DOH: Monthly Rate-Setting Briefing

Carl J. Pucci in Finance & Reimbursement


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

2013/14 Revised Rates

DOH is processing three separate rate schedules as follows:

  1. Update of the January 2013 and April 2013 rates to include the July 2012 CMI adjustments (approximately $80M).These rates are scheduled to go to DOB and EMEDNY within the next two weeks.
  2. Update of the initial January 2014 rate to include numerous capital corrections, as well as a rollover of the July 2012 CMI.  Scheduled to go to DOB/EMEDNY by mid-January 2014.
  3. Update of the July 2013 and January 2014 rates for the January 2013 CMI adjustments.  (Approximately $60M).  Scheduled to go to DOB/EMEDNY no later than 2/14/14 (DOH rate-setting deadline in order to ensure payments are released by the end of the state’s current fiscal year.)

Note:  All CMI updates above will be capped at the 5% corridor, pending OMIG audit reviews. 

DOH remains committed to pay the CMI adjustments noted above, rather than hold payments due to an adverse lawsuit decision with respect to the 5% cap (which they are appealing).  They did note that any further directives from the court related to the lawsuit that required immediate staff attention could disrupt the above rate processing timetables.

Case Mix Analysis 

DOH/OMIG continue to note discrepancies in examining RUGS scoring used for reimbursement.  In an effort to better train and educate MDS staff (and thus potentially reduce future OMIG audit findings), DOH, CMS and the School of Public Health have announced a series of in-person workshops and webinars for 2014.  Attached is the informational page and schedule.  Providers are encouraged to access these important training opportunities.

Cash Receipts Assessment Reconciliation 

DOH plans on reconciling the 2011 CR assessment during the First Quarter 2014.  Approximately $18M in net revenue is targeted for release by the end of the state’s fiscal year.

Vital Access Program 

Approximately $80M is still available to be funded within the current state fiscal year, with the goal to expend these dollars by 3/31/14.  VAP I and VAP II awardees have been notified.  There is approximately $18M remaining out of the targeted monies ($30M) earmarked for SNFs.


The NAMI provider survey is in final draft stages, with release expected by 12/31/13.  Providers will have approximately two weeks to complete the one-page survey, which will focus on estimating the expected dollar value of both collected and uncollected NAMI for 2012.  NYSHFA will issue a special member mailing, along with a DOH directive, to launch the survey.

Universal Settlement 

NYSHFA, and other provider associations, submitted requested feedback to the Governor’s office on the draft term sheet issued in late November.  At yesterday’s briefing, DOH withheld further comment per the Attorney General’s office request.


DOH noted that it continues to process SNF mortgage re-financings (24 applications to date, with 10 applications still pending).  The Capital Workgroup is scheduled to meet next week.  DOH has also processed over 250 requested capital adjustments, which will be included in the revised 2014 rates noted above. 

Hurricane Sandy

Approximately $7M in payments to the remaining 69 providers affected will be processed in early January.  DOH is working with a very small number of providers with unique issues related to resident transfers, shelters, specialty rates, etc.

Quality Pool

DOH acknowledged certain methodological issues with the initial release of quality pool data.  They anticipate revising the quality pool within the next few weeks.  NYSHFA has advocated for a SNF preview of results prior to finalizing and has discussed a number of problematic areas regarding quality pool during this time.  Members are urged to keep their HCS accounts active to ensure timely access to all DOH information and data.

NYSHFA will monitor and update members on these topics going forward.

Director, Finance & Reimbursement
518-462-4800 x36