DOH Rate-Setting Update

Carl J. Pucci in Finance & Reimbursement

DOH conducted its monthly rate-setting briefing earlier this week.  The topics discussed included the following:

2012 CR Assessment Reconciliation

The CR Assessment Reconciliation has gone to EMEDNY for processing and will be processed in cycle 1959 (check date 3/9, release date 3/25 – See yesterday’s Priority Alert.)  Note that DOH will be updating billing rate code 3836 to the 2012 reconciled per diem.

2015 Initial Rates

The revised 1/1/15 rates have also been sent to EMEDNY and will be included in cycle 1959.  These rates will still be based on the January 2014 CMI.  A further update to the July 2014 CMI is expected to be processed sometime during April.

2013 Quality Pool

The 2013 Quality Pool rates are back from DOB.  DOH will finalize the data and send to EMEDNY by the end of March (with expected processing in April.)

Case Mix Audits

The 2012 OMIG audits which affect the July 2012 and January 2013 rates are expected to go to DOB by the end of March, and should be processed sometime in late April.  The expected statewide impact upon release of the 5% CMI cap is approximately $14M.

DOH has met with OMIG to discuss the Associations clinicians’ recommendations and will issue instructions and clarifications regarding audit data findings sometime prior to the April MDS collection period.  DOH will also recoup any OMIG audit recoveries through the rate-setting system (vs. OMIG collections.)  All provider audit rights will be preserved.

Transition Billing Workgroup

NYSHFA continues to submit MLTC transition billing issues and concerns to DOH in advance of the next Workgroup meeting, which is slated for later this month.


DOH continues to address the issue of uncollectable NAMI’s with CMS as it pursues the state takeover of NAMI collections.

Capital Workgroup

The Workgroup will continue to focus on the Capital streamlining process.  DOH is seeking input from various CPA firms, who will be asked to join the Associations in efforts to provide DOH information on capital corrections, equity issues and useful life considerations.  NYSHFA will approach its Payment for Services Committee to seek representation to the Workgroup.

Energy Initiative

DOH will resume Workgroup discussions centered on establishing an energy audit demonstration program.  Language has been introduced in this years’ Executive Budget.  DOH will contact NYSERDA and set up a meeting of the Workgroup in the next few weeks.

NYSHFA will keep members informed of these issues as they develop.


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