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Finance & Reimbursement

CMS Issues FY25 SNF Proposed Payment Rule

CMS has issued the Proposed Rule for the SNF PPS rates for fiscal year 2025. The Proposed Rule calls for a net market increase of 4.1%, which upon finalization, would be effective on 10/1/24. Please see ... Read More

Nursing Home Benefit Limitation DAL

The purpose of the attached letter is to notify nursing homes of the intention of the Department of Health to conduct another “Batch Process” disenrollment to continue implementation of the change in coverage of the long term nursing home care benefit in the ... Read More

Nursing Home Medicaid UPL Report

Attached, for your information, is NYSHFA’s Press Statement regarding the attached Report by CliftonLarsonAllen stating that New York has an additional $2,693,516,127 in room available to skilled nursing facilities to increase Medicaid rates without violating any of the federal UPL principles ... Read More

AHCA/NCAL: Change Healthcare Update - CMS Approves Advanced Payments

Electronic Payments Expected Back Online as Early as March 15. As shared previously, UnitedHealth Group Inc.’s technology subsidiary Change Healthcare announced that its systems were adversely affected by a security incident a few weeks ago. AHCA/NCAL has advocated that the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) take specific actions in response to this issue ...

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DOH Monthly Briefing – February 2024

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed:  2% Supplemental Rate / 2022 NHQI The 2% supplemental payments have just been approved. DOH is working with eMedNY to finalize the lump-sum payment adjustments and will release a DAL with further information in the next few weeks. The 2% supplemental rate package is not linked to the 2022 NHQI calculation as in previous years in order to be released ahead of the NHQI processing timeline. The NHQI payment adjustments are currently under executive review. DOH will be updating their website for the NHQI rankings in the next day or so.  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). The State Plan Amendment (SPA) to CMS requests approval for the federal match of the 7.5% rate increase. DOH is still seeking CMS approval of the SPA and has not received further guidance. 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, with the updated case mix as well as the 2024 minimum wage adjustment to be added prospectively.
  • Capital Component: The capital component of the 2024 notice rates are based upon the facility’s 2022 cost report.
Updates to the initial notice rates are still being developed. 2022 CRA Reconciliation The 2022 Cash Receipts Reconciliation is under executive review. No timetable for release was given. Capital Rates /Appeal Process DOH is reviewing the in-house 2023 appeals (including historic appeals from 2009) within the context of the current appeals cap.  All 2024 capital attestations have been received and DOH has begun the related rate-setting process. 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 at this time. PDPM DOH recognizes the importance of the 10/2023 assessment changes related to PDPM. They are not planning on moving to the Optional State Assessment (OSA) for collection of data, but rather are developing a plan to change to PDPM. The final RUGs related rates will be processed on January 1, 2024. Subsequently, a rate freeze will be in effect for the 1/1/24 collection period (4/1/23 – 9/30/23), as DOH works on this transition. DOH further indicated that a solution may be included within the context of the FY 2024-25 State Budget. DOH is in the early stages of this process and reiterated its commitment to include the Associations and providers in future PDPM discussions. 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. 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. MDS Audits – OMIG reported the 2018 MDS audits for all statewide regions are complete. OMIG is reviewing subsequent MDS data prior to commencing 2019 field work. NYSHFA | NYSCAL CONTACT: Carl J. Pucci Financial Consultant 518-462-4800 x36 Read More

DOH Extends Appeal Attestation Deadline

NYSHFA has received numerous member questions seeking clarity with respect to attestation of appeals related to changes of ownership. Subsequently, NYSHFA entered into discussions with DOH and strongly advocated for further modifications to the instructions pertaining to appeals filed by both current and prior ownership. As a result, DOH has issued the following update related to the Statewide Appeals Processing Project, as noted below. DOH has also extended the appeal attestation deadline to January 16, 2024. “This is an update to the instructions for the Statewide Appeals Processing Project implemented by the Department of Health pursuant to 10 NYCRR 86-2.14(f). The original instructions required facilities to attest to all open appeals. We understand that there are concerns regarding the ability of facilities to attest to appeals that were filed under previous ownership. This update modifies the instructions to address those concerns. Appeals filed by current ownership: Please continue to attest to and provide information for each appeal that was filed under your current ownership. All such appeals must be fully and completely addressed in the workbook. There is no change for these appeals. Appeals filed by prior ownership: If you have sufficient information to attest to the content of these appeals, please do so. If, however, you are unable to access sufficient information about them or unable to work with the prior owners to review and attest to those appeals, then you may identify such appeals in the workbook and attest to them simply as “Prior Ownership”. For appeals that were filed by prior ownership, you must complete the column in the workbook for “Appeal #” and then in the Comments column, enter “Prior Ownership”. DOH will consider this to be an attestation to the existence of the appeal but not an attestation to the accuracy of the contents of the appeal. Appeals filed under prior ownership for which the accuracy of the contents of the appeal cannot be attested will be addressed following the completion of the Statewide Appeals Processing Project.In light of this update, the deadline has been further extended to January 16.” Attached is the original 10/3/23 DAL and the appeals attestation form. NYSHFA | NYSCAL CONTACTS: Stephen B. Hanse, Esq. President & CEO 518-462-4800 x11 Carl J. Pucci Financial Consultant 518-462-4800 x36 Read More

