DOH Monthly Briefing - May 2020

Carl J. Pucci in Finance & Reimbursement

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed:  

COVID -19 

NYSHFA raised the question of appropriate Medicaid reimbursement for the recent Executive Order mandating biweekly employee testing. DOH is presently discussing the issue internally and will communicate guidance when a decision has been reached. 

January 1, 2020 Rates 

DOH will initially release the 1/1/20 rates to include the updated capital, maintaining the existing case mix currently being paid via the July 1, 2019 rates. This would ensure that the capital rate would not be further delayed due to the MDS submission process described below. The rates would then require DOB approval, so most likely would not be issued until sometime next month. 

DOH will then move forward with an enhanced and simplified MDS collection process, which will be based on the July 31,2019 census picture date for case mix revisions to the 1/1/20 rate. A DAL and webinar will provide guidance related to this planned “streamlined” MDS collection process. The Jan. 1, 2020 rates will then be reissued to include the revised case mix adjustment utilizing the 7/31/19 census picture date. 

We stressed the importance of the rate issuance and subsequent update to the Benchmark Rates, as providers encounter difficulties with the MLTC plans paying retroactive rate adjustments, which will now approach six months.

The 2020/21 Executive Budget cuts, including the increase in the Medicaid claims payment cut from 1% to 1.5%, the 5% capital rate reduction and the loss of residual reimbursement (all effective 4/1/20) are still under review at DOB. NYSHFA will be addressing the cuts to residual reimbursement directly with DOH sometime next week. 

FFS Transition  

The implementation of the MLTC-FFS nursing home benefit limitation continues to be delayed. DOH has notified plans that June 1, 2020 implementation date will not occur for long-term nursing stay residents to disenroll from MLTC plans. Once the DOH-coordinated batch disenrollment occurs, residents meeting the three-month threshold going forward will be disenrolled by individual plans. 

DOH has indicated OHIP guidance will be released in the next few weeks and we have again requested a coordinated briefing with OHIP to discuss the transition implementation. Members should continue to forward questions and concerns to NYSHFA and/or

Medicaid Lag / CRA Suspension 

NYSHFA has requested that DOH suspend both the two-week Medicaid payment lag as well as the monthly CRA payment obligation due to the cash flow constraints caused by the pandemic. DOH recognizes this issue and is discussing at the department’s executive level. No additional information is available at this time.

2019 RHCF 

The RHCF process is being review across the entire LTC sector. No specific date on either the software release or the filing deadline was announced. Once issued, DOH will allow the same response time as in previous years for filing. 

NYSHFA will keep members updated on these rate-setting issues as they develop. 


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