Issue: October 15, 2015

Published on October 15, 2015

Articles in this issue:

DOH Rate-Setting Update

Author: Carl J. Pucci* Published in Finance & Reimbursement

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

Rate Packages

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

Don't Forget to Sign Up for FQC's Free Webinar this Friday 10/16 on Cultural Competence!

Author: Gayle Farman and Rick Patterson

Dr. Anne O'Brien Carelli is presenting a FREE Webinar titled, "Person-Centered Care Checklist: Making Sure Your Facility is Culturally Competent" this Friday, October 16th from 10:00 AM - 11:30 AM. 
1.5 credits have been approved by NAB for LNHA/ALA.

Anne O’Brien Carelli, PhD, faculty of the Foundation for Quality Care Long Term Care Leadership Program, has extensive experience in assisting facilities in taking a practical, realistic approach to cultural competence. 

In this webinar, leaders of skilled nursing and assisted living facilities will be provided specific strategies for ensuring culturally competent person-centered care.  The proposed changes to the CMS “Requirements of Participation” for SNFs refers to ensuring that care planning addresses “culturally competent” care.  This webinar will provide checklists and practical tips for topics such as memory care, ethnicity and disease prevalence, disparities in health care, language and communication, beliefs about end-of-life, and bias-free organizational policies and procedures. 
Participants will:


Target Audience: Open to all Administrators, DONs, Managers, Supervisors, Staff Development Coordinators, facility teams and all departments in Skilled Nursing Facilities and Assisted Living Facilities.

To Register:

This Program has been funded by the New York State Department of Health and Department of Labor Health Workforce Retraining Initiative.


Gayle Farman
Sr. Director of Resource Development
518-462-4800 x34

Rick Patterson
Executive Director
518-462-4800 x19


CMS Payment Reform Initiative – NY-RAH Phase 2 Recruiting 60 Facilities – Free Informational Webinar on October 21; 1:00 pm

Author: Nancy Leveille* Published in Clinical & Quality

Greater New York Hospital Association (GNYHA) Foundation is pleased to announce an informational webinar regarding the opportunity to join an initiative sponsored by the Centers for Medicare & Medicaid Services (CMS) focused on payment reform and incentives for nursing homes and their practitioners.

Please join GNYHA and CMS on Wednesday October 21 at 1:00 pm to hear how your facility can participate in Phase Two of the New York-Reducing Avoidable Hospitalization (NY-RAH) project.  GNYHA Foundation is recruiting 60 additional nursing facilities in New York to participate in the payment reform intervention, which consists of:

Wednesday, October 21, 2015
1:00 – 2:00 pm
Dial (888) 437-3179

CMS Nursing Home Project New York-Reducing Avoidable Hospitalizations (NY-RAH): Joining Phase Two

Please dial in directly in order to ask questions, and mute the audio on your computer.

Ashley Hammarth, MPH
Deputy Project Director
Greater New York Hospital Association
555 West 57th Street, 15th Flr
New York NY 10019
P: 212-506-5421
F: 212-262-6350

NYSHFA is supporting that members get informed about GNYHA's grant funded program to assist with payment reform and incentives for SNF and their practitioners. We encourage all to listen in on this free webinar explaining the grant and how you can benefit. See attached for further information.


Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20

AHCA Submits Comments to CMS on Requirements of Participation

Author: Nancy Leveille* Published in Clinical & Quality

Thanks to all who have submitted comments to CMS on their proposed Requirements of Participation for LTC.  Attached is AHCA's announcement related to their comments along with the full list of information they submitted.


Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20

DOH - Influenza Fact and Fiction What You Need to Know Webinar, Thursday, October 22, 2015; 12:00 – 1:00 pm

Author: Nancy Leveille* Published in Clinical & Quality

DOH is sponsoring a free webinar to assist with the flu vaccination campaign for this fall. They will provide factual information to support the benefits of vaccination. See attached information to register.


Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20

Audio Conference: Effective Infection Prevention and Control Program

Author: Scott Jackson CMP* Published in Education

Join us on October 21, 2015 for "Effective Infection Prevention and Control Program:  Improve Quality of Care and Reduce Hospital Re-Admissions" audio conference from 10:00 am - 12:00 pm presented by Amy Lee, Coretactics.

There is no shortage of new germs and regulatory changes to keep healthcare workers on their toes.  This session will include a review of current infection control standards, isolation/outbreak control, communicable disease reporting guidelines, best practices and utilization of a QAPI approach based on data driven outcomes.  This program will help guide your organization to establish an effective Infection Prevention and Control Program, improve quality of care and reduce hospital re-admissions.

In addition, this session will help you become familiar with proposed changes to the Requirements of Participation for Long-Term Care Facilities (Proposed Rule) related to infection control and an antibiotic stewardship program under §483.80.  Understand how this will impact your operations and current systems for preventing, identifying, reporting, investigating and controlling infections and communicable diseases for residents, staff, volunteers, visitors and other individuals providing services to your facility.

2.0 CEUs for LNHAs and ALAs

Brochure & Online Registration

NYSHFA Contact:
Scott Jackson, CMP
Director, Education & Conference Planning
518-462-4800, ext. 27