DOH Rate-Setting Update

Carl J. Pucci in Finance & Reimbursement

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

Rate Packages

  • 2016 Notice Rates – the 2016 notice rates have been posted to the HCS.  (See attached DAL).  The rates include the revised pricing transition for the 2016 operating component, as well as the initial 2016 Capital rate.  Included as part of the capital streamlining initiative is the attestation form, which enables providers to correct inaccuracies in their capital rate.  DOH will not accept partial attestations, and providers who choose not to attest to changes in their capital rate will forego the traditional hotline period in which to appeal.  Note:  DOH expects the revised 1/1/16 rates (issued in early January 2016) to incorporate the January 2015 CMI.
  • 2012 Case Mix Audited rates are with DOB; DOH reported that they are striving to process payments by the end of December.
  • 2013 Case Mix Audited rates are in process, but have not yet gone to DOB.  Expected payments on these rates would now be early 2016.

CRA 2014 Reconciliation

DOH continues to work on the reconciliation data and expects to complete the 2014 CRA reconciliation by year-end, as well as revise the 2016 CRA paid per diem to 2013 levels.

Universal Settlement (US)

DOH is conducting a call with the attorneys later today in an effort to finalize the term sheet, general releases and exclusion documentation related to the US.  Upon final agreement, DOH expects to release documents to providers.  Providers will then have approximately 2 – 3 weeks for review.  Anticipated signing dates and locations are being targeted for late November (further details will follow).  CMS is awaiting these final documents prior to their approval.  Upon finalization of the US, NYSHFA will schedule a conference call to brief all members.

Advanced Training Initiative (ATI)

DOH reported that all but 20 or so facilities out of 227 eligible completed the ATI application, which was due last Friday.  The Associations are reaching out to their respective members who have yet to file.  NYSHFA advocated for extra time this week to allow for notification to facilities who did not respond.  DOH will accept applications through tomorrow, 11/6/15.  The $46M funding (pending CMI approval) is still on track to be paid by year end.

Quality Pool

There was no additional information related to the 2013 and 2014 Quality Pool which remains on hold due to pending litigation.

Energy Initiative

NYSERDA and DOH outlined the rollout of the energy initiative and have selected 30 facilities who will have the option to engage specific energy contractors throughout New York State for a Level II energy audit.  The audits, expected to cost between $30-40k, will be paid by NYSERDA and DOH.  Please note, providers will be responsible to pay 50% of the audit cost upfront (DOH share) and then would be reimbursed lump-sum via an expedited capital appeal.  DOH is prohibited from funding Medicaid monies directly to outside entities.  A webinar will be scheduled to detail the audit process, scope of work and other related information.  The goal is to complete the audits by 3/31/16, and providers are reminded that there is no obligation to implement the audit findings.

CMS/DOH Meeting

An 11/17/15 meeting between DOH and CMS will be held to discuss pending State Plan Amendments, including those related to ATI, NAMI and Capital Refi-Shared Savings proposals.


DOH has requested all inquiries to the NFrates e-mail address specify the areas within DOH that providers are trying to reach in order to better facilitate the inquiry.

NYSHFA will continue to monitor these issues and update the membership accordingly.


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