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, 2017. Attached 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.


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