DOH Monthly Rate-Setting Briefing

in Finance & Reimbursement

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

CMI Payments
As announced in Friday’s member mailing, DOH has released the balance of Case Mix monies for the January 2012 Case Mix Adjustment. Revised rates for July 1, 2012, January 1, 2013, and April 1, 2013 have been posted to the HCS. Attached is the related DAL with further details, as well as contact information for related questions.

DOH is presently reviewing the July 2012 census data, and expects to complete work on affected rate runs in the upcoming weeks. There is a statewide increase of approximately 2.5% related to this Case Mix period.

OMIG Audits
OMIG continues to expand audit staff and will focus upcoming audits in the Buffalo, North Country, and Capital Region areas. Engagement letters will be sent, and OMIG continues to work on developing protocols related to the combined audit periods of January and July 2012.

Universal Settlement
DOH continues to meet with counsels from the Governor’s office and the Attorney General’s office regarding the Universal Settlement proposal. DOH is awaiting the AG’s reaction to the proposal, and then will develop a communication strategy, as well as finalize the rate impacts of the potential additional funding. DOH acknowledged that close to $100M is still preserved in 2013 for this proposal, should it be enacted.

NAMI Process
DOH has had initial discussions with CMS regarding a possible State takeover of the NAMI process. A joint policy must be developed, and DOH will work with the provider associations to form a sub-workgroup to further explore this initiative. NYSHFA will participate in the design of a brief member survey in order to place a value on both collected and uncollected NAMI monies, which is part of the required CMS data collection effort. Members are urged to watch for and complete the survey, expected in the next few weeks.

Capital Workgroup
The Workgroup is initially focusing on streamlining and fast-tracking mortgage refinancings. DOH is meeting with both its Certificate of Need office staff as well as OMIG to ensure that proposed policies related to the refinancings are acceptable. In addition, long-range objectives of the Capital Workgroup are being drafted for review at next week’s Capital Workgroup meeting. More details will be released at that time.

Hurricane Sandy
DOH announced that approximately $7M will be released to 69 facilities (of the 126 who reported receiving residents) whose data reconciled to the EMEDNY system. These initial calculations will be offline (i.e., out of the rate system) and will be sent via the HCS directly to those facilities. All affected facilities will be receiving a notification and DOH will work with those facilities that have data discrepancies to ensure appropriate subsequent reconciliations are made. They also will work with facilities that were taken off the 2-week payment lag, in order to align Sandy payments with restoration of the lag.

NYSHFA will continue to provide updates on these topics as is necessary.

NYSHFA contact: 

Carl Pucci
Director, Finance & Reimbursement

518-462-4800 ext 36