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

The July 2012 CMI resulted in an aggregate statewide increase of 2.4%, equating to $50M in additional funding over a six month period (payable 1/1/13 – 6/30/13).  Almost 30% of nursing homes exceeded the 5% threshold, and DOH is still uncertain as to the release date of the rates, but most likely would not be prior to mid-November.

CMI Audits

The combined audit period (1/1/12 and 7/1/12) is still slated for completion by OMIG by mid-February 2014.  OMIG will then begin auditing the combined 1/1/13 and 7/1/13 audits.  Attached are revised audit guidelines for the July 2012 CMI which were presented.  The 2012 audits completed to date are through “draft” stages, and OMIG letters will be going to providers shortly.

2014 Notice Rates

The initial 2014 notice rates are scheduled to be released on 11/1/13.  These rates will include the initial 2014 capital, continuation of the January 2012 CMI, the 2014 prices (year 3 of transition), as well as corrections to patient days for providers affected by Hurricane Sandy.  Note:  in terms of sequencing, DOH stated that the 2014 notice rates would be issued in advance of the 7/1/12 CMI adjusted rates.

Nursing Home Managed Care Transition Workgroup

NYSHFA attended this meeting held earlier today.  Attached are PowerPoints from both the opening presentation, as well as the Quality Pool session.  The sub-workgroups then met for further discussion.  DOH will summarize those meetings and we will update the membership accordingly upon receipt of this information.

Hurricane Sandy

The 9/13/13 DAL outlined the final reconciliation timetables with a submission deadline of October 7, 2013.  DOH remitted approximately $7M to facilities who had no reconciliation discrepancies via Medicaid payment cycle 1883.

Universal Settlement

Discussions continue with the Governor’s Council, the Attorney General’s Council and DOH regarding talking points on the settlement.  A term sheet is being developed in conjunction with revised impacts of the settlement proposal.  The settlement is not expected to require legislation, but a CMS State Plan Amendment (SPA) must be approved.  The associations again reiterated the importance of protecting this funding going forward into Medicaid Managed Care, perhaps similar to the proposed treatment of the capital component.

NAMI Process

DOH requested association and provider contacts to form a workgroup to assemble the data necessary to support this initiative to CMS.  NYSHFA discussed this with its’ Payment for Services Committee earlier this week, and is accumulating provider input for presentation to DOH.


The Vital Access Program (Phase 1 applicants) has received CMS approval.  DOH is currently prioritizing Phase 2 applicants and will further discuss with the Governor’s office next week.  $30M in funding for FY 13/14 continues to be earmarked for nursing homes as part of the Phase 2 funding.

NYSHFA will continue to update members on these important issues as necessary.


Director, Finance & Reimbursement
518-462-4800 x36