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. 


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:

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. 


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