DOH Monthly Briefing – Finance – January 2020

Carl J. Pucci in Finance & Reimbursement

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

FFS Transition

CMS has approved the 1115 Amendment on limiting the MLTC partial plan nursing home benefits to three months (i.e., MLTC to FFS transition) for those that have been designated as long-term nursing home stay (LTNHS) residents, formerly described as “permanently placed” residents.

DOH Division of Long Term Care is working with Maximus to notify LTNHS dual eligible residents who are seeking enrollment that they no longer need to enroll in a plan. Those residents who have already been scheduled to enroll will receive a notice that effective 2/1/20, their plan enrollment will end, and they will continue to receive services through regular Medicaid FFS. Mandatory enrollment of LTNHS dual eligible members has already been terminated to avoid unnecessary enrollments in light of this policy change. 30-day notices to all MLTCP enrollees will be mailed within the next week.

Members should refer to the attached DOH PowerPoint for specific timelines related to prospective enrollees (slide 3), as well as to the “Upstate/Downstate” implementation designation (slide 4.) Disenrollment information will be added to the existing Maximus form, to be distributed in late March (slide 5.)

DOH will be issuing a detailed DAL which will provide next steps. A Frequently Asked Questions (FAQ), as well as enrollee transition to the community guidance will also be developed. Initial questions should be forwarded to NYSHFA will closely monitor the transition back to FFS and provide regular updates over the coming weeks.

1% A-T-B Medicaid Cut 

As announced previously, the State has imposed a 1% Across-The-Board (ATB) cut to all non-exempt Medicaid providers. (See member mailing 1/2/20).

DOH will begin recouping 1% of FFS Medicaid claims via the EMEDNY system for dates of service 1/1/20 and forward. The CMS State Plan Amendment (SPA) will be modified accordingly. The MLTC’s will have their premium payments reduced 1%, also effective 1/1/20. DOH has not yet made a decision on whether the 1/1/20 benchmark rates will be adjusted for the 1% cut. 

Case Mix – July 1, 2019 Rates

DOH is presently processing the MDS certifications, which were due today (1/14/20). The 7/1/19 rates are expected to be recalculated next week. The rates will then move to DOB for approval. DOH will provide a payment cycle date as soon as possible. The Medicaid lag suspension will remain in place until the 7/1/19 rates are issued. Members should prepare for estimated resumption of the lag shortly after the rates are released, most likely mid to late February. 

January 1, 2020 Rates   

The 1/1/20 notice rates are under internal agency discussion as a result of our case mix litigation Preliminary Injunction. Further guidance regarding the 1/1/20 rates will be forthcoming once the 7/1/19 rates are issued. Subsequently, DOH will provide MDS data collection period guidance based on the 7/31/19 picture date in preparation for the 1/1/20 rates. Questions related to the notice rates should be emailed to DOH via the

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. DOH expects to release payment cycle dates in the very near future. 

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. The 2% QP will be issued separately, once the 2018 NHQI/1% restoration rate package noted above is released. 

2018 CRA Reconciliation 

The 2018 CRA Reconciliation has been approved by DOB. DOH should be finalizing the calculations in the upcoming weeks. 

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. 

OMIG MDS Audits 

The 2016 final audit reports are in process. The 2017 field work will commence shortly in the Central Region.