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.


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