DOH Rate-Setting Update

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly rate-setting briefing earlier this week.

Note:  At the outset of the meeting, DOH explained that delays in many of this year’s rate packages were as a result of internal IT issues (specifically a significant turnover of programmers).  They expressed confidence that these programming issues/backlogs are now behind them and that faster system processing should result.

The agenda items discussed included the following:

2015 Rates (cycle 1983)

DOH acknowledged confusion on the part of some providers, as the cycle 1983 rate package included both an update to the July 14 CMI, as well as the 5% Cap correction.  Combining these variables made it difficult for facilities to confirm their proper payment.  DOH has shared an impact schedule with the associations in order to clarify each component of the rate package.  Members with specific questions on cycle 1983 should contact NYSHFA.  A reminder that cycle 1983 check release date is 9/9/15.  NYSHFA urged DOH to adjust the 2015 Benchmark rates for the July 2014 CMI as soon as possible.

CRA 2013 Reconciliation

Again citing programming issues, DOH committed to posting the 2013 CRA rate calculation by 9/11/15.  They realize that all future rate postings should be linked with the respective DAL’s in order to establish accurate appeal due dates.

Case Mix Audits

  • 2012 – completed by OMIG
    • Rates processed, but not yet sent to DOB (expect mid-late October payments)
  • 2013 – completed by OMIG
    • Rates not yet processed
    • Statewide positive impact of approximately $17M (with the 5% Cap release)
  • 2014 – in process (starting in Western NY Region)

Quality Pool

Both the 2013 and 2014 Quality Pool remain on hold due to impeding litigation.  DOH will issue emergency regulations going forward as it manages the litigation.

1% Restoration

The CMS State Plan Amendment is in process for submission prior to the quarterly 9/30/15 deadline.  The 1% Restoration, retroactive to 4/1/14, approximates $70M to providers.

Other Budget Initiatives/Work Plans:

Universal Settlement (US)

DOH has extended the deadline to contest US excluded appeals to Friday, September 11, 2015.  They expect to post final determinations by EOM.  DOH urged providers to avoid duplicate submissions of excluded appeals, and will continue to review case-by-case questions related to excluded appeals issues.

Capital Streamlining

Is on target to affect the 2016 capital rates.  Facilities will have opportunities to attest to changes of their initial 2016 capital rate, once the preliminary rates are issued in mid-September, as well as after the initial rates are posted on 11/1/15.  The attestation form, along with a DAL, will be forthcoming.  This will, in effect, replace the capital “Hotline Period” used in prior years.

Advanced Training Initiative (ATI)

Significant progress has been made to finalize the ATI application and instructions.  The 2014 RHCF data (Schedule P) is being analyzed, and facility selection process will follow in the coming weeks.  The goal is to pay the $46M (year one funding) in mid-December.

Refinancing/Shared Savings

CMS remains supportive of this initiative, DOH is providing additional information requested by CMS.  A draft of the policy paper is presently being reviewed by the Workgroup.


Further discussions with CMS are underway regarding the revised policy paper recently submitted by DOH.

NYSHFA will continue to monitor and communicate updates on these important issues as they evolve.


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