DOH Monthly Rate-Setting Briefing

Carl Pucci in Finance & Reimbursement

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

OMIG Audits/CMI Payments
As reported in last evening’s member mailing, DOH has provided both a case mix audit timeline, as well as initial audit findings related to OMIG/CMI audits to date.  OMIG reported that exit conferences for those audits are complete, with draft audit reports next to be completed.  As noted in the timeline, 6/17/13 will be the decision point on paying all or some of the remaining $70M attributable to the January 2012 CMI increases.  DOH continues to develop audit protocols necessary to combine the January and July 2013 CMI changes, with the goal to complete the necessary audits moving forward on a semi-annual basis.

Universal Settlement
DOH indicated that the Governor’s office is very close to releasing draft language related to the settlement.  The $100M settlement would become part of the Medicaid reimbursement “base” during the transition period into a managed care environment.

Financially Disadvantaged (FD)/Vital Access Program (VAP)
DOH has submitted the State Plan Amendment (SPA) to CMS, and continues to respond to related SPA questions.  There are approximately 150 applications (all providers).  DOH will prioritize those financially disadvantaged providers applications (94) and begin working with outside contractors as it enters the implementation phase of the program.

Pricing Phase-in Calculation
DOH has committed to recalculating the six-year pricing phase-in impact (last provided in early 2011).  It is expected to be released in the next few weeks.

Capital Workgroup
DOH has asked the Associations for related agenda items, as well as workgroup representatives with the goal of establishing this workgroup in the very near future.  NYSHFA will utilize both it's Payment for Services Committee and it's Managed Care Task Force in providing capital recommendations to the workgroup.

Accounts Receivable Update
DOH will soon be issuing letters to providers who owe monies back to DOH for both retro-rate packages, as well as the cash receipts assessment.  DOH noted that approximately $500M (all providers) is owed, with a substantial amount due from the nursing home sector.

Hurricane Sandy Reconciliation Process
DOH continues to align survey data as it attempts to match it with Medicaid billings by affected providers.  They are addressing various policy issues that have been submitted and a workgroup meeting will be scheduled within the next few weeks.  The Associations are advocating that the “cleanest percent of matched claims” be paid out in advance of those few providers who have data discrepancies.  DOH also reported that the federal aid package is progressing, but gave no timetable on distribution of funding.

NAMI Process
DOH has developed a position paper as it discusses the NAMI process with CMS.  DOH is looking at various scenarios under a managed care environment.

Specialty Providers
DOH, realizing that specialty rates are still set at 2009 levels, is beginning to discuss formation of a separate workgroup to address rates, as well as a potentially different transition timeline into managed care.

NYSHFA will continuously provide updates of these topics as is necessary.



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

Refer to #2013-302