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.


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.


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