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.


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. 


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