DOH Monthly Briefing - Finance - November 2019

Carl J. Pucci in Finance & Reimbursement

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

Case Mix – Preliminary Injunction Granted 

Last Thursday, November 7, 2019, the Court granted our request for a Preliminary Injunction to halt the State’s implementation of its Medicaid case mix cut pending a final determination of our litigation on the merits. In its Order, the Court enjoined the State from implementing the new case mix methodology adopted for the 7/1/19 rates and directed the State to use the prior methodology for calculating Medicaid case mix rates. Consequently, DOH is going to begin the process of calculating the 7/1/19 rate pursuant to the prior methodology. Additionally, DOH is also beginning the process to determine its methodology to return funds to providers that were withheld pursuant to its new methodology. 

July 1, 2019 Rates 

The 7/1/19 rates were issued on 10/9/19, utilizing an 8/8/18 through 3/31/19 MDS catchment period. The payment for these rates commenced with Medicaid cycle 2200 (check release date 11/6/19). DOH is under internal agency discussion with regards to next steps in reaction to the recently issued preliminary injunction (see above). No immediate changes have yet been transmitted to EMEDNY regarding future rate payment adjustments, and the 7/1/19 benchmark rates currently posted will stay in effect until DOH establishes an operational plan. Any further action by the Court could also affect DOH’s plan of action. 

January 1, 2020 Rates 

The 11/1/19 notice rates, effective 1/1/20, have been issued. They include the initial 1/1/20 Capital Rate, the 1/1/20 Minimum Wage adjustment and a Case Mix adjustment which utilized the 4/1/19 through 9/30/19 MDS catchment period. As with the 7/1/19 rates, the 1/1/20 notice rates are under internal agency discussion as a result of the preliminary injunction. Questions related to the notice rates should be emailed to DOH via the

Universal Settlement 

DOH indicated that the fifth and final payment of Universal Settlement has been approved by DOB. The facility outstanding receivable calculation is being revised prior to MFM (Medicaid Financial Management) releasing the payment to the Trustees for facility distribution. 

2018 NHQI/1% Restoration 

The 2018 NHQI data results have been posted to the DOH website. DOH has indicated the 2018 NHQI and 1% Restoration are under Executive review. DOH also plans on again offsetting the NHQI adjustment with the 1% Restoration payments, similar to last year. 

2% QP Penalty 

The 2% Penalty rate package will be sent to DOB within the next few weeks. 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 issuance. 

2017 CRA Reconciliation 

The 2017 and 2019 CRA rates have been issued. Payments were processed in Medicaid cycles #2197 (10/16/19 check date) and #2198 (10/23/19 check date). 

2018 CRA Reconciliation 

The 2018 CRA Reconciliation is under Executive review. A timetable for finalization has not yet been established. 

Advanced Training Initiative (ATI)  

The DOH ATI surveys have been completed by Providers, and DOH has funded both 2018/19 and 2019/20 to the MLTC plans who, in turn, have recently begun funding providers. NYSHFA continues to strongly advocate for an extension to the 3/31/20 ATI training deadline. 

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.  

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.   

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