

The January 2017 MDS submission process will begin in the next week or so. Members are urged to submit accurate and timely MDS data to avoid delays in CMI adjustments in the upcoming July 1, 2017 rates.

Advanced Training Initiative (ATI)

DOH will survey eligible facilities receiving funds from this year’s ATI. The survey will seek information on facility training efforts to date, and request five employees individually respond from each facility. NYSHFA will have input to the survey in advance of finalization.

Quality Pool

The 2013-15 Quality Pool distribution continues to be delayed pending litigation. Note:  The 2016 NHQI results have been posted to the HCS.

Capital Attestations

Work continues to approve remaining outstanding Capital Attestations. 4/1/17 is the anticipated deadline for final review.

Refinancing/Shared Savings

DOH expects to release its’ Policy & Procedures in the next few weeks. All approved refinancings after 4/21/15 are eligible to be considered for shared savings. DOH indicated it is current with all refinancing applications and anticipates a 30-day turnaround on future refinancing applications.

NYSHFA/NYSCAL will continue to keep members updated on these issues moving forward.

NYSHFA/NYSCAL CONTACT:

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

DOH Monthly Briefing – Finance – February 2017

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed:

Rate Packages

  • January 2017 Rates:  DOH issued the 1/1/17 rates a week or so ago, with expected payment date via cycle #2059, check release date of 2/22/17. Please see NYSHFA member mailing (1/31/17) for full details as well as the rate DAL.
     
  •  Cash Receipts Assessment (CRA) 2015:  DOH has acknowledged system errors related to the 2015 CRA, first disclosed via DAL issued last week. Corrections are slated to be in place by cycle #2061, check release date 3/8/17. DOH has outlined the correction process, which it shared with the Associations. NYSHFA is presently reviewing the information and will provide further details to members via a NYSHFA EXTRA in the next few days. Members are not required to take any further action at this time.

Minimum Wage

Per diem adjustments for the minimum wage have been included on line 13 of the 1/1/17 rate cover sheet. NYSHFA has requested clarification and supporting documentation of the payment methodology to ensure that reimbursement for the minimum wage increases approximate facility-specific DOH wage surveys. DOH will be sharing the payment methodology with the Associations, and has agreed to provide the facility-specific calculations. NYSHFA will update members once the data has been received.

Advanced Training Initiative (ATI)

The $46M funding for year 2 of the ATI has been processed through MFM (Medical Financial Management) via cycle #2056 (check release date 2/1/17.) DOH has scheduled a Workgroup meeting to discuss performance measures needed for compliance evaluation going forward. NYSHFA is conducting member conference calls this week to discuss training program options for eligible members. (Thursday, February 9, 2017 at 10:00 am is the next scheduled call.)

OMIG Audits

The 2012 adjusted audit rates have been paid. The 2013 audited rates (effective 7/1/13 and 1/1/14) have been approved by DOB and are slated to be paid by cycle #2057 (check release date 2/8/17.) The 2014 audits are currently being processed by OMIG, with draft audit reports being circulated to providers.

Medicaid Payment Lag

DOH is presently reviewing the list of providers currently off of the two-week Medicaid payment lag (through prior approved requests.) The required lag affects the Global Spending Cap, and as such, DOH will be making efforts to reinstate the lag for many of the estimated 100 facilities currently exempted. Letters will be sent to those facilities requesting financial documentation to support continued lag relief going forward. DOH will allow sufficient time for any facility brought back on the lag to adequately prepare for the resulting cash flow effect.

Equity Withdrawal

Letters will be sent to providers who have not received DOH prior approval for equity withdrawals over the 3% limit. The DOH letter will remind providers of the prior approval requirements as well as potential penalties associated with withdrawal violations. DOH will include equity withdrawal guidelines as part of a webinar related to capital issues currently being developed.

1% Restoration

As previously reported, the payment methodology to proportionally increase the direct and indirect prices has been approved by DOH, but still awaits CMS approval.

Capital Attestations

DOH will continue to review pending 2017 Capital Attestations through the end of the first quarter.

NYSHFA will continue to keep members updated on these issues moving forward.

