DOH to Correct 1/1/19 Rates

Carl J. Pucci in Finance & Reimbursement

DOH will correct the Case Mix cap in the 1/1/19 rates in upcoming Medicaid cycle #2185 (check release date 7/24/19). The initial 1/1/19 rates issued on 6/21/19 did not update the July 2018 Case Mix cap through January 2019. Below is the DOH email with further details:

This email provides you with information about your residential health care facility (RHCF) Medicaid reimbursement rates for the period January 1, 2019. 

The Nursing Home rates were updated in cycle 2185 to correct the 5% MDS cap in the rate. Along with the updated rates being loaded into eMedNY, a copy of the updated rate sheet has been posted to the Healthcare Financial Data Gateway under 2019 REVISED NURSING HOME INITIAL RATES, and the Benchmark Rates have also been updated to reflect these corrections.

Due to a technical issue, the rate sheets for the ADHC facilities do not reflect the 1.5% investment. We have posted a copy of the 1-1-19 ADHC rate sheet to the Healthcare Financial Data Gateway, as well as an excel spreadsheet showing the calculation of the 1.5% investment value for each ADHC facility.


Carl J. Pucci
Chief Financial Officer
518-462-4800 x36