DOH Monthly Briefing – December 2023

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed: 2% Supplemental Rate / NHQI The 2% supplemental rate add-on is under Executive review. DOH did not give an expected date for release but noted that the add-on will not be linked to the NHQI calculation as in previous years. The 2% add-on will be issued as a separate rate package in order to be released ahead of the expected NHQI processing timeline.  MDS Collection (Jan. 2024 Rates) DOH has received certified MDS data from approximately half of the nursing homes to date. DOH will provide a list to the Associations of facilities still outstanding as the 12/21/23 certification deadline draws nearer. 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). The State Plan Amendment (SPA) to CMS requests approval for the full 7.5% rate increase. DOH is still awaiting CMS approval of the SPA. July 2023 Rates The July 2023 Medicaid Rate Sheets were posted on the HCS in late September. The rates were updated for case mix (ARDs from Oct. 1, 2022 through March 31, 2023). Payments were made in Medicaid cycle # 2406 (check release date of 10/8/23). DOH continues to seek approval in order to update the related benchmark rates. 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, with the updated case mix as well as the 2024 minimum wage adjustment to be added prospectively.
  • Capital Component: The capital component of the 2024 notice rates are based upon the facility’s 2022 cost report. The 2024 capital attestation period has now been closed.
2023 Appeals DOH has begun reviewing the in-house 2023 appeals. A process for historic appeals (from 2009) has begun within the context of the current financial cap. DOH has conducted an informational webinar, and providers will be asked to submit financial information and an attestation, subject to audit. NYSHFA, working in conjunction with General Counsel, Neil Murray, and key members of its Payment for Services Committee, was successful in persuading DOH to extend the Nursing Home Rate Appeal Attestation deadline from October 30, 2023, to COB Monday, January 8, 2024. All attestation forms and excel files must be submitted via email to NFRates@health.ny.gov. The subject line of the email should state “Nursing Home Rate Appeal Attestation.” Please remember that no modifications should be made to the structure of the workbook, and it must be submitted in Excel (no other formats will be accepted).The appeals processing webinar, documents and supporting information are posted at Nursing Home Rates (ny.gov). DOH has received attestations for approximately one quarter of all outstanding appeals to date. Members are encouraged to complete their appeal attestations as soon as possible in advance of the upcoming January 8th deadline. 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 to NHSafeStaffing@health.ny.gov. No further information is available at this time. 2% Quality Penalty DOH has processed the 2% Quality penalty for affected providers. Medicaid cycle #2401 (check release date 9/13/23). The quality penalty (retroactive to Jan. 1, 2022) affected providers who scored in the lowest NHQI quintile for 2021 and, also were in the fourth or fifth NHQI quintile for 2020. PDPM DOH recognizes the importance of the upcoming 10/2023 assessment changes related to PDPM. They are not planning on moving to the Optional State Assessment (OSA) for collection of data, but rather are developing a plan to change to PDPM. The final RUGs related rates will be processed on January 1, 2024. Subsequently, a rate freeze will be in effect for the 1/1/24 collection period (4/1/23 – 9/30/23), as DOH works on this transition. DOH further indicated that a solution may be included within the context of the FY 2024-25 State budget. DOH will continue to include the Associations in future PDPM discussions. 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. 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. MDS audits OMIG reported the 2018 audits for most statewide regions are complete, with audits for the NYC region slated to begin in January 2024. NYSHFA | NYSCAL CONTACT: Carl J. Pucci Financial Consultant 518-462-4800 x36 Read More

2023-2 MDS Collection

The attached letter provides information regarding the Minimum Data Set (MDS) data collection periods for the January 2024 Medicaid reimbursement rates. Certifications are due by 12/21/23 ... Read More

REMINDER: NYSDOH 2024 Notice Rates

The notice rates are posted on the Health Commerce System (HCS) application (Healthcare Financial Data Gateway) under the heading of 2024 Notice Rates. If you have questions regarding the rates ... Read More

2024 NH, Specialty & ADHC Notice Rates

Please find information below regarding the 2024 NH, Specialty and ADHC Medicaid Notice rates and Capital Attestation process. Please note that there is a programming issue in the specialty rate headers, in which line 7 of ... Read More

DOH: Statewide Appeals Processing Guidance

In response to questions regarding operating appeals submitted on the 12/08/2008 publication date, to be reviewed in conjunction with the Statewide Appeals Processing Program, please see the attached letter issued on 9/16/2009. Operating appeals submitted on this appeal publication date we deemed invalid as those operating rates appealed, were never paid. Further information can be found in the attached letter on page 3 under the Appeals heading. NYSHFA | NYSCAL CONTACTS: Stephen B. Hanse, Esq. President & CEO 518-462-4800 x11 Carl J. Pucci Financial Consultant 518-462-4800 x36 Kristin DeVries, MA, MPP Director of Government Relations |518-462-4800 x14   Read More

DOH Grants NYSHFA’s Request for Rate Appeals Extension

NYSHFA, working in conjunction with General Counsel, Neil Murray, and key members of its Payment for Services Committee, was successful in persuading DOH to extend the Nursing Home Rate Appeal Attestation deadline from October 30, 2023, to January 8, 2024. Attached is the revised Nursing Home Appeals Extension DAL, along with the Open Appeals Attestation Formand the Impact Workbook. NYSHFA | NYSCAL CONTACTS: Stephen B. Hanse, Esq. President & CEO 518-462-4800 x11 Carl J. Pucci 518-462-4800 x36 Kristin DeVries, MA, MPP Director of Government Relations 518-462-4800 x14 Read More

DOH Monthly Briefing – September 2023

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed: 7.5% Rate Increase – DOH submitted the State Plan Amendment (SPA) to CMS and it is presently under review. The SPA requests approval for the full 7.5% rate increase. The DOH could not provide a timeline for CMS approval. A question was raised as to whether the DOH would release the state share in advance of CMS SPA approval. While the DOH indicated that it is procedurally much easier to front the State share of a lump sum payment as opposed to a rate payment, the Department indicated that it would investigate the matter further. October MDS/CMI Change – DOH is going to freeze case mix for the 1/1/24 collection period (4/1/23 – 9/30/23) as they work to revise the methodology. The Department stated that they are seeking a broader solution and will engage support from associations as they continue to work on this transition. DOH further indicated that a solution may be included within the context of the FY 2024-25 State budget. July 2023 Rates - No timeline for rate release, in review. Cinergy Payment – Both the Federal 2022-23 and the State 2023-24 payments have been approved by DOB. Capital Rates/2023 Appeals – 2023 appeals in-house, starting review process. The Department will provide more information when further along. Process for historic appeals (from 2009) to begin shortly within the context of the current financial cap.  DOH will be conducting an informational webinar in the next couple of weeks on the process. The DOH will identify a subset of appeals. Providers will be asked to submit financial information and an attestation, subject to audit. There is no timeline for final approvals/denials. Enhanced ATI – Payments related to the Enhanced ATI for the period 4/1/23 through 3/31/24 will be processed in upcoming Medicaid cycle #2402 (check date 9/20/23). See attached DAL with further details. 2022 CRA Reconciliation – Remains in process, as additional time from the 2022 FY is required to complete the reconciliation. 2% Quality Penalty – Updated in the system, effective cycle #2401 (check release date 9/13/23). 2022 Cost Report – The vast majority of providers have now submitted their 2022 cost reports, some with formal extensions. 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. 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 soon. MDS audits – OMIG reported that the 2018 audits are completed in the Capital District, Central NY, Buffalo, and Westchester regions.  OMIG is currently working on audits in NYC and Long Island. They have issued 56 summation letters and terminated 2 audits.  Draft audits should be mailed in September. Minimum Wage Adjustment AL (January 2023) – The DOH is utilizing a reconciliation approach and will conduct a survey at end of 2023; to result in retro payment going back the full year. NYSHFA | NYSCAL CONTACT: Carl J. Pucci 518-462-4800 x36   Read More

Nursing Home Benefit Limitation DAL – Due 8-4-23

The purpose of the attached letter is to notify nursing homes of the intention of the Department of Health to conduct another “Batch Process” disenrollment to continue implementation of the change in coverage of the long term nursing home care benefit in the Medicaid Managed Long Term Care Partial Capitation plan (MLTCP plan). This “Batch Process” disenrollment will be effective October 1, 2023 ... Read More

