DOH Rate-Setting Update

Carl J. Pucci in Finance & Reimbursement

DOH held its monthly rate-setting update earlier this week.  The agenda items discussed included the following:

Rate Packages

  • 2012 Case Mix audited rates have been sent to DOB, with expected payments by the end of November
  • 2013 Case Mix audited rates are in process, and will be sent to DOB next month, with anticipated payments by year-end.
  • July 2015 rates (updated for January 2015 Case Mix) are being updated.  DOH reports no extensive issues with the CMI data, and will work to process the rates as soon as possible.
  • January 2016 notice rates are still on track to be posted in early January.

CRA 2014 Reconciliation

The 2014 CRA Reconciliation is targeted for late November/early December.  DOH has confirmed it will update the CRA billing per diem to 2013 with this reconciliation.

Capital Streamlining

As previously reported, the Capital Streamlining process will enable providers to correct and attest to their 2016 capital rate component, thus avoiding the standard appeal process.

The 2016 capital rates are expected to be posted early next week.  Facilities may accept DOH calculation, or attest to their own revisions, subjected to DOH review and OMIG audit (for inconsistencies).  All attestations are due no later than December 15, 2015.  Inquiries should be directed to the NF rates mail log.

Advanced Training Initiative (ATI)

The Phase I application has just been posted to the HCS for qualified facilities.  All impacted facilities should have received DOH notices via direct email.  (NYSHFA also sent a reminder notice earlier this week).  The deadline for completing the application is October 30, 2015.  Approximately $46M (or approximately $3.84 per Medicaid day) is expected to be funded by year-end.

Quality Pool

Both the 2013 and 2014 Quality Pool remain on hold until a resolution to the impending litigation is achieved.

One Percent Restoration

The CMS State Plan Amendment was submitted last week.  DOH confirmed that upon approval, the monies would be added to the base rate.

Universal Settlement

Attorneys are working with DOH Legal to finalize the agreement, with facility issues and reconsiderations complete.  Packages which will contain the agreement/exclusions/determinations are expected to be released in the next few weeks.  Facilities will have approximately 30 days to review and sign-off on the settlement.  DOH will orchestrate three “location signings” (NYC, Albany, Rochester) in mid to late November.  Note:  these location signings are optional – providers may sign and mail-in if preferred.  CMS is waiting on the final agreement document prior to approval.


The NAMI letter has been revised and sent to DOH Division Director.  Once approved, it will be forwarded to CMS for further discussions.

Refinancing/Shared Savings

DOH has responded to CMS request for additional information (RAI), and remains very supportive of the initiative.  The 50/50 Shared Savings applies to mortgage refinancings on or after 4/1/2015.  (DOH stated their goal is to review and respond to requests within 30 days.)

Energy Initiative

Estimated Level II energy audit costs of approximately $30k will be shared by DOH and NYSERTA.  However, due to state contracting regulations, providers will be required to front their half of the cost ($15k) and be subsequently reimbursed by DOH (via a lump-sum payment through the capital rate).  Facilities will have to choose NYSERTA approved contractors to qualify, and will be under no obligation to make the suggested changes recommended by the energy audit.  Funding will be guaranteed if the process is started prior to 12/31/15.  DOH will approach approximately 40-50 facilities in the coming weeks to seek interest in the energy initiative.

MDS 5-Day Issues

DOH reported that facilities are sending 5 day Medicare assessments to HMO’s rather than to CMS resulting in a BC1 default score.  DOH will send an email blast to providers to clarify this issue.

Neuro Degenerative Specialty Rate

DOH is exploring the need to determine the specific population, as well as additional cost analysis prior to establishing a specialty rate methodology.

Young Adult Rate

DOH will issue a letter of interest (LOI) to gauge facility interest prior to reviewing criteria in establishing a young adult rate.

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


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