DOH: Monthly Rate-Setting Briefing

Carl Pucci in Finance & Reimbursement


DOH held its monthly rate-setting briefing yesterday, which included the following topics:

CMI Payments – July 2012 Census

DOH is concluding its final analysis of the July 2012 census data.  The corresponding CMI adjustments (which will affect the 1/1/13 rates) are expected to be paid by 10/31/13.  The aggregate statewide CMI increase for this census period is approximately 1.5%.  DOH/OMIG have yet to decide if the payments will be released in their entirety, or if a 5% cap (pending audits) will again be put into place.

Case Mix Audits

Progress continues on the combined audit period (Jan 2012 / July 2012) for facilities across the state.  OMIG expects to complete the remaining 250 facility audits by mid-February, 2014.  Although the same audit selection criteria is being utilized, DOH indicated that the July 2012 audits will also focus on the various payors.

Nursing Home Transition Sub-Group

The Nursing Home Transition Finance sub-workgroup have completed their potential recommendations to the states Managed Care Workgroup (see attached PowerPoint).  These and the other sub-workgroup’s (Enrollment, Contracting and Quality) potential recommendations will be discussed at tomorrows Managed Care meeting.  DOH recognizes that numerous operational issues related to rates need to be addressed (i.e., billing forms, prompt pay requirements, etc.).  NYSHFA will issue a complete Medicaid Managed Care update to members next week.

Universal Settlement

As previously reported, discussions continue with the Governor’s office and Attorney General’s office regarding the proposal.  The revised rate impacts are complete, but require the Attorney General’s approval prior to release.  The associations stressed the importance of “protecting” the additional funding related to the Universal Settlement going forward into a Managed Care environment.

NAMI Process

Preliminary discussions with CMS regarding a potential state takeover of the NAMI process are going well.  CMS requires an estimate of the cost of the takeover of uncollected NAMI.  DOH has requested that the associations appoint one or two members who regularly work with NAMI to form a small workgroup to assist in this effort.  A survey of associations membership may also be developed to gather additional data necessary to obtain CMS approval.

Hurricane Sandy

DOH announced that the initial Sandy payments (approximately $7M) for affected facilities with no data discrepancies will be issued in Medicaid cycle #1883 (10/9/13 check release date).  For those facilities with reconciliation discrepancies, DOH will be posting facility-specific data to the HCS (Rate-Setting section) in the next few days, giving facilities an opportunity to either adjust initial/raw data figures and/or input post-2/7/13 activity.

NYSHFA will continue to monitor these topics and keep members informed as is necessary.

Director, Finance & Reimbursement
518-462-4800 x36