Issue: June 12, 2020

Published on June 12, 2020

Articles in this issue:

DOH Monthly Briefing – June 2020

Author: Carl J. Pucci

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


NYSHFA had previously raised the question of appropriate Medicaid reimbursement for the Executive Order mandating biweekly employee testing. DOH is still discussing 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 are currently at DOB for approval, and most likely will be issued sometime later this month. 

DOH is moving 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 has been issued, and a webinar providing guidance related to the “streamlined” MDS collection process has been scheduled for next Wed. 6/17/20 at 10:00 am and repeated at 1:00 pm. (Registration details to follow, and the webinar will be archived). The Jan. 1, 2020 rates would then be reissued to include the revised case mix adjustment utilizing the 7/31/19 census picture date. 

The associations 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 exceed six months. 

April 1, 2020 Rates 

The April 1, 2020 rates, which include the 5% capital rate reduction, and the loss of residual reimbursement (both enacted within the 2020/21 Executive Budget) are under DOB review. These rates may be issued within close proximity of the 1/1/20 rates, to be determined by DOB. Additionally, the increase in the Medicaid claims payment cut from 1% to 1.5% is also currently pending. 

NYSHFA is working with regional associations to address the cuts to residual reimbursement directly with DOH, and follow up discussions with DOB will be scheduled in an attempt to eliminate or forestall implementation of this cut. 

MLTC to FFS Transition  

OHIP has released guidance related to the MLTC Nursing Home Benefit Limitation, now slated to be implemented on 8/1/20. (See NYSHFA Priority Alert).  Subsequently, a DAL has just been issued which revises the initial transition guidance first published this past January. Members should continue to forward questions and concerns to NYSHFA and/or  

2019 RHCF 

The cost report software is now being loaded onto the HCS network. Attached is the related DAL. DOH is extending the response time to file the RHCF to 90 days, in recognition of the current Covid-related challenges. The RHCF filing deadline is now 9/15/20. 

OMIG - MDS Audits 

OMIG continues work on finalizing the 2016 MDS audits but is delaying the issuance of final audit reports due to the current COVID challenges that providers are facing. The 2017 audits will resume once other state agency COVID-related requirements are met. 

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. 

NHQI Score Finalization 

DOH will be finalizing the NHQI feedback and related questions with respect to the final scoring within the next 30 days. 


The associations have asked for clarification on whether the federal stimulus funds and/ or PPP loan disbursements would be subject to the cash receipts assessment. DOH continues internal discussions, but as yet does not have any further guidance. 

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


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