DOH Monthly Briefing – July 2023

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed: 7.5% Rate Increase – DOH has submitted the State Plan Amendment (SPA) to CMS. The rate package was also submitted for state executive review. July 2023 Rates - No timeline for rate release. Hoping to move forward for executive review soon. October MDS/CMI Change – DOH recognizes the importance of the upcoming 10/2023 assessment changes related to PDPM. They are not planning on moving to the Optional State Assessment (OSA) for collection of data, but rather are developing a plan to change to PDPM. Final RUGs related rate will be the January 1, 2024. After that a rate freeze is being considered. They are in the early stages of planning, however, will work on future methodology with stakeholders to ensure it is tailored to the LTC population and is capturing acuity changes. 2% Quality Penalty – In executive review. MDS audits – 2018 audits are ongoing in the upstate area.  NYC and Long Island audits to begin in August. The following items were not discussed on the call today, however, please see summary below from the previous monthly meeting: 2022 Cost Report – DOH released the cost report software on June 9th. There are no major changes to the 2022 cost report. The filing deadline is Wednesday, August 9, 2023. Members are strongly urged to verify their HCS access capabilities prior to the filing deadline. 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. See NYSHFA member mailing (attached) for a summary of the webinar. DOH is directing any further questions on safe staffing to NHSafeStaffing@health.ny.gov. 2022 CRA Reconciliation – Currently in process, as additional time from the 2022 CY is required to complete the reconciliation. Healthcare Workers Bonus (HWB) – The HWB FAQs were recently updated on 7/6/23. The updated HWB webpage can be found here. Health Care Worker Bonus Program Frequently Asked Questions (ny.gov) Below is the update with regard to vesting period 3:
  1. I’m an eligible Employer, I submitted for vesting period three, when should I receive payment?
  2. If you submitted for vesting period three, please see the table below for payment information. This table will be updated as information becomes available.
Submission Period MMIS Submission SFS Submission
One (08/03/2022 – 09/02/2022) eMedNY Cycle 2352 10/05/2022
Two (10/01/2022 – 11/30/2022) eMedNY Cycle2366 01/11/2023
2.5 (02/01/2023 – 03/03/2023) eMedNY Cycle 2382 05/032023
Three (04/01/2023 – 05/01/2023) eMedNY Cycle 2393 07/19/2023
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. 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 but did not specify a payment release date. NYSHFA | NYSCAL CONTACT: Carl J. Pucci 518-462-4800 x36 Read More

DOH Monthly Briefing – May 2023

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed: 7.5% Rate Increase – DOH is working on the State Plan Amendment (SPA) to CMS. The SPA will request the full 7.5% rate increase. More information will be released going forward. A question was raised as to whether DOH could release the 6.5% state share in advance of CMS SPA approval. DOH indicated it would look into further. Enhanced ATI Payments - The Federal Share portion of the enhanced Advanced Training Initiative payments for eligible providers will be released in Medicaid cycle #2386 (check release date 5/31/23). Eligible facilities were separately notified. Attached is the DAL with further information. MDS Data Collection – DOH issued a DAL on 5/23/23 regarding the upcoming data collection period for assessments submitted with ARD’s between 10/1/22 and 3/31/23. Please ensure your updates are completed by June 7, 2023, as the certification deadline is June 14, 2023. Attached is the DAL with further information. Note: due to technical issues, which have been corrected, the certification deadlines have now been extended by one day to June 8th and June 15th respectively. 2022 Cost Report – DOH expects to release the cost report software in the next few weeks. There are no major changes to the 2022 cost report. The filing deadline will remain at 60 days post software release. Safe Staffing – the State Share of funding to assist nursing homes in meeting staffing level requirements was contained in Medicaid cycle #2377. DOH is working with CMS on the related SPA, and upon approval, a second lump distribution will be made for the federal share. DOH is directing any further questions on safe staffing to NHSafeStaffing@health.ny.gov. 2022 CRA Reconciliation – is currently in process, as additional time from the 2022 CY is required to complete the reconciliation. 2% Quality Penalty – DOH did not give a timetable for processing. October MDS/CMI Change – DOH recognizes the importance of the upcoming 10/2023 assessment changes related to PDPM. They are seeking a broader solution and will engage support from the field as they continue work on this transition. DOH indicated that a solution would be within the context of next year’s state fiscal budget. Internal discussions continue and the work plan, once drafted, will be shared with the Associations. Healthcare Workers Bonus (HWB) – The HWB FAQs were last updated on 5/23/23. The updated HWB webpage can be found here. Health Care Worker Bonus Program Frequently Asked Questions (ny.gov) 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. 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 but did not specify a payment release date. MDS audits – OMIG reported that the 2017 MDS final audits are complete, and the 2018 audits are in process across various regions of the State. NYSHFA | NYSCAL CONTACT: Carl J. Pucci 518-462-4800 x36   Read More

Medicaid Rate Litigation

NYSHFA has been advised that within the past week several of its member facilities have been solicited by a law firm to participate in litigation challenging the adequacy of nursing home Medicaid reimbursement rates set by the New York State Department of Health (“DOH”). This solicitation sets a deadline of this Friday, May 26th for a facility to join the litigation. Additionally ... Read More

Medicaid Update – April 2023

The Office of Health Insurance Programs of the New York State Department of Health has approved the release of the April 2023 Medicaid Update. Please find the improved, interactive issue as a PDF (Portable Document Format) file available to be downloaded at ... Read More

Medicaid Update Special Edition – Updates to New York State Medicaid Coverage of Coronavirus Disease 2019-Related Services Following the Expiration of the Federally Declared Public Health Emergency

The Medicaid Update Special Edition, issued  Wednesday, May 10, 2023, by the New York State Department of Health, featuring “Updates to New York State Medicaid Coverage of Coronavirus Disease 2019-Related Services Following the Expiration of the Federally Declared Public Health Emergency,” is available ... Read More

2024 SNF Proposed Payment Rule

CMS has issued the 2024 SNF Proposed Payment Rule. Among the highlights ... Note: AHCA will review key details of the proposed rule via a member webinar tomorrow, Friday, April 7 at 2:00 pm Read More

