DOH: Monthly Rate-Setting Briefing

Carl J. Pucci in Finance & Reimbursement


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

2014 Initial Rates

The initial draft rates, issued last Friday on the HCS, contain the 2014 capital component, the 2014 pricing component (year 3 of the pricing transition), as well as continuing the January 2012 CMI.  DOH expects to update these rates on or around January 15, 2014, which will include the July 2012 CMI update, as well as any significant operating/capital corrections which are due to DOH no later than December 2, 2013.  Note:  DOH once again will cap the July, 2012 CMI increase at 5%, pending OMIG audit review.  Facilities above the 5% threshold can expect payments once the OMIG audits are complete. Assuming a March 2014 completion of audits (see below), facilities can expect to receive payments in the May/June time period (allowing for normal rate processing and payment timelines.)  Attached is a rate processing chart which outlines the various rate schedules to be issued over the next six months or so.

CMI Audits

OMIG expects to complete the combined 1/1/12 and 7/1/12 audits by mid-March, 2014.  They have completed most of the upstate area’s audits, and will focus on NYC/LI beginning in January, 2014.  Attached is an overview of recent MDS audit findings.  DOH is currently collecting the July, 2013 CMI data, which projects to a statewide increase of 1.5% over the January, 2013 data.

Universal Settlement

Weekly discussions continue with the Governor’s office and Attorney General’s office revolving around the term sheet which is being developed.  The associations continue to press for revised financial impacts related to the additional funding should the settlement be approved.

Hurricane Sandy

Approximately 98 facilities have yet to be reimbursed for residents cared for (out of 183 affected facilities).  Presently, the remaining facilities data is being verified to the E-MEDNY system.  Remaining payments are expected to be issued in December.  DOH gave assurances that those without further data discrepancies will be batched and issued at that time, and not be delayed further by facility data outliers.

CR Assessment

DOH will provide an update shortly on this issue.  We will issue information on this topic as it is provided.


As reported last month, DOH is prioritizing Phase Two applicants with recommendations going to the state’s Medicaid Director in the next few weeks.

NAMI Process

NYSHFA and other associations have formed a sub-workgroup to formulate a member survey to obtain the necessary NAMI data to present to CMS.  DOH will release a bulletin, along with the association survey, in the upcoming weeks.

Quality Pool

DOH has yet to release the quality pool data to providers for 2013.  They still await CMS SPA approval, and are currently preparing a DAL to accompany the data release.  DOH stated that corresponding rate adjustments would be indexed to a facilities rate, and be retroactive to January 1, 2013.

The Quality Pool Workgroup met earlier this week.  (See attached summary from Nancy Leveille.)

NYSHFA will continue to update members on these issues as they develop.

Director, Finance & Reimbursement
518-462-4800 x36