DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed:
PDPM Update
DOH is undergoing preliminary stage work and has contracted with Myers & Stauffer to provide data collection and analysis, impact modeling, and outreach training, among other things. A 5-year contract between the Department and Myers & Stauffer was approved on 7/29/24 with DOH for $31,875,000 through 4/14/29.
NYSHFA inquired about shared data analysis and modeling efforts and initiatives and requested the opportunity to meet with DOH and Myers & Stauffer as soon as possible. The Department committed to this meeting.
NYSHFA also inquired about the timeframe for PDPM implementation, but DOH did not provide a date, citing that it will depend on a variety of factors. DOH reiterated its commitment to include stakeholders in a collaborative effort to transition to PDPM at various “touchpoints” during the transition. No such “touchpoint” has yet occurred.
NYSHFA has expressed its concerns to the Executive and DOH regarding the State’s transition to PDPM. Additionally, among other things, NYSHFA has submitted a letter to the Commissioner of Health outlining NYSHFA’s issues and concerns regarding the State’s transition to PDPM (
see attached).
Case Mix Freeze
The final enacted State Budget froze the case mix date effective July 1, 2023 until full implementation of the PDPM case mix methodology is developed. The SPA was recently approved by CMS, effective April 1, 2024. NYSHFA is litigating this matter.
7.5% Rate Increase
DOH has posted nursing home rate sheets reflecting the 6.5% increase to Medicaid rates that is retroactive to April 1, 2023. Payment was made in Medicaid cycle #2408 (check release 11/2/23). DOH released the additional 1% to reach the full 7.5% uniform rate increase in Medicaid cycle #2448 (check release date 8/7/24).
NYSHFA inquired about the SPA for the $285 million disbursement and was told that it had not yet been sent to CMS. The disbursement methodology has yet to be finalized.
2023 RHCF Deadline
The 2023 RHCF cost report deadline has been extended to Friday, September 20, 2024.
1/1/2024 Notice Rates
The 2024 notice rates are posted on the Health Commerce System (HCS) under the heading of 2024 Notice Rates. The all-inclusive rates provided on the Gateway include the following components:
- Operating Component: The non-specialty rates reflect the pricing methodology, which includes the 2024 minimum wage adjustment.
- Capital Component: The capital component of the 2024 notice rates is based upon the facility’s 2022 cost report, and subsequent approved capital attestations. The capital component is reduced by five percent, now reflected under the capital rate sheet line (vs miscellaneous per diem line). Payment of the 1/1/24 updated rates occurred in Medicaid cycle #2445 (check release date 7/17/24).
- Capital Cut: DOH is working on the application to CMS. Adjustments to the rate setting system needed to be made and DOH is finalizing this and building the rate setting packages.
The initial notice rates have been approved and the information is being loaded into the rate-setting system. A DAL is forthcoming.
4/1/24 Rates
The 4/1/24 rates are still under development prior to executive review. DOH noted that the methods of payment of the approved Medicaid rate increase are still to be determined per the budget statute.
Safe Staffing
The State Share of funding to assist nursing homes in meeting staffing level requirements was contained in Medicaid cycle #2377 (check release date 3/29/23). DOH is working with CMS on the related SPA, and upon approval, a second lump distribution will be made for the federal share. DOH conducted a webinar on 7/6/23 regarding the minimum staffing level compliance reviews, which has been archived. DOH is directing any further questions on safe staffing or the 70/40 spending cap to
NHSafeStaffing@health.ny.gov. No further information is available.
2022 Cash Receipts Reconciliation (CRA)
The 2022 CRA has been updated for facilities with incomplete data. (8/6/24 DAL).
These rates have been reconciled and were processed in Medicaid cycle #2451 (check release date 8/28/24).
2023/24 Enhanced ATI
The third and final year of the Enhanced ATI initiative was released (8/28/24 DAL).
Payments will be made in upcoming Medicaid cycle #2454 (check release date of 9/18/24).
July 2023 /January 2024 Benchmark Rates
DOH has updated the Benchmark rates for both the 7/1/23 and 1/1/24 rates.
Capital Rates /Appeal Process
The in-house 2023 appeals (including historic appeals from 2009) are in process and being forwarded to the Executive for review and finalization. This first package does not include facilities that have the highest magnitude and need additional scrutiny, open litigation, and those with financially distressed markers. If a provider did not submit an attestation as required, they are not included. DOH is cautiously optimistic that the appeals will be moving before the end of the calendar year.
MDS Audits
OMIG reported the 2018 MDS audits for all statewide regions are complete. There were 208 summation letters, 2 terminations, 121 draft reports, and 109 final audits completed. OMIG is getting started with 2019 in the Capital District, Buffalo, and the North Country regions.
2025 Minimum Wage Survey
DOH release the 2025 Nursing Home Minimum Wage survey (8/29/24 DAL). All providers are required to complete the survey, which is due no later than 9/25/24.
2023-24 IGT/UPL
The Department of Health continues to work with CMS to provide all necessary information to enable CMS approval of the 2022 State Plan Amendment related to the UPL and associated payments. No significant update was provided.
Please contact
NFRates@health.ny.gov with “2022 NH UPL
” in the subject line if you have any questions. DOH has had positive interactions with CMS and expects to have an update in the near future.
ALPs
The SPA for non-institutionalized care (as well as long-term care) has not yet been submitted to CMS but DOH reiterated that it is on track in terms of timing. No reimbursement methodology has been determined.
NYSHFA | NYSCAL CONTACT:
Stephen B. Hanse, Esq.
President & CEO
518-462-4800 x.11
Carl J. Pucci
Financial Consultant
518-462-4800
Kristin A. DeVries, MA, MPP
Director of Government Relations
518-462-4800 x.14
Read More