DOH Monthly Briefing - March 2023

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed: 1/1/23 Rates – The 1/1/23 Medicaid rates were released on 3/8/23. The rates included a CMI adjustment based on the 4/1/22 - 9/30/22 MDS data assessments. The 1.5% ATB increase implemented in November 2018 was recalculated to reflect the January operating rate. The Minimum Wage add-on was also updated for 2023 increases. The capital component of the rate reflects the submitted capital attestations and includes the 5% capital rate cut previously enacted. Payment for these rates will be in Medicaid cycle #2377 (check release date 3/29/23). Attached is the DAL with further information. 2021 NHQP – The 2021 Nursing Home Quality Pool was issued on 3/7/23 (DAL attached). Payments and/or recoupments will be processed in Medicaid cycle#2377 (check release date 3/29/23). The NHQP is being processed in conjunction with the 1/1/23 rate package to alleviate cash flow issues related to facilities with NHQP recoupments. Enhanced ATI Payments - The State Share portion of the enhanced Advanced Training Initiative payments for eligible providers will also be released in Medicaid cycle #2377 (check release date 3/29/23). Eligible facilities were separately notified. Upon CMS approval of the related SPA, the remaining federal share will be released. Attached is the DAL with further information. Safe Staffing – the State Share of funding to assist nursing homes in meeting staffing level requirements is also contained in Medicaid cycle #2377. DOH is working with CMS on the related SPA, and upon approval, a second lump distribution will be made for the federal share. A press release and notification letters are expected to be released in the next day or so. 2021 CRA Reconciliation – has been completed and will be processed in Medicaid cycle #2378 (check release date 4/5/23). 2022 CRA Reconciliation – is currently in process, as additional time from the 2022 CY is required to complete the reconciliation. 2% Quality Penalty – DOH did not give a timetable for processing. Benchmark Rate Posting – the 2021 and 2022 Benchmark rates have been updated. The 2023 Benchmark rates should be updated within the next two weeks. Assessment Filing Changes (PDPM) – DOH recognizes the importance of the upcoming 10/2023 assessment changes related to PDPM. They are seeking a broader solution and will engage support from the field as they continue work on this transition. DOH indicated that a solution would be within the context of next year’s state fiscal budget. Healthcare Workers Bonus (HWB) – The HWB FAQs were last updated on 3/14/23. The updated HWB webpage can be found here. Health Care Worker Bonus Program Frequently Asked Questions (ny.gov) 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. 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 but did not specify a payment release date. Attached is the DAL with further information. MDS audits – OMIG reported that the 2017 MDS final audits are nearing completion, and the 2018 audits are in process. ALP 2022 Rates – The individual survey results from the 2022 ALP minimum Wage surveys have been incorporated into the January 1, 2022 ALP rates effective in cycle #2378 (check release date 4/5/2023). Accordingly, the minimum wage add-on component is now included in the April 1, 2022 and October 1, 2022 rates, which are also in the cycle #2378 update. The provider-specific rates have been posted for your information at the following location under ALP 2022 Minimum Wage Add-On: https://www.health.ny.gov/facilities/long_term_care/reimbursement/alp/ If you have any questions regarding the Home Care Aide Wage Increase, please send an email with the subject line ALP January 2022 Minimum Wage Increase to ALP-Rates@health.ny.gov. NYSHFA | NYSCAL CONTACT: Carl J. Pucci 518-462-4800 x36 Read More

2023 Medicare Part B Schedule

Attached is the 2023 Medicare Part B fee schedule, effective 1/1/23 through 12/31/23. To identify the fee amount for your facility, please locate the appropriate CPT/HCPCS code and match it to the respective facility location column ... Read More

Exception Submission Period for HWB Program Expansion Opens February 1, 2023

On November 17, 2022 the New York State Department of Health (the Department) announced notification of an expansion to the Healthcare Worker Bonus (HWB) Program to include additional titles and eligible provider types. The Exception Submission period, during which employers impacted by this expansion can submit their newly eligible employees, will begin on February 1, 2023 and will remain open for 30 days ... Read More

Exception Submission Period for HWB Program Expansion Opens February 1, 2023

On November 17, 2022 the New York State Department of Health (the Department) announced notification of an expansion to the Healthcare Worker Bonus (HWB) Program to include additional titles and eligible provider types. The Exception Submission period, during which employers impacted by this expansion can submit their newly eligible employees, will begin on February 1, 2023 and will remain open for 30 days ... Read More

Medicaid Update – November 2022

The Office of Health Insurance Programs of the New York State Department of Health has approved the release of the November 2022 Medicaid Update. Please find the new and improved, interactive issue as a PDF (Portable Document Format) file available to be downloaded at ... Read More

2023 Nursing Home Minimum Wage Survey

DOH has issued the 2023 Nursing Home Minimum Wage survey, which is due by COB Friday, December 23, 2022. The survey is applicable to upstate facilities only, as NYC, Long Island and Westchester have reached the statutory minimum wage of $15.00 per hour. Attached is the DAL with further information. The survey link is found here. Questions regarding the minimum wage survey should be directed to nfrates@health.ny.gov. NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

DOH Posts July 1, 2022 Rates

DOH has finalized and posted the July 1, 2022 rates to their website. The rates include an updated case mix adjustment for the MDS period 10/1/21 through 3/31/22. Payment for the rates will be in Medicaid cycle #2362 (check release date 12/14/22). The website link and DAL provide detailed facility-specific information. The Benchmark rates have also been updated accordingly. In addition, DOH is also issuing the 2% supplemental rate increase and 2023 ATI funding (for those who were pre-qualified) on 12/14/22. NYSHFA will update members once DOH releases further information with respect to the 2% supplemental increase. NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

DOH Monthly Briefing – November 2022

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed: 7/1/22 Rates – The 7/1/22 Medicaid rates are still under Executive Review. DOH did not indicate a release date. 2023 Capital Attestation – DOH reminded providers that the 1/1/23 Capital Attestations are due by Wednesday, November 30, 2022. Last week’s informational Webex is now posted on the DOH website and will soon be posted to the HCS. Also, the 5% capital rate reduction will be now applied directly to the 1/1/23 capital rate (vs. a negative rate adjustment on the “miscellaneous line” of the Medicaid rate sheet). Healthcare Workers Bonus (HWB) – The HWB was launched on 8/3/22. The FAQs were last updated on 11/1/22 (see attached notice). Members can access the portal through 11/30/22 for both vesting period 1 and 2 submissions. DOH also clarified that the HWB is not subject to the Cash Receipts Assessment. DOH rate-setting is not directly involved in the HWB processing and recommended all provider questions be referred to the call center or web address on the HWB webpage. 2021 CRA Reconciliation – DOH has begun work on the 2021/22 Cash Receipts Assessment (CRA) reconciliation. More information will follow. ALP – 10/1/22 Rates – The ALP Homecare Aide wage increase will be processed in Medicaid cycle #2360 (check release 11/30/22). The DAL is attached with further information. The 1/1/22 and 1/1/23 ALP minimum wage surveys will be issued in the next few weeks. NYSHFA/NYSCAL CONTACT: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

Healthcare Worker Bonus Period 2 is Extended

DOH has extended the Healthcare Worker Bonus (HWB) Period 2 submission date until November 30, 2022. Below is the MRT Listserv notice released last evening: In order to allow appropriate time for all Employers to submit claims for Vesting Period 1 and 2, the Department will keep the Healthcare Worker Bonus (HWB) Portal open to claims submissions until November 30.  Qualified Employers can continue to submit claims for eligible employees during this time. Please be advised that, in accordance with SOS § 367-w(4)(f), claims submitted after October 31, 2022 for Vesting Period 1 and 2 are technically late for filing purposes. The Department is aware of several technical issues during the initial submission periods for Vesting Periods 1 and 2 that impeded the ability of certain Qualified Employers to submit claims. All Employers should document and retain information regarding the reason for any late submission for audits and investigation purposes relating to the submission of claims for the HWB Program. This information will be reflected on the HWB website tomorrow. Thank you. Medicaid Redesign Team (MRT) Updates New York State Department of Health Office of Health Insurance Programs One Commerce Plaza Albany, NY 12237 mrtupdates@health.ny.gov NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

