DOH Monthly Rate-Setting Briefing

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly rate-setting briefing earlier this week, which included the following updates:

2013/14 Revised Rates

DOH has posted additional rates to the HCS system this week, updated to reflect the January 2013 CMI adjustments.  Below is a chart which summarizes recent rate postings.


CMI Period

Rate Effective Date

Medicaid Cycle

Check Date/Release Date



July 2012

1/1/13, 4/1/13, 1/1/14

1906 &


3/3/14  -  3/19/14

3/10/14  -  3/26/14


January 2013

7/1/13, 1/1/14


3/10/14  -  3/26/14

Note:  The July 2013 CMI adjustments are estimated to be paid during 2nd Quarter 2014, and the January 2014 CMI collection upload will commence in April.

All rates continue to be subject to the 5% biannual CMI cap, pending OMIG MDS audits.

Quality Pool adjustments for 2013 continue to be absent from the rates, pending CMS federal approval.

OMIG Audits

OMIG is due to complete their 2012 MDS audits by the end of this month (approximately 20 facilities remaining.)  The associations requested an OMIG audit report, which DOH will provide, in a continuing effort to assist providers for training and education purposes going forward.  OMIG will then initiate the 2013 MDS audit process.

CR Assessment Reconciliation (2011)

DOH is sending these adjustments ($14M in statewide payments) to DOB in the next few weeks.  DOH will begin work on the 2012 CR assessment reconciliation once the data is accumulated later in May.

Managed Care

DOH will be conducting a meeting/webinar at its New York City offices this Monday, March 10, 2014 at 10:30 a.m., to further discuss the transition to Medicaid Managed Care.  NYSHFA will be represented at the meeting. (Note:  Attendance is limited due to space restrictions.)

Below is the webinar information (pre-registration is not necessary).

Members should also review the latest Medicaid Update for important information related to the Managed Care transition.

Hurricane Sandy

Approximately $12M in additional payments to 65 providers are slated for Medicaid cycle 1907 (check date 3/10/14; release date 3/26/14.)  This represents final payments for those impacted, other than a small number of facilities with unique issues that DOH is dealing with directly.  (A reminder that Medicaid recoupments will be applied if warranted.)  Providers who had been taken off of the two week Medicaid payment “lag” should be mindful that DOH will re-institute the lag at some point following these payments.

2% Restoration

DOH continues to assess various scenarios related to the restoration of the 2% cut under the Medicaid Global Cap (2013/14 Executive Budget.)

NYSHFA will continue to track these issues as noted above, and keep members regularly informed.

Director, Finance & Reimbursement
518-462-4800 x36