DOH 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 January 2014 CMI adjustments have been sent to DOB, and the resulting CMI adjustments affecting the July 1, 2014 rates are expected to be paid in October.

The July 2014 census roster data will be uploaded during the weeks of 9/29/14 through 10/17/14 (see today’s separate NYSHFA member mailing for details).

OMIG Audits

The 2012 audit data is being reviewed by DOH rate-setting, and is expected to be finalized in the next few weeks.  The resulting “audit rates” should be processed in November.  The audit rates will affect the 7/1/12 - 12/31/12 and 1/1/13 through 6/30/13 rate periods.  The associations have requested definitive timelines for audit rate packages going forward.

OMIG will commence the 2013 audits (for both the January and July MDS census periods) in the western and upstate regions this fall, with audits in the downstate areas expected in early 2015.

CR Assessment

The 2012 CR Assessment will be sent to DOB in early October, and is expected to be processed in November.  The assessment add-on being paid will continue to be based on 2010 rates.  A reminder that the August Cash Assessment report is due on 9/15/14.

Capital Rates

As announced last week, DOH has posted the preliminary 1/1/15 capital rates in advance of the 11/1/14 posting to allow additional time for data correction.  Members should notify DOH of any changes by 10/3/14 in order to ensure the corrections are in the 11/1/14 notice rates.

Managed Care

DOH expressed serious doubts that the 10/1/14 Medicaid Managed Care transition date would be implemented.  CMS has yet to issue formal STC’s (Special Terms & Conditions) to DOH, who then would be required to respond and/or comply with.  The associations await more definitive timelines from DOH regarding Medicaid Managed Care implementation.

DOH has scheduled a Billing/Operational Workgroup meeting in early October with the associations to discuss unresolved nursing home transition issues.

2% Restoration

The 2% Restoration of the budget cut is still pending CMS SPA approval.  The specific payment methodology related to the restoration has not yet been presented by DOH.

Quality Pool

The 2013 Quality Pool is still awaiting CMS SPA approval.  DOH has begun reviewing 2014 Quality Pool data and is expected to release it during the fourth quarter.


The proposal to take over NAMI collection by NYS has been sent to CMS.  Initial meetings between DOH and CMS regional office are under way.  CMS has indicated initial concerns with the uncollected NAMI amounts.  NYSHFA will continue to support DOH in its effort to gain CMS approval of the proposal.

Energy Survey

Working in conjunction with DOH and NYSERDA, NYSHFA is coordinating a statewide energy survey of nursing homes whose energy cost exceeds benchmarks as determined from DOH/RHCF data measurements.  NYSHFA will provide additional details in a separate member mailing this coming Monday (9/15/14) following release of the survey.

Capital Restructuring

DOH, in conjunction with the DSRIP initiative, is awarding $1.2B in capital restructuring funding.  Although DSRIP applications will be prioritized, funding will be available to non-DSRIP applicants as well.  Applications will be available on or around November 1, 2014.  DOH will conduct an applicant conference at the beginning of November, with the application deadline being 12/16/14.  Funding will be awarded during 1st Quarter 2015.

NYSHFA will continue to monitor these issues and keep members informed as they develop.


Carl J. Pucci
Director, Finance & Reimbursement
518-462-4800 x36