Revised January 1, 2022 Rates Issued

The revised January 1, 2022 Medicaid rates are now posted on the HCS. The rates were updated to include the 2022 capital rate component and will be processed in Medicaid cycle #2350 (check release date 9/21/22). Attached is the DAL with further details. Questions should be sent to nfrates@health.ny.gov. NYSHFA/NYSCAL CONTACT: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

Medicaid Reimbursement Update

DOH has issued a DAL related to the release of the MDS Index Cap as well as effective dates for the recalculation of the 1.5% ATB investment.  The 1.5% investment was still based on the initial 11/1/18 effective rate, and that value was never updated. DOH is now updating the 1.5% add-on based on each facilities operating rate from 1/1/19 forward. These rate adjustments will be paid via Medicaid cycle #’s 2349/2350, with check release dates of 9/14/22 and 9/21/22. The rates will be available on the HCS by this Friday, August 26, 2022. Note:  In addition, please note that a separate DAL will be issued regarding the new 1% ATB increase, effective 4/1/22. NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

Healthcare Worker Bonus (HWB) – DOH Webinar

DOH will be hosting an informational webinar which will provide an overview of the HWB program this Friday, August 19, 2022 at either 11:00 am – noon or 1:00 pm – 2:00 pm which will include the following topics of interest to all qualified employers:
  • Eligibility and requirements,
  • Account registration process,
  • Vesting periods,
  • Manual and bulk upload process,
  • Frequently asked questions.
All members are strongly encouraged to attend one of these sessions. Please see attached for details. NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

DOH Monthly Briefing – August 2022

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed: 70/40/5 Law Amendments – The final Executive Budget excluded the cash receipts assessment from the definition of revenue. Also excluded from the revenue definition was the capital per diem portion of the rate for CMS four- and five-star facilities that are not attributable to a capital expenditure made to an entity with a common familial ownership. The associations requested additional guidelines related to implementation of the staffing requirements as well as the associated $64M state funding to be provided. NYSHFA, through its General Counsel, submitted comments directly to CMS regarding the proposed 70/40 State Plan Amendment (SPA), which was filed by DOH in early July. The comments clarified the direct care revenue exclusions adopted by the Governor’s Executive Budget. The comments also noted the SPAs planned use of Federal Medicare reimbursement to fund the state’s Medicaid program is a major concern. Healthcare Workers Bonus (HWB) – The HWB was launched on 8/3/22 (see NYSHFA member mailing). DOH rate-setting is not directly involved in the HWB processing and recommended all provider questions be referred to the call center or web address in the above NYSHFA link. 1/1/22 Rates – The January 1, 2022 rate were posted to the HCS in early July, reflecting an updated case mix, 2022 minimum wage adjustment and a revised 1.5% ATB investment adjustment. The 2022 capital rates recently have been approved and will be loaded into the rate setting system. The 1/1/22 Benchmark rates will then be updated. 7/1/22 Rate / MDS Data Collection – The MDS data collection for the upcoming July 2022 Medicaid rates is currently underway. Members should have reviewed their census data and made appropriate changes for all assessments for the period 10/1/21 through 3/31/22. Final MDS certifications are due this Friday, August 12, 2022. 5% MDS Cap Release - The 5% MDS Cap is no longer in regulation. As such, DOH will process payments/recoupments attributable to the cap for the period 7/1/17 – 1/1/21. DOH will issue lump-sum payments for those providers who are due monies related to the 5% cap. For providers who owe recoupments due to the cap, DOH will apply the standard weekly 15% recoupment until all monies are repaid. Specific year-to-year payments and/or recoupments will be netted into one provider transaction. DOH indicated that this revision is still in process. 2022 ALP Rates – The 4/1/22 ALP rates were issued on 8/4/22. The rates included a 1% operating increase, which members should have received in Medicaid cycle #2342 (check date 7/27/22). 2017 – 2021 ALP Minimum Wage Rates – DOH has updated rates for provider-specific corrections, which will be processed in upcoming Medicaid cycle #2347 (check release date 8/31/22). 2017/18 OMIG Audits – The 2017 MDS audits are nearly complete. OMIG expects to begin the 2018 audit field work in early Fall. NYSHFA/NYSCAL CONTACT: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

NYS Launches Healthcare Worker Bonus (HWB) Program

Governor Hochul today gave a press conference which centered on strengthening New York’s healthcare workforce. Citing a 32% workforce shortage realized as early as 2018, compounded by the pandemic, the Governor stated it is a crisis for all New Yorkers, and that it was time to bolster New York’s healthcare workforce. Governor Hochul's 2022 State-of-the-State address committed to a 20% increase in healthcare funding over the next five years. A two-step approach was previewed:
  • Making it easier to enter the healthcare workforce via 1,000 new nursing scholarships ($15M in funding), noting that there presently were 9,300 healthcare openings.
  • A $3,000 bonus for current eligible healthcare workers earning less than $125k.
An online portal has been established to facilitate submission by eligible employers on behalf of their qualified employees for allocation of the $1.2B funding related to the HWB. NYSHFA will provide updates regarding the HWB rollout as further information is released. Below is the MRT Listserv notice which contains links to the HWB program announcement, program portal, and program FAQ’s: New York's essential frontline health care and mental hygiene workers have seen us through a once-in-a-century public health crisis that transformed our state into a model for battling COVID-19. As part of the Fiscal Year 2023 New York State Executive Budget legislation, $1.2 billion has been allocated by Governor Kathy Hochul and the State Legislature via the Health Care and Mental Hygiene Worker Bonus (HWB) Program for the payment of bonuses to "recruit, retain, and reward health care and mental hygiene workers" who meet specified eligibility requirements. The official press release can be found at the following link: Governor Hochul Launches Health Care Worker Bonus Program. This listserv notice is to inform our provider community that the New York State Department of Health, working with the Governor’s Office and other state agency partners, has launched the HWB Program Portal to facilitate submission by eligible employers on behalf of their employees who qualify for bonus payments. As a next step, all providers are strongly encouraged to visit the following links for more information: HWB Program Announcement and Information https://www.health.ny.gov/health_care/medicaid/providers/hwb_program/ HWB Program FAQs https://www.health.ny.gov/health_care/medicaid/providers/hwb_program/hwb_program_faq.htm HWB Program Portal https://www.nysworkerbonus.com/ Providers with additional questions may contact the Health Care Worker Bonus Call Center at (866) 682-0077 or via email at nysworkersbonus@health.ny.gov. NYSHFA/NYSCAL CONTACTS: Stephen B. Hanse, Esq.` President & CEO 518-462-4800 x11 Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

