DOH Monthly Briefing – Finance – September 2019

Carl J. Pucci in Finance & Reimbursement

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

Case Mix

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 still uncertain as to DOH's response to the Workgroup recommendations. NYSHFA is actively opposing the State’s proposed changes in the Case Mix methodology and DOH acknowledged that opposition in today’s briefing. 

July 1, 2019 Rates 

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

Universal Settlement 

DOH indicated that the fifth and final payment of Universal Settlement is on track to be issued during Fourth Quarter 2019. 

Capital Attestations 

The DAL outlining this years' capital attestation process has been issued. A reminder that all providers must file an attestation, regardless of whether their capital rate is correct or not. The due date is Wednesday, September 25, 2019. 

2017 CRA Reconciliation 

The 2017 Cash Receipts Assessment Reconciliation is under review with DOB and should be finalized during the next few weeks. The 2019 CRA rates are also under review with DOB. DOH will issue a corresponding DAL. 

2018 NHQI/1% Restoration/2% QP Penalty 

The 2018 NHQI data results have been posted to the DOH website. DOH has indicated it will prepare the 2018 NHQI, 1% Restoration, and 2% QP Penalty rate packages for submission to DOB by the end of September (following finalization of the 2018 RHCF data.) DOH also plans on again offsetting the NHQI adjustment with the 1% Restoration payments, similar to last year. Facilities who are either coming off the 2018 2% QP Penalty or being added to the 2019 2% QP Penalty will have their 1/1/19 rates retroactively adjusted. DOH will share drafts of the respective rate calculations with the Associations in advance of issuing. 

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. The FAQs are close to finalization and should be released in the near future. Members should continue to email their bedhold questions to both as well as to NYSHFA. 

Advanced Training Initiative (ATI) 

DOH is finalizing the ATI surveys for both 2018 and 2019 and should release them within the next week. Additional training options have been added. DOH will prepare two separate calculations and fund two years to bring ATI to current status. Eligibility will be determined utilizing the respective 2017 and 2018 RHCF Sch P retention calculation. Since the MLTC to FFS transition has not yet been approved, ATI funding will once again flow through the MLTC plans. 

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 continues to follow-up with DOH Legal seeking guidance related to the EO-38 filing. A separate member mailing will be issued once EO-38 guidance has been received. The State has proposed rule-making language which conforms to the court decision, and is found in the NYS Register.

FFS Transition 

DOH is responding to CMS request for additional information (RAI) related to the transition back to FFS. DOH is still in discussions with CMS. No further updates were provided.  

IGT Payments

IGT payment calculations are being finalized, and still await CMS SPA approval. As in prior years, the IGT funding will be split into two payments (tentatively September 2019/March 2020). 

OMIG MDS Audits 

The 2016 audit field work is complete. OMIG has begun to distribute 2016 audit reports to Providers. The 2017 OMIG MDS audit plan is currently being developed. 


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