NYSHFA/NYSCAL CONTACT:

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

DOH Monthly Briefing – Finance – January 2017

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following is a brief summary of the topics discussed:

Rate Packages

Updates to the following rate packages were noted by DOH: 

  • January 2017 rates:

The rates, which now include the fully-implemented pricing methodology, will also be updated for July 2016 Case Mix, approved 2017 Capital Attestations, and the Minimum Wage adjustment. The rates have been approved by DOB and are expected to be posted in the next few weeks.

  • Cash Receipts Assessment (CRA):

The 2015 CRA has been approved by DOB. The estimated statewide impact to providers is $20M, and is expected to be posted this January.

Advanced Training Initiative (ATI)

The $46M in funding for the ATI is being processed through MFM (Medical Financial Management). Payments should be expected in cycle 2056 (check release date 2/1/17). DOH will schedule a meeting in the next few weeks to discuss related metrics.

Minimum Wage

The rate adjustment attributable to the minimum wage methodology, (still pending CMS approval), will be incorporated into the January 1, 2017 rate package for both SNFs and ALPs. Rate adjustments will be incorporated into the miscellaneous adjustment line on the rate sheets. The minimum wage workgroup will reconvene in early 2017 to discuss preparations for the April 2017 rate impacts.

Capital Attestations

DOH received 340 capital attestations, and have approved approximately 200 to date, with 90 rejections. The remaining attestations were not reviewed due to time constraints. DOH has released capital discussion points as well as proposed capital processing options going forward (attached). Note: The Capital Attestations will be mandatory for all providers next year.  A webinar will be upcoming regarding the attestation process.

OMIG Audits

The 2012 adjusted audit rates have been paid. The 2013 audited rates (effective 7/1/13 and 1/1/14) have been approved by DOB and will be going to EMEDNY for processing over the next few weeks.

DOH and OMIG are expected to release further MDS audit guidance to better assist facilities with their MDS submission process.

1% Restoration

As previously reported, the payment methodology which would proportionally increase the direct and indirect prices, has been approved. DOH is still awaiting CMS approval prior to sending on to DOB.

Quality Pool

2013 – 2015 Quality Pool continues to be delayed pending litigation.
Note:  The 2016 NHQI results are being posted to the HCS. Look for a separate NYSHFA member mailing tomorrow with more details.

Equity Withdrawal

DOH reviewed the 2014 RHCF, and cited an increasing number of equity withdrawals without prior approval. The 1/1/17 rate DAL will contain “reminder language” outlining the equity withdrawal requirements. DOH will next compare 2015 RHCF data to 2014’s, prior to potential further action.

NYSHFA will continue to keep members updated on these issues moving forward.

NYSHFA CONTACT:

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

DOH Monthly Briefing – Finance – December 2016

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following is a brief summary of the topics of discussion:

1% Restoration
DOH has shared its proposed methodology to process the 1% restoration, which encompasses rate years 2014/2015 ($140M), as well as rate year 2016 ($70M). The methodology would proportionally increase the direct and indirect prices to achieve the required funding based on a facility’s total revenue percentage to statewide revenue percentage. The restoration dollars, once in the base prices, would thus be affected by both Case Mix Index (CMI) and Wage Equalization Factor (WEF) going forward.

NYSHFA shared the proposed calculations with its Payment for Services Committee earlier today, and is in general support of the methodology, as are the other statewide and regional associations. The 1% Restoration is still pending CMS approval, thus DOH has not given specific payment timelines. A DAL with further information is expected.

Minimum Wage
The rate increase attributable to the minimum wage methodology, still pending CMS approval, is slated to be incorporated into the January 1, 2017 rate package for both SNFs and ALPs. The minimum wage workgroup will reconvene in early 2017 to discuss preparations for the April 2017 rate impacts. Rate adjustments will be incorporated into the miscellaneous adjustment line on the rate sheets.

Rate Packages
Updates to the following rate packages were noted by DOH:

•    July 2016 rates: updated for January 2016 case mix paid via cycle 2047, check release November 30, 2016.

•    January 2017 rates: At DOB for approval. Rates will be updated for July 2016 case mix, minimum wage (once CMS approves) and 2017 capital attestations. Expect rates mid-January 2017. Note: DOH noted that it has achieved its goal of issuing scheduled rates updated with the most current MDS submissions.