Nursing Home Vital Access Provider Assurance Program (VAPAP)

The Department of Health has rolled out the Nursing Home Vital Access Provider Assurance Program (VAPAP). The State will be accepting and reviewing applications on a rolling basis. Up to $100 million were made available to support New York State's nursing homes pursuant to the FY 23 Enacted Budget. Under the VAPAP program, nursing homes in severe financial distress can apply for financial relief dollars to maintain operations and vital services through March 31, 2023, while they implement longer-term solutions to achieve financial sustainability. Successful applicants must identify and begin implementation of initiatives during the funding period that will improve the likelihood of future financial sustainability while maintaining essential services to their communities. Nursing Homes that have already reached out to the Department about financial assistance should submit a formal application on or before August 1, 2022. Applications and questions should be submitted to NHVAPAP@health.ny.gov. NYSHFA/NYSCAL CONTACTS: Stephen B. Hanse, Esq. President & CEO 518-462-4800 x11 Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

DOH Issues January 2022 Rates

DOH has posted the 1/1/22 Medicaid rates to the HCS (Healthcare Financial Data Gateway). The operating rates include an updated case mix for the period 4/1/21 thru 9/30/21, as well as the 2022 minimum wage increase. The 2021 capital rate continues forward pending update of the 2022 capital rates. The rate payments will be in Medicaid cycle #2343 (check release 8/3/22). Attached is the DAL with further information. NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

REMINDER: Urgent Information Needed Regarding COVID Related Immunity Lawsuits

Neil Murray, NYSHFA’s General Counsel, is seeking information regarding Covid-19 immunity related lawsuits. Specifically, he needs to know how many NYSHFA members have been sued for negligence with respect to Covid-19.  NYSHFA plans to file an Amicus Brief on behalf of all members, and must first determine the number of facilities presently affected. Members should contact Carl Pucci at NYSHFA ASAP but no later than COB Friday, June 10, 2022 if your facility is involved in such a lawsuit.  NYSHFA/NYSCAL CONTACT: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

Urgent Information Needed Regarding COVID Related Immunity Lawsuits

Neil Murray, NYSHFA’s General Counsel, is seeking information regarding Covid-19 immunity related lawsuits. Specifically, he needs to know how many NYSHFA members have been sued for negligence with respect to Covid-19.  NYSHFA plans to file an Amicus Brief on behalf of all members, and must first determine the number of facilities presently affected. Members should contact Carl Pucci at NYSHFA ASAP but no later than COB Friday, June 10, 2022 if your facility is involved in such a lawsuit.  NYSHFA/NYSCAL CONTACT: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

DOH Releases 2021 RHCF Software

DOH has just posted the 2021 RHCF software to the HCS. The filing deadline is Monday, July 11, 2022. Note: Third-party software will no longer be acceptable for RHCF submission. Below is the DOH notice: Dear Administrator: This letter provides you with information regarding the 2021 RHCF Cost Report submissions. The 2021 software is now available through the internet-based Health Commerce System (HCS). The 2021 cost report and applicable electronic certifications are due to the Department by Monday, July 11, 2022. No changes have been made to the software, however, please note, CPA certifications have been updated to be in accordance with the New York State Society of Certified Public Accountants (NYSSCPA) recently updated Statement on Auditing Standards (SAS 134 ), which aligns the generally accepted auditing standards with the standards issued by the International Auditing and Assurance Standards Board. The following documents are located on the HCS in the NH Cost Report section to aid in the submission:
  • RHCF Cost Report Submission Guidelines
  • RHCF Cost Report Electronic Certification Access Instructions
  • Updated CPA certification documents (in accordance with SAS 134)
Additionally, as referenced in the communication from the Department on March 4, 2022, the software provided by the Department is the SOLE software that can be used for submission of the cost report. Third party software creates errors in submission and can no longer be accepted. If you or your delegate fills out the cost report in a third-party software and then loads the data into the Department's software, the cost report does NOT load correctly and as such the cost report will be deemed unsubmitted and the provider will be subject to penalty. It is critical that all providers and their delegates prepare and submit their cost report ONLY through the Department of Health software. If you have any questions regarding the submission of the Cost Report or HCS access, please send an email to RHCF-HCS@health.ny.gov Please include RHCF Submission or HCS access in the subject line. NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

A Message from Mark Parkinson: Submit Comments on the SNF Payment Rule to CMS

As you know, the Centers for Medicare & Medicaid Services (CMS) issued the FY 2023 SNF Proposed Payment Rule last month. The proposed rule provides for a net market basket increase for SNFs of 3.9 percent beginning October 1, 2022. It also includes a proposed parity adjustment of 4.6 percent. (This parity adjustment is a 4.6 percent cut.) We need your help submitting comments to CMS on the proposed payment rule ... Read More

DOH Monthly Briefing – May 2022

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed: Budget Initiatives:
  • 1% Rate Increase – DOH is working on the CMS State Plan Amendment (SPA). Once submitted and approved, the 1% rate increase will become effective retroactive to 4/1/22.
  • 1.5% ATB Cut Restoration –The restoration cut was eliminated via Medicaid cycle #2330 (4/1/22). DOH is working on the CMS SPA.
70/40/5 Law Amendments – The final Executive Budget excluded the cash receipts assessment from the definition of revenue. Also excluded from the revenue definition was the capital per diem portion of the rate for CMS four- and five-star facilities that are not attributable to a capital expenditure made to an entity with a common familial ownership. The Governor did not issue an additional 30-day implementation delay; therefore, the effective date is 4/1/22. The associations again requested additional guidelines related to implementation of the staffing requirements as well as the associated $64M state funding to be provided. DOH does not yet have additional guidance related to the 70/40/5 amendments. 1/1/22 Rates – The 1/1/22 rate package is under Executive Review. Rather than further delay, DOH will issue the 2022 operating rates in advance of the pending 2022 capital rates. DOH did not release the expected 1/1/22 operating rate issuance date. 5% MDS Cap Release – The 5% MDS Cap is no longer in regulation. As such, DOH will process payments/recoupments attributable to the cap for the period 7/1/17 – 1/1/21. DOH will issue lump-sum payments for those providers who are due monies related to the 5% cap. For providers who owe recoupments due to the cap, DOH will apply the standard weekly 15% recoupment until all monies are repaid. Specific year-to-year payments and/or recoupments will be netted into one provider transaction. Capital Attestations – The 2022 capital preview rates, and respective attestation process were issued on 3/29/22, with a final attestation submission deadline of May 13,2022. Although there were no changes to the capital reimbursement methodology or attestation documents, DOH has added a revised Capital Preview Attestation. Capital rate errors due to incorrect 2020 RHCF data will now require the facility to refile their corrected 2020 RHCF. DOH reminds providers to submit detailed supporting documentation in support of any additional capital reimbursement requests. Also, all operators must certify, in addition to the CPA firms, when attesting or refiling the 2020 RHCF. Cost Report Software – DOH reported no significant changes to the upcoming 2021 RHCF software. Release of the software should occur within the next few days. It is expected that DOH will allow 60 days for completion of the 2021 RHCF. 2017 - 2021 ALP Minimum Wage Rates – DOH issued a DAL on 4/22/22 which provided information related to the 2017 – 2021 ALP minimum wage survey and related rate calculations. The updated minimum wage calculations will be active in Medicaid cycle #2333, check release date 5/25/22. Numerous provider questions have since arose regarding the recoupment calculations. As such, DOH is working to identify the magnitude of both the payments and recoupments associated with revised calculations, and will issue further guidance. Advanced Training Initiative (ATI) – DOH funded the 2021/22 ATI program in Medicaid cycle # 2325 (check release date of 3/30/22). Providers have until 12/31/22 to complete their associated ATI trainings. 2017/18 OMIG Audits – The 2017 MDS audits are nearly complete. OMIG expects to begin the 2018 audit field work mid-late summer. NYSHFA/NYSCAL CONTACT: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

