Issue: September 12, 2013

Published on September 12, 2013

Articles in this issue:

DOH: Monthly Rate-Setting Briefing

Author: Carl Pucci* Published 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


$26.8 Million in Grants Available for Health Workforce Retraining Initiative (HWRI) 2014-15

Author: Gayle Farman

Title:  Health Workforce Retraining Initiative 2014-15

Application Release Date:     September 9, 2013
Questions Due:     September 25, 2013
RFA Update and Questions and Answers Posted:     October 4, 2013
Application Deadline:     October 31, 2013, 3:00 PM

Description:   The NYS Departments of Health and Labor are jointly soliciting applications from organizations proposing to train or retrain health industry workers to obtain new positions; meet the new job requirements of existing positions; or otherwise meet the requirements of the changing public health and health care market and diversity of the populations seeking health care services.   
Eligible Applicants:  general hospitals, long term care facilities; other health care facilities; health worker unions, labor-management committees; health care facility trade associations; joint labor-management training funds established pursuant to the provisions of the Federal Taft-Hartley Act; and educational institutions.

Funding Available:  Up to $26,812,800 is available to support this RFA.  Funding is distributed by regional formula outlined in the RFA.

Link to Additional Information:

CDC: Key Facts and Q&As Related to Seasonal Influenza

Author: Nancy Leveille and Karen Morris* Published in Clinical & Quality


On September 4, 2013 NYSHFA held a free audio conference presented by Dr. Emily Lutterloh, Director, Bureau of Healthcare Associated Infections, NYSDOH (the archived version will be posted to our website within the next two weeks). During this in-service, Dr. Lutterloh emphasized the need for effective education of staff to better assist their flu immunization decision making.

The DOH website: has a wonderful Health Care Facility Influenza Immunization Toolkit.  Also contained on this page are Centers for Disease Control and prevention fact sheets and educational materials available for updating and answering questions of your staff , residents and families.  Two of which are: Seasonal Influenza and Key Facts about Seasonal Flu Vaccine.  We encourage members to review this material in preparation for the upcoming flu season.

Sr. Director, Member Operational Support
518-462-4800 x20
  Karen Morris, RN, MS
Director, Clinical & Quality Services
518-462-4800 x15

AHCA: Antipsychotic Consumer Fact Sheet Now Available!

Author: Nancy Leveille* Published in Clinical & Quality

AHCA/NCAL and NYSHFA members are making tremendous progress in safely reducing the off-label use of antipsychotic medications. But we can't reach our Quality Initiative goal in a vacuum.  We must build an environment where consumers are collaborators in the care giving and decision-making process.  And that starts with increasing their knowledge of dementia and the use of antipsychotics.

Therefore, AHCA/NCAL is proud to release their new antipsychotic consumer fact sheet.  The fact sheet provides family members and others involved in a resident's care background on the off-label use of antipsychotics, as well as frequently asked questions regarding loved ones living with dementia. It also gives family members suggestions on how they can partner with providers to get the best possible care for their loved one.  See attached for full information.

NYSHFA CONTACT: Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20