DOH Monthly Rate-Setting Briefing

Carl Pucci in Finance & Reimbursement

DOH held its monthly rate-setting briefing yesterday. The following topics were discussed.

Medicaid Managed Care
    The State’s Medicaid Director outlined the upcoming steps necessary for the non-dual (i.e., Medicaid Only) nursing home residents to transition to Medicaid Managed Care (scheduled for October 2013). Steps include developing a small workgroup composed of the provider associations, consumer advocates, providers, and both state and local district staff. From these meetings, a work plan for implementation of the transition of the non-duals will be developed. Key policy and operational issues will be addressed, among them: specific issues related to rate setting, eligibility and enrollment, access and quality, and the overall managed care network. DOH is soliciting policy and operational questions from the associations at this time. The association’s prompted further discussion on the Medicaid eligibility lag (i.e.: Medicaid pending), specialty services, assessment reimbursement, benchmarking rates, and prompt pay timelines in a managed care environment. As previously noted, NYSHFA’s Managed Care Task Force recommendations will be submitted, and NYSHFA representatives will attend the initial workgroup meeting, tentatively set for late next week.

OMIG Audits/CMI Payments
    The phase one OMIG audits have been completed (approximately 75 facilities) and the corresponding data is presently being evaluated. OMIG and the DOH have set a meeting with the associations for next Thursday, May 9 to review the audit results as well as “establishing a schedule of deliverables” resulting in payment of the $70 million balance due from CMI increases. The OMIG meeting will also discuss timelines for the audit/payments related to the 1/1/2013 and 7/1/2013 CMI’s. DOH also indicated that OMIG is considering using IPRO as OMIG explores additional resources to assist in completing ongoing CMI audit work.

Universal Settlement
    Draft language is still under review with the Governor’s Counsel and Division of Budget. DOH will issue a federal public notice, as well as initiate the SPA process to CMS. The association’s again reiterated the need for updated fiscal impacts related to the proposed settlement.

Financially Disadvantaged (FD)/Vital Access Program (VAP)
    As noted in previous NYSHFA budget updates, the $30M funding for FD is being shifted to the VAP program. The CMS State Plan Amendment (SPA) for the VAP program has yet to be approved by CMS.

Hurricane Sandy Reconciliation Process
    DOH expressed its appreciation for the associations’ efforts to maximize compliance with the reconciliation survey submissions. They will now begin survey comparisons to the Medicaid billings submitted via the eMedNY system. DOH stated that the resulting reconciliation data will be shared with the Sandy Workgroup prior to payments. The revised estimated timeline is July 1, 2013 for settlements. The workgroup will continue to address policy related questions that providers have submitted. DOH also reminds providers that relief of the two-week Medicaid payment lag is still available for those who qualify.

2% Cut / 0.8% Assessment Offset
    As previously announced in budget updates, the 2% across-the board rate cut was continued effective April 1, 2013 through March 31, 2015. DOH has agreed with the Joint Association’s recommendations to continue the 0.8% non-reimbursable assessment add-on, similar to the previous two year budget cycle. Thus the 6.8% assessment, which had been slated to be reduced to 6.0% on April 1, 2013, will instead remain at 6.8%. (Due to federal matching of State Medicaid dollars, the 0.8% add-on achieves the same required state budget savings as a 2% rate cut would have achieved, but results in a lessor negative impact to providers Medicaid revenue.

RHCF Software
    DOH announced that the RHCF software should be posted to the HCS, possibly as soon as tomorrow, or early next week.

NYSHFA will continue to update members on these topics, as is necessary.



Carl J. Pucci
Director, Finance & Reimbursement
518-462-4800 x36

Refer to #2013-237