CMS Issues FY 2023 Proposed Payment Rule

CMS has issued the SNF Proposed Payment Rule which provides a market basket increase of 3.9%, BUT also includes a negative 4.6% PDPM parity adjustment, all effective 10/1/22.  AHCA has provided a summary of the rule below, and is conducting a member webinar this Thursday, April 14th at 4:00 pm... Read More

DOH Issues Capital Preview Rates and Attestation Documents

DOH has just issued the 2022 SNF Capital Preview Rates and supporting Attestation documents. The signed Capital Attestation form is due Friday, May 13, 2022. Although there are no changes to the capital reimbursement methodology or attestation documents, DOH has added a new Capital Preview Rate Sources template which provides line-by-line source and calculation guidance from the capital rate sheet, as well as a revised 2022 Capital Preview Attestation Request, which defines the applicable documentation required for requested changes to the Capital Preview Rate. Below are the attached forms in the 2022 Attestation package: Note: New this year - capital rate errors due to incorrect 2020 RHCF data now require the facility to refile the corrected 2020 RHCF (with revised DCN# and applicable CPA certification) as required by regulations. Questions should be sent to nfrates@health.ny.gov NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

DOH Extends Appeals Deadline

DOH has extended the capital and operating appeals deadline to April 15, 2022. Attached is the March 2, 2022 DAL which originally set an appeal deadline of 3/31/22. Below is the extension notice from DOH: An extension to file hearing appeals to recently processed appeals in December and March has been granted through midnight of April 15, 2022. The previous publication date of 3/2/2022 is still open through April 2. A new publication date allowing the extension for filing hearing only appeals is 3/24/2022. Acceptable appeals only include items that were processed and posted in December of last year and March 2 of this year. If you have any questions, please reply to this message. Thank you. Cynthia Treis Principal Health Care Fiscal Analyst NYS Department of Health Bureau of Residential Health Care Reimbursement 1 Commerce Plaza 99 Washington Avenue Albany 12210 NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

2021-2 MDS for Reimbursement DEADLINE REMINDER

This message serves a reminder that the deadline for MDS Census verification is MARCH 25, 2022. Please take steps to ensure you have reviewed and finalized the census roster on the Health Commerce System by March 25 and that the census certifications are timely filed ... Read More

DOH to Conduct Additional MLTC Batch Process Disenrollment

DOH will again implement another “batch process” disenrollment in its efforts to continue change in coverage for the long-term nursing home benefit. Providers should submit appropriate resident listings to DOH by Friday, April 1, 2022. Below is the DOH notification and respective attachments: The purpose of the attached letter is to notify nursing homes of the intention of the Department of Health to conduct another “Batch Process” disenrollment to continue implementation of the change in coverage of the long term nursing home care benefit in the Medicaid Managed Long Term Care Partial Capitation plan (MLTCP plan).  This “Batch Process” disenrollment will be effective June 1, 2022. To implement this additional batch disenrollment, and as further described in the “Implementation and Information Required from Nursing Homes” section of the attached letter, the Department of Health (the Department) is requesting nursing homes transmit to the Department a list of all residents who are designated as long term nursing home stay (LTNHS), are enrolled in an MLTCP Plan, and have an active discharge plan to transition to the community. The Department is now working closely with MLTCP plans to identify current MLTCP plan enrollees who are designated as LTNHS, have met or exceeded the three-month benefit period, and were not disenrolled in prior batch processes. To ensure that members who may be in the process of transitioning to the community are not disenrolled from their MLTCP plan, the Department is requesting nursing homes use the attached template to provide a list of their nursing home residents who have been designated LTNHS and who have an active discharge plan to transition to the community no later than Friday April 1, 2022. We appreciate your assistance. Questions may be directed to DOH.sm.MLTCNH@health.ny.gov. Please see all necessary attachments below: NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

DOH Suspends MDS Collection

NYSHFA alerted DOH yesterday as to our concerns related to missing MDS data within the six-month collection period (4/1/21 – 9/30/21), as originally issued via the 3/4/22 DAL.  Consequently, late yesterday, DOH temporarily suspended the 2021-2 MDS collection process. DOH will notify providers of the revised start date once the missing data has been restored to the HCS. NYSHFA will keep members informed as to the MDS collection status as it develops. NYSHFA/NYSCAL CONTACT: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

MDS collection 2021-2

This letter provides information regarding the Minimum Data Set (MDS) data collection periods for the January 2022 Medicaid reimbursement rates ... Read More

DOH Issues Appeals Notice

DOH has issued a DAL which outlines upcoming payments/recoupment information related to outstanding capital and operating appeals for rate years 2009 through 2021. Two payment mechanisms will ... Read More

