Issue: September 19, 2013

Published on September 19, 2013

Articles in this issue:

Medicaid Managed Care Update

Author: Carl Pucci* Published in Finance & Reimbursement


The DOH Nursing Home Transition Workgroup met last week to present recommendations from each of its sub-workgroups on Medicaid Managed Care implementation.


Benchmark Fee-For-Service (FFS) rates would be established for a two-year transition period once a county is deemed mandatory for nursing home enrollment into a managed care plan (slated to begin in 2014).  The benchmark rate would include the fully-phased in 2017 pricing rate, a capital benchmark rate, as well as the Universal Settlement, if approved.  NYSHFA has advocated for a full-pricing component as well as the protection of the additional universal settlement funding after the transition period expires.  In addition, we continue to stress the importance of continued CMI adjustments outside of the benchmark rates.  We continue to work with DOH to assist their efforts in taking over collection of the NAMI as well.  The full Nursing Home Transition Workgroup PowerPoint is attached.


DOH stressed that a workflow be established for each managed care population (i.e., does the transition period satisfy industry concerns?)  Permanent placement would still require physician/medical director approval, the five-year look-back would remain unchanged and transfer of asset issues would still need to be addressed.


For network requirements, the proposal is that each Medicaid Managed Care Plan contract with at least the lessor of 1) 30% of nursing homes per county or 2) eight nursing homes per county.  In addition, plans would be required to contract with at least two facilities for specialty services in counties where available.  DOH stressed that plans will need sufficient nursing home contracts to maintain resident access to care.  Medicaid pendings would still be covered under a FFS arrangement, as is the case presently.

Access to Care/Quality

The admissions process will follow existing authorizations, and it is recognized that considerable training and teaching is needed for nursing homes to operate in a Managed Care environment.  Three quality incentive programs are currently proposed:


NYSHFA has developed a summary PowerPoint, highlighting the workgroups recommendations to date.  There is still much work to be done, and questions to be answered.  We will continue to monitor and report on future workgroup meetings as each occurs.  Additional information is found in the Managed Care section of the NYSHFA website under Facility Resources--Reimbursement--Managed Care.

Director, Finance & Reimbursement
518-462-4800 x36


Gold Stamp: Free Webinar with Dr. Elizabeth Ayello

Author: Nancy Leveille* Published in Clinical & Quality


Dr. Ayello, Coauthor of the “Pocket Guide to Pressure Ulcers” will present a one hour webinar on the assessment and proper documentation of pressure ulcers.  This material is appropriate for all professional staff working in administration and direct care in all health care settings.  See attached brochure for more information.

Click here to register.

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


NYSHFA/NYSCAL 18th Annual Fall Education Conference

Author: CMP Scott Jackson* Published in Education

NYSHFA/NYSCAL 18th Annual Fall Education Conference
November 13-14, 2013
Hilton Garden Inn, Troy, NY

This conference will provide the information that you need today:  information that will change your future.  The industry is changing at a rapid pace.  Don't be left behind!

This conference is recommended for Owners, Owner/Operators, Administrators, Nursing Administrators, Human Resource Directors, Financial Directors and other members of the Interdisciplinary Team. 

Ten and 1/2 (10.5) hours of Continuing Education Credits (CEUs) have been applied for from the National Association of Boards of Examiners of Long Term Care Administrators.  Ten and 1/2 (10.5) hours of Continuing Education Credits are approved for Licensed Certified Public Accountants (CPAs) by the New York State Education Department.

Brochure & Registration Materials

Hotel Reservations

NYSHFA Contact: Scott Jackson, CMP (518) 462-4800 ext. 27
Director, Education & Conference Planning