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:

2013 Cash Receipts Assessment (CRA) Reconciliation

DOH continues work on the 2013 CRA Reconciliation, and again expects a statewide negative impact to providers.  As noted in last week’s DAL, DOH has rectified the 2012 CRA recoupment calculation and will be updating the payment per diem to more accurately reflect facility revenues.

Quality Pool

The 2013 Quality Pool rates are being sent to EMEDNY this week for processing.  The 2014 Quality Pool, which CMS has recently approved, is still at rate-setting prior to being sent to DOB for approval.

Case Mix Audits

The 2012 OMIG audits affecting the July 2012 and January 2013 rates have again been delayed due to programming issues.  DOH expects these rates to reach DOB and EMEDNY within the next 3-4 weeks (which would put expected payment adjustments towards the end of May).

MDS Collection Period

As announced previously in DAL, the 1/28/15 census roster submissions are being accepted through April 17, 2015.  This information will be used to adjust the 7/1 – 12/31/15 Medicaid rates going forward.  A series of FAQs is expected from DOH following the Associations clinician meetings with DOH regarding OMIG audit findings.

2014 RHCF

DOH will be releasing the 2014 RHCF software on or around 4/15/15, one month earlier than normal.  The due date will remain 8/14/15, but DOH indicated that with the earlier release date now in place, next year’s 2015 RHCF deadline will be moved forward to a July 2016 deadline.  A DAL containing further information is expected to be posted next week.  A reminder that a timely filed RHCF/Certification is part of the Quality Pool requirement.

Universal Settlement

To date, approximately 450 facilities have provided responses to the excluded matters (appeals/litigation) requirement.  NYSHFA continues to seek responses from members still outstanding.  DOH has recently extended the notification deadline to Friday, 4/24/15.  We urge those members to email their excluded matters document to us ASAP.


DOH is meeting with CMS later this month to discuss financial issues concerning the state’s proposed takeover of NAMI collections.  NYSHFA offered DOH continued assistance leading up to these discussions, following up earlier workgroup participation.

Benchmark Rates

NYSHFA continues to advocate for updated benchmark rates (which will correspond with a facilities Medicaid rate sheet plus add the Quality Pool and CR Assessment add-on).  We also stressed that timely updates for case mix changes are critical going forward into a Managed Care environment.  DOH estimates the revised benchmarks to be posted to its’ website within the next two weeks.

Capital Streamlining

A draft policy has been developed by DOH regarding efforts to streamline the capital portion of the Medicaid rate.  NYSHFA has submitted representatives from its Payment for Services Committee to assist the Capital Workgroup in the implementation phase.  DOH hopes to finalize prior to the 2016 capital rate calculation.

Energy Initiative

DOH has had discussions with NYSERDA and the NY Green Bank, and continues to work towards an energy audit pilot program (consisting of 20-25 potential facilities).  DOH will develop a work plan, including a cost-benefit analysis, to submit to the legislature.  The 2015/16 Executive Budget does contain start-up funding for the energy initiative.

Shared Savings

DOH is developing a work plan which would offer a minimum of 50% shared saving’s on qualified mortgage re-financings (post 4/1/15).  This proposal requires CMS approval.  More details will follow once the work plan has been finalized.


DOH discussed funding in this year’s Executive Budget for advanced training initiatives ($46M) neuro-degenerative rates ($5M) and development of a young adult rate ($2M).  More details to follow as these work plans are rolled out.  These initiatives will each require CMS approval.

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


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