DOH Monthly Rate-Setting Briefing

Carl Pucci in Finance & Reimbursement

DOH held its monthly rate-setting briefing yesterday.  In addition, a Hurricane Sandy Workgroup meeting was held earlier in the week.  Both meetings are summarized below:

OMIG Audits/CMI Payments

As reported last week, NYSHFA, along with other statewide and regional associations, was instrumental in obtaining the release of the additional $70M attributable to the January 2012 CMI increase over the 5% established cap (attached).  We appreciate DOH securing final approval following numerous discussions over the past month.  DOH stated that the timelines given for the payments (7/29/13 check date with an 8/14/13 release date) remain on track.  Respective rates and a DAL should be issued in early August.  In addition to the revised 7/1/12 rate, DOH will reissue the 1/1/13 rate (including the January 2012 CMI rollover), as well as a revised 4/1/13 rate.

DOH is still evaluating the subsequent CMI census period (July 2012) which will impact the 1/1/13 rates going forward.  Although the 5% CMI cap remains in regulation, initial indications are that the aggregate statewide CMI increase is lower than the January 2012 increase of 7+%, which hopefully will prompt full release of the corresponding payments.  OMIG continues to work towards combining the January and July 2012 census audits, and stated their goal is to audit all providers within a two year period.  The same audit sampling criteria will be utilized, with added focus on the Dementia and BMI add-ons, as well as on payor mix.  OMIG has also contracted with upstate regional nursing staff to help expedite the audit process.

Universal Settlement

The state’s Medicaid Director continues to work with the Governor’s office in developing draft language related to the settlement.

Pricing Phase-in Calculation

DOH remains committed to issuing revised pricing/universal settlement phase-in calculations towards the end of July.  (This has been delayed due to the work necessary to revise the CMI rates for 7/12, as noted above).

Accounts Receivable Update

With respect to the recent DAL outlining the revised collection policy (copy attached), DOH has stated it will only adopt options 1 and 2 at this time (both of which offer abatement of interest charges depending on repayment deadlines being met).

DOH will work with providers who cannot meet either of these options to develop a repayment plan going forward (even past Managed Care implementation target dates if necessary).  This will avoid excessive Medicaid recoupment percentages that would have occurred under option 3 (which set a final repayment deadline of 3/31/15).

FD/VAP Status

DOH is still accepting applications for the Vital Access Program (VAP).  The CMS state plan amendment has been filed, and is “close to approval.”  Over 150 applications have been received with total annual funding set at $182M (which includes the 2013 financially disadvantaged funding of $30M).

Capital Workgroup

NYSHFA will be represented in the capital workgroup.  DOH has established a 90-day timeline with the dual goal of presenting proposals related to capital reimbursement in a Managed Care environment, as well as streamlining the capital refinancing process by a target date of 10/1/13.

Managed Care

There was a general discussion with regards to the transition to Managed Care.  Various implementation challenges that both DOH and Stakeholders jointly faced were noted.  Formation of Managed Care workgroups continue to develop to address the implementation phase.

Hurricane Sandy Reconciliation Process

DOH reported on both the federal relief and statewide reconciliation efforts.  DOH has submitted applications for social security block grants, which would be available to all providers (approximately $235M covering 14 affected counties).  DOH will be distributing additional information related to block grants in the future.  With respect to Medicaid reimbursement, DOH needs an additional three weeks to finalize the EMEDNY data, and will distribute this information directly to affected providers at that time.  DOH will issue “milestone payment dates” via a separate transmittal next week.  They also reiterated that Medicaid payments will be made “outside of the claims process.”  DOH has also responded to many of the billing related questions, as well as other policy questions raised by members.  This will be distributed upon completion.
Note:  For 2012 RHCF reporting, affected providers should report Medicaid patient days as they actually occurred.  The notebook section should be utilized to record what would have been normal patient day volume (using 2011 as the baseline).  DOH will send an e-mail blast shortly to provide further related RHCF reporting instructions.

NYSHFA will provide further updates on these important topics as is necessary.



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