•    2015 Cash Receipts Assessment: Presently at DOB, expect January/February processing. Note: paid per diem will remain at 2014 base thru 2017 rate year (NYSHFA continues to advocate for a 2015 updated base).

Advanced Training Initiative (ATI)
Rate package is in final review, DOH expects to pay by year-end. Performance measures/ benchmarks are in discussion between DOH and the associations.

Quality Pool
2013 – 2015 Quality Pool continues to be delayed pending litigation. Regulations have been approved.

Transportation Carve-Out
2007 Base year medical transportation costs are to be removed from the pricing rates. CMS has approved the state plan amendment, and regulations are in process. Expect during first quarter 2017.

OMIG Audits
The 2012 adjusted audit rates are complete and should be posted in the next few days. The 2013 audited rates are currently at DOB and should be processed sometime in January. The 2014 audits are still in process, as DOH and OMIG continue to work towards streamlining future audits so as to authorize release of the 5% CMI cap where applicable, as well as minimize retroactivity issues with the MLTC’s going forward. DOH will be issuing further OMIG audit guidelines to better assist facilities with the MDS submission process.

Capital Attestation
DOH received 350 capital attestations, and have approved approximately 160 to date, with 40 rejections. The remaining 150 attestations remain under review, as DOH attempts to finalize by late next week. Those attestations still not approved may be delayed until April 1, 2017. DOH may then carry-forward a facility’s 2016 capital rate into 2017 pending final attestation determination.

DOH will continue to keep members updated on these issues going forward.


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

DOH Monthly Briefing – Finance – November 2016

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier this afternoon. The following is a brief summary of issues that were discussed:

Minimum Wage

The payment methodology is at DOB awaiting final approval, and regulations are still being finalized. CMS must also still approve the State Plan Amendment. It is DOH’s intention to process the minimum wage adjustment in the upcoming January 2017 rates. (see below). Approximately $9.1M would be allocated based on a WEF-adjusted regional pricing methodology.

2017 Notice Rates

2017 Notice Rates were issued last week, which included the initial 2017 capital rates, DOH expects to issue the final rates on or around 1/15/17, and should include approved capital attestations, the updated July 2016 casemix, as well as the minimum wage adjustment (assuming CMS approval is in place).

MDS Case Mix

The July 2016 MDS data submission is being completed. DOH noted that approximately 53 facilities have missing or incomplete MDS data (from the October catchment period). DOH is reviewing CMI regulations and is convening another meeting next week with the Associations to determine how to treat what they perceive is a chronic facility reporting issue. Options may include issuing a default rate and/or holding those facilities back as a separate rate package, so as not to penalize the over 550 facilities who successfully uploaded their MDS data in a timely manner.

OMIG Audits

2012 OMIG Audits are now finalized and to DOH executive staff for review. 2013 audit data has left OMIG and is now with DOH rate-setting. DOH will release Medicaid payment cycles once they have been established.

Cash Receipts Assessment (CRA) – 2015

The 2015 CRA is due to be processed in early December. DOH will continue to roll the 2014 base payment into the 2017 rates going forward.

1% Restoration

The CMS SPA has been filed, and all requests for additional information have been responded to by DOH. Appropriate regulations are in place. DOH will be sharing a draft rate run with the Associations, as well as a summary of the payment methodology. No timetable was given regarding the release of the monies ($140M for 2014/15 and $70M for 2016).

Quality Pool

The regulations and CMS SPA have been approved for 2013, however, pending litigation continues to delay processing.

Advanced Training Initiative (ATI)

DOH expects payment for the ATI Year-2 funding to occur in December. The ATI Workgroup will be meeting next week to discuss performance metrics in an effort to satisfy CMS requirements, and as a necessary step in advancing the ATI further (presently only approved for 2 years).

2017 Capital Attestations

2017 Capital Attestations are due on December 2, 2016. No extensions will be granted. Facilities with specific issues concerning the attestation process are urged to email DOH ASAP.

Equity Withdrawal

The Governor’s office has requested that DOH review equity withdrawal data (from 2014/2015 RHCFs), to assure adherence to the equity withdrawal regulations and prior notice requirements. NYSHFA will be in discussions with DOH to gather further information.

NYSHFA CONTACT:

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

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 census, affecting 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.

NYSHFA CONTACT:

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

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 ...

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 ...

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 ...

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 ...