DOH Monthly Briefing - Finance - May 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. 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. It is expected that the Case Mix Adjustment will be updated for the July 2018 MDS, following past practice.

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 Case Mix Workgroup meeting.

Also included in the 1/1/19 rate is the initial 2019 Capital Rate, the 2019 Minimum Wage add-on, as well as the 1.5% Transformation Fund Increase. Additionally, various 2018 operating and capital rate corrections are also under review.

Case Mix Workgroup 

The DOH Case Mix Workgroup members have been selected, with NYSHFA having five representatives on the Workgroup. The initial meeting will be on 5/22/19. The Statute calls for Workgroup recommendations no later than 6/30/19. The recommendations are expected to address the upcoming July 2019 CMI methodology. 

2018 RHCF Software 

The 2018 RHCF software is expected to be released in the next week or so, along with the respective DAL. The RHCF filing deadline will be 60 days after the software release date. 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.

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.

2015 OMIG Case Mix Audits 

The 2015 OMIG Case Mix Audits are under Executive review. The 5% CMI Cap will be released for affected providers upon finalization. OMIG has completed their 2016 audit fieldwork and will be releasing draft reports in the next 30 days or so. The 2017 audits should be commencing over the summer months.

NHQI – 2018 Quality Scores 

DOH is nearing completion of the 2018 NHQI Quality Scores. CMS has approved the 2018 NHQI State Plan Amendment. DOH will issue additional information and guidance in the near future.

Advanced Training Initiative (ATI) 

ATI funding was included in the Enacted 2019/20 Budget. The ATI is currently under preparation by DOH. No further timetables were given. Since the MLTC to FFS transition has not yet been approved, ATI funding may once again flow through the MLTC plans during 2019.

2019 Upper Payment Limit (UPL) 

The 2019 UPL has been submitted to CMS for approval. The 2018 IGT/UPL payments have recently been completed.

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, which will include the applicable form and further guidance. The start date for refinancing submissions remains April 2015 and forward.


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