DOH Monthly Briefing – Finance – December 2019

Carl J. Pucci in Finance & Reimbursement

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

Case Mix - 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). Pursuant to our Preliminary Injunction, DOH will revert to the January 1, 2019 rates, (retroactive to July 1, 2019), which will go live in upcoming Medicaid Cycle #2207 (check release date 12/25/2019). All recoupments and/or shortages experienced by Providers will be adjusted in the system automatically upon implementation of the January 2019 rate. 

DOH has removed the two-week eMedNY lag for cycle #2207, as such, the targeted payment date will now be December 11, 2019. DOH remains on track with the December MDS collection process, (as outlined in the 11/21/19 DAL), to calculate the revised 7/1/19 rates. The lag will be reinstated once the 7/1/19 rates are recalculated. NYSHFA has requested that DOH give providers as much advance notice as possible as to the date the lag will be reinstated (expected to be sometime in January 2020) for cash flow planning. 

January 1, 2020 Rates 

The 1/1/20 notice rates are under internal agency discussion as a result of our Preliminary Injunction. Further guidance regarding the 1/1/20 rates and collection process will be forthcoming once the 7/1/19 rates are completed. Questions related to the notice rates should be emailed to DOH via the

Universal Settlement 

The fifth and final installment of the Universal Settlement has been transmitted to the Trustee’s (O’Connell and Aronowitz and Hinman Straub) accounts. The Trustees will reconcile Medicaid liabilities being applied to the payments prior to processing Provider checks. The Trustees expect to release the payments to Providers by the end of this month. 

FFS Transition 

DOH discussions with CMS have begun winding down. Specific guidance and next steps will be forthcoming from the Division of Long Term Care.

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 final Executive review at DOB. DOH plans on again offsetting the NHQI adjustment with the 1% Restoration payments, similar to last year.

2% QP Penalty 

The 2% Penalty rate package is also under final review at DOB. 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. 

2018 CRA Reconciliation 

The 2018 CRA Reconciliation is under review at DOB. 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 funded providers. NYSHFA continues to strongly advocate for an extension to the 3/31/20 ATI training deadline, and DOH has indicated extensions are likely to be granted. 

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) document. Members should continue to email any bedhold questions to both as well as to NYSHFA.


The 2016 audit field work is complete. OMIG has begun to distribute 2016 audit reports to Providers. The 2017 OMIG MDS field work has concluded in the Western and Northern Regions. OMIG will next begin MDS audits in the Long Island Region. 


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