DOH: Monthly Rate-Setting Briefing

Carl J. Pucci in Finance & Reimbursement


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

2013/14 Revised Rates

DOH continues to work on two separate rate schedules as follows:

  1. Update of the January and April 2013 rates, as well as the January 2014 rates to include the July 2012 MDS census adjustments (capped at 5%).  These rates are scheduled to DOB by end of week, and on to EMEDNY by the end of January.
  2. Update of the July 2013 and January 2014 rates to include the January 2013 MDS census adjustments (capped at 5%).  These rates are scheduled to DOB by the end of January, and on to EMEDNY by mid-February.

Attached is the revised rate processing schedule from DOH. 

Cash Receipts Assessment Reconciliation

Due to prioritization of the above rate packages, DOH is pushing back the 2011 CR Assessment Reconciliation to the end of February, which will result in the funding of approximately $18M early in the state’s 2014/15 fiscal year.

Case Mix Audits

DOH stated that the OMIG audits of January 2012 and July 2012 are still targeted for completion by end of First Quarter 2014.DOH will next revise the January 2014 rates utilizing the July 2013 MDS census adjustments, with timelines still to be determined. 

NAMI Survey

The DOH NAMI Survey (released this past Monday) is designed to provide vital NAMI data necessary to support the state’s initiative to take over the NAMI process.  Once the data is accumulated later this month, the NAMI Workgroup will reconvene to analyze and further assist in the state’s proposal to CMS.  NYSHFA strongly advises all members to complete the brief survey, due back January 21, 2014.

Managed Care

DOH has issued a draft Managed Care Transition Policy document to the Transition Workgroup.  The document responded to various workgroup issues raised over the past few months.  The Workgroup is presently reviewing the draft document and will, in turn, provide feedback to DOH prior to the next scheduled Workgroup meeting later this month. 

Universal Settlement

DOH once again declined further comment, other than to acknowledge a webinar is being scheduled for later next week.  A DAL is expected from DOH prior to the webinar which will provide further details.

Vital Access Program

VAP II recommendations have been sent to the Governor’s office for review.  DOH noted that there is still some residual funding left for fiscal year 2013/14. 

Hurricane Sandy

Approximately $11M in payments to 69 providers is expected during First Quarter 2014.  (The associations continue to press DOH for a specific Medicaid payment cycle date).  Additionally, DOH has committed to pay facilities for residents sent to shelters and have also confirmed a vent rate will be in place for affected vent unit residents.

Quality Pool

DOH continues to work on Quality Pool adjustments, noting that CMS has not yet approved the related state plan amendment.  A reminder that when approved, the adjustments will be retroactive to 1/1/13. 

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

Director, Finance & Reimbursement
518-462-4800 x36