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:

Case Mix

The July 2013 CMI adjustments will be sent to DOB within the next two weeks, and are expected to be paid by 5/31/14.  Note that DOH will “re-set” the CMI base biannually prior to calculating a new 5% cap limitation.  DOH will provide more information related to the CMI cap methodology, as well as an example calculation in an upcoming DAL. (Attached is a nursing home rate matrix outlining the above as well as other pending rate-setting issues.)

The January 2014 MDS census collection is presently under way, with data uploads due by 4/25/14.  DOH also noted a coding error with respect to tube feedings had been discovered.  Affected facilities should re-check their scores vs. anticipated scores and notify DOH if there are discrepancies.  DOH will send a separate blast email reminder as well.

OMIG Audits

The 2012 OMIG audits are complete and the data is being entered into the rate-setting system.  Audit exit conferences have been held, however, no final RUG revisions have yet been distributed.  DOH noted that all audit reconciliations will be processed through rate-setting (i.e., rate adjustments) vs. OMIG recoupments.  DOH will request OMIG to hasten their audit start-ups in an effort to improve the timeliness of future CMI adjustment periods.

CR Assessment Reconciliation

2011 reconciliation is expected to be finalized by the end of April, with an estimated payment in May (approximately $14M statewide).  2012 reconciliation is expected sometime during August, 2014.

Once again, NYSHFA strongly advocated to update the paid assessment rate so as to minimize future reconciliation differences, as well as provide a more accurate benchmark rate as the transition to Managed Care approaches.

2% Restoration

Following the restoration of the 2% Medicaid cut in the 2014/15 Executive Budget, DOH is meeting internally next week to determine the payment methodology which will restore the cut.  They are seeking legal clarity, as well as determining CMS SPA implications as they examine options which include eliminating the 0.8% non-reimbursable assessment currently in effect or providing a 2% rate-add-on as an alternative.

Quality Pool

The 2013 Quality Pool adjustments still await CMS SPA approval.


NYSHFA will keep members informed as these and other rate-setting issues are updated.


Director, Finance & Reimbursement
518-462-4800 x36