DOH Rate-Setting Update

Carl J. Pucci in Finance & Reimbursement

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

Rate Packages

  • 2015 rates (7/14 CMI) – DOB has approved the revised 1/1/15 rates incorporating the July 2014 CMI. Rates are to go to EMEDNY next week with payments expected in mid-August.
  • 2013 Cash Receipts Assessment (CRA) Reconciliation – DOB has also approved, and these will also be sent to EMEDNY next week.
  • Case Mix Audits – The 2012 Case Mix Audit Rate package is scheduled to go to DOB next week.  These rates, affecting 7/1/12 and 1/1/13, will have the corresponding 5% CMI cap restraint released.  Expected timeline for payment would be the end of August.  Note:  The 2013 Case Mix Audit data is presently at rate-setting, and should reach DOB by mid-August (with forecasted payment during 4th Quarter).
  • 2013 Quality Pool – Emergency regulations and subsequent rate processing have been suspended due to impending Quality Pool litigation.
  • 2014 Quality Pool - The data is still under review by DOH rate-setting.  The associations have requested that the 2014 Quality Pool rate adjustment be included in the benchmark rates as soon as possible.

Other Budget Items/Work Plans

  • Capital Streamlining – OMIG has agreed in principle to the work plan being developed.  Work is proceeding on an attestation form in advance of the initial 2016 capital rate release this coming Fall.
  • Shared Savings – The CMS State Plan Amendment (SPA) has been submitted, and DOH is developing work plan and related industry guidelines.
  • Advanced Training Initiative (ATI) - Approximately $46M in funding has been approved over the next two state fiscal years (2015/16 and 2016/17) for certain direct care staff training.  (See member mailing 7/7/15).  NYSHFA, DOH, 1199 and other stakeholders are meeting to develop application criteria, as well as payment determination options.  (Members are urged to carefully follow 2014 RHCF-Sch P instructions related to staff turnover reporting.)
  • Energy Efficiency - DOH and NYSERDA legal staffs are developing a plan to pay for energy audits related to the demonstration program, versus requiring provider cash outlays.  NYSERDA is meeting with various energy contractors to obtain timelines for the initial energy audits.
  • Universal Settlement – The DOH tracking system issues related to the appeal exclusions are mostly resolved.  A hand full of providers with continued tracking issues will be contacted directly by DOH to resolve.  DOH will re-post the rate appeal exclusion listings to the HCS in the next week or so, and extend the response due date accordingly.
  • RHCF-4 – Reminder that the filing deadline for the RHCF-4 is August 14, 2015 (for both filing and attestation.)
  • NAMI - DOH will share recent documentation presented to CMS regarding the state’s takeover of the NAMI with provider associations.  NYSHFA will continue to assist DOH in its efforts to obtain CMS approval.

NYSHFA will continue to keep members appraised of the above issues as they develop.


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