DOH Monthly Briefing – Finance – July 2019

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly briefing earlier today. The following summarizes the topics discussed: 

July 1, 2019 Rates 

The 7/1/19 rates are under Executive review. No further updates were given. 

Case Mix Workgroup 

The Case Mix Workgroup recommendations were submitted to DOH on 6/28/19 (see member mailing).As the 7/1/19 rates are still under review, it is uncertain as to DOH’s response to the Workgroup recommendations. 

Bedhold Revised Regulations 

The revised bedhold regulations were adopted, effective 5/29/19 (see member mailing). NYSHFA has been compiling members’ bedhold questions and has forwarded them to DOH. DOH is formulating a Frequently Asked Questions (FAQ) based on questions submitted by the Associations and Providers. Members should continue to email their bedhold questions to both as well as to NYSHFA. 

November 1, 2018 Rates 

The 11/1/18 rates which include the 1.5% transformation fund will be in Medicaid Cycle #2183 (check release date 7/10/19). Providers should see a positive retroactive adjustment from 11/1/18 forward through current billings. 

January 1, 2019 Rates 

The January 1, 2019 rates will be processed in upcoming Medicaid Cycle #2184 (check release date of 7/17/19). 

As noted in NYSHFA member mailing, the rates will be corrected for the Case Mix cap adjustment in upcoming Medicaid Cycle #2185 (check release date 7/24/19). 

2018 RHCF 

The 2018 RHCF filing deadline is Monday, July 29, 2019. Providers are urged to test the HCS/Gateway Portal for the proper authorization(s) to ensure timely filing of the RHCF. Members encountering any specific issues with the RHCF software should immediately email

2017 CRA Reconciliation

The 2017 Cash Receipts Assessment Reconciliation is under review with DOB and should be finalized during third 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. The CRA per diem will again be updated to the 2019 rates, upon final approval. This process should minimize the reconciliation effect, as well as lead to more timely reconciliations going forward. 

2018 NHQI/1% Restoration 

The 2018 NHQI data results were posted to the DOH website last week. DOH has indicated it would implement the NHQI rate adjustments early Fourth Quarter 2019 (following the 2018 RHCF submissions). DOH also plans on again offsetting the NHQI adjustment with the 1% Restoration payments, similar to last year. 

EO-38 Website 

DOH is in discussions with their counsel regarding the EO-38 website updates. The form on the current website still requires a waiver for Executive salaries exceeding $199,000, despite the court ruling excluding non-Medicaid funds from the calculation (and this potentially negating the waiver requirement). NYSHFA expressed concerns given that the EO-38 filing date is rapidly approaching (7/29/19). 

Advanced Training Initiative (ATI) 

ATI funding was again included in the Enacted 2019/20 Budget. The ATI is currently under Executive review. 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. 

FFS Transition

DOH is responding to CMS request for additional information (RAI) related to the transition back to FFS. DOH rate-setting will inquire internally as to the status of the RAI. No further updates were provided. 

Universal Settlement (US) 

DOH indicated that the fifth and final payment of US could again take place as early as Fall 2019.