DOH Monthly Briefing - August 2020

Carl Pucci

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

January 1, 2020 Rates 

DOH has released the 1/1/20 rates which include the updated attested capital component. The case mix has not yet been updated to reflect the 7/31/19 census picture date, pending finalization of the current MDS submission process. The 1/1/2020 rates will then be reissued to include the updated case mix adjustment.

NYSHFA stressed the importance of the revised rate issuance and subsequent update to the benchmark rates, as providers encounter difficulties with the MLTC plans paying retroactive rate adjustments. The DAL for both the 1/1/20 and 4/1/20 rates is attached. 

April 1, 2020 Rates 

The 4/1/2020 rates, which include the 5% overall capital rate reduction and the elimination of residual equity payment (both enacted within the 2020/21 Executive Budget) have been issued. Payment of both the 1/1/20 and 4/1/20 rates are scheduled for Medicaid cycle #2243 (check release date 9/2/20). 

July 2020 CMI 

DOH will announce the timeline for the upcoming July 2020 MDS collection period shortly after the current MDS submission process is finalized.

MLTC to FFS Transition 

OHIP has released guidance related to the MLTC Nursing Home Benefit Limitation, which was implemented on 8/1/20. NYSHFA has raised member concerns regarding residents that meet the criteria for disenrollment but have not yet been included in the initial 8/1/20 DOH batch disenrollment process. These issues have been forwarded to OHIP, as we await their response. Members should continue to forward transition questions and concerns to NYSHFA and/or 

COVID -19 

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.

2019 RHCF 

The cost report software has been loaded onto the HCS network. DOH has extended the response time to file the RHCF to 90 days, in recognition of the current Covid-related challenges. The 2019 RHCF filing deadline is 9/15/20. Prospective questions related to the 2020 RHCF filing are not able to be addressed at this time. 

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. OMIG recognizes the stress that providers are currently facing and will “work with facilities” as they begin commencing future MDS audits. 

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. 


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 continue to keep members updated on these rate-setting issues as they develop.



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