DOH Monthly Briefing – February 2022

DOH held its Monthly Briefing yesterday. The following summarizes the topics discussed: 70/40/5 and 3.5 Minimum Staffing Requirements - The associations requested additional guidelines related to implementation of the staffing requirements as well as the associated $64M state funding to be provided. DOH noted that technical amendments to the executive budget for the 70/40 were proposed, and that they were not prepared to issue further guidance at this time. The Governor has issued an additional 30-day implementation delay thru 2/28/22. 1/1/22 Rates – Work continues on the 1/1/22 rate package. DOH is processing the MDS collection process for the rolling 6-month average period (4/1/21 - 9/30/21) and will update the case mix index accordingly. The initial 2022 capital rate component will be included upon completion of the capital attestation verification. (See below). DOH did not release an expected 1/1/22 rate issuance date. Capital Attestations – The capital attestation process is still delayed due to system software issues, specifically data migration from a number of facility specific software submissions. DOH will correct these issues prior to release of the 2021 cost report software. DOH, per regulation, will continue to impute the 90% occupancy requirement with respect to the capital rates. Any adjustments to the 90% occupancy threshold would require regulatory revision and, if justified, would be subject to approval in the upcoming Executive Budget cycle. Cost Report Software – DOH reported no significant changes to the upcoming 2021 RHCF software. Release of the software should follow the normal timelines (i.e., April release date with a July submission date), however specific dates were not yet disclosed. Advanced Training Initiative (ATI) – DOH does not expect to fund the ATI program prior to the end of the current state FY (3/31/22). Providers have until 12/31/22 to complete their associated ATI trainings. 2021 ALP Rates – DOH has sent the 2021 minimum wage surveys to ALP Providers, which are due back to DOH by 3/2/22. Once this data is collected and processed, the 2021 ALP rates will then be revised and issued. 2017/18 OMIG Audits – The 2017 MDS audits are nearly complete. OMIG expects to begin the 2018 audit field work mid-late summer. eMedNY Reports – DOH will prompt eMedNY to release calendar year ending 2021 provider remittance reports to better assist members with their annual outside audits. NYSHFA/NYSCAL CONTACT: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

DOH to Release ALP Minimum Wage Survey

NYSHFA/NYSCAL participated on a DOH call earlier this week in which the Department indicated that the 2020/2021 ALP Minimum Wage survey would be released within the next week or two. The survey will ... Read More

2022 Medicare Part B Schedule

Attached is the 2022 Medicare Part B fee schedule, effective 1/1/22 through 12/31/22. To identify the fee amount for your facility, please locate the appropriate CPT/HCPCS code and match it to the respective facility location column. As a reminder ... Read More

PRF Phase 4 Update

HRSA has provided updated information on the PRF Phase 4 and ARP Rural payments. Specifically, responses to the Phase 4 award amounts to-date, additional payment methodology, base payment and bonus payment information, and updates on the provider support timelines (including Phase 3 and expected Phase 4 reconsideration applications). Attached is the complete AHCA summary, which contains various additional informational links related to the Phase 4 update. NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

UPDATED: NYS Medicaid Reimbursement Policy for Administration of COVID-19 Testing and Monoclonal Antibody (mAb) Therapeutic Dispensing or Administration

The New York State Department of Health has updated the following policy and billing guidance documents regarding Medicaid’s reimbursement policy for the administration of COVID-19 Testing and Specimen Collection at Pharmacies, At Home COVID-19 Testing, and COVID-19 Monoclonal Antibody (mAb) Therapeutic Dispensing or Administration at Pharmacies. Read More

Statewide Health Care Transformation Program

The New York State Department of Health (DOH) updated Attachment 1 to the Statewide Health Care Facility Transformation Program III RFA (RFA #18406), on December 15, 2021. Attachment 1 is the Application Cover Sheet and is revised to include all Eligible Applicant provider types, including nursing homes ... Read More

HRSA Distributes Phase 4 PRF Payments

HRSA announced the distribution of $9 Billion in Phase 4 Provider Relief Funding (PRF). The Phase 4 awards will consist of a base payment based on reported revenue and expense changes for the period 7/1/20 to 3/31/21, as well as a bonus payment based on a providers’ level of participation in Medicaid, the Children’s Health Insurance Program and Medicare. Attached is the AHCA overview, including links to the payment methodology, statewide payment breakdown, payment reconsideration webpage for Phase 4 funding and HHS press release. NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

DOH Schedules Additional MLTCP Batch Disenrollment

DOH has scheduled an additional Batch Disenrollment process, which will be effective February 1, 2022.  DOH is requesting nursing homes to provide a list of residents who are designated LTNHS and who have an active discharge plan to the Department by Friday, December 3, 2021.  Below is the DOH notice with further information... Read More

2022 Capital Preview Rates

The 2022 Capital Attestation process has been delayed due to system programming issues that have occurred in transferring the cost report data into the rate setting software. DOH is assuring Providers that the normal Capital Attestation response timeframe will be maintained. Below is the DOH notice with further details...   Read More

Capital Cost Reimbursement Update

As most members are aware, DOH (per regulation) imputes a 90% occupancy requirement to skilled nursing facilities in calculating their capital rate component. The upcoming 2022 capital rate will utilize ... Read More

DOH Monthly Briefing – November 2021

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed: 70/40/5 and 3.5 Minimum Staffing Regulations – DOH expects the final regulations for both the 70/40/5 and 3.5 minimum staffing requirements to be published in the State Register, possibly within the week. Upon publication in the State Register, the draft regulations will be open for a 60-day public comment period. It is anticipated that the published draft regulations will mirror those presented by the DOH at the 10/7/21 Public Health & Health Planning Council meeting. DOH is working on SPA language for the additional $64M funding that was included in the 2021/2022 State Budget to support implementation of the staffing mandates. DOH is not ready to release either the specific 1/1/22 rate methodology for the additional funding or the specific facility rate runs. The Department did not respond to inquiries on whether the 2019 RHCF would be the “test year” to base the initial 70/40/5 staffing requirements. When questioned, DOH acknowledged the anomalies related to COVID during the 2020 RHCF reporting year. Provider Restoration Payments - CMS has approved the additional 1% restoration SPA (which had been previously utilized to fund the Universal Settlement payments.) DOH expects to combine the additional 1% restoration, the “traditional” 1% restoration (which will include the “doubling up” for previous retroactive periods) and the 2020 NHQI into one lump-sum package. The rate package remains under Executive review. Providers should expect issuance by year end. As such, this should result in a 3% lump sum restoration payment (prior to any offset due to NHQI.) 7/1/21 Rates – The 7/1/21 rates have been updated and utilize the 6-month rolling MDS collection period from October 1, 2020 through March 31, 2021 (DAL posted 10/5/21). The payment for the 7/1/21 rates were processed in Medicaid cycle #2304 (check release date 11/3/21). Capital Attestations – DOH expects to commence the capital attestation process in early December. There are currently IT issues with the RHCF software converting to the Rate-Setting system. This also has delayed release of the 11/1/21 notice rates (which contain the initial 1/1/22 capital rate). DOH, per regulation, will continue to impute the 90% occupancy requirement with respect to the capital rates. Any adjustments to the 90% occupancy threshold would require regulatory revision and, if justified, would be subject to approval in the upcoming Executive Budget cycle. 1.5% Transformation Payment – When asked if the transformation payment would continue into 2022, DOH indicated that the current positive 1.5% transformation payment “has not been removed” from the upcoming 2022 rates. No further clarification was given. Cash Receipts Assessment (CRA) – A DAL was issued on 11/3/21, noting that the 2020 CRA rates have been updated and will be processed through EMEDNY in Medicaid cycle #2308 (check release date of 12/1/21). Providers have 30 days to appeal technical corrections to the rates. 2021 ALP Rates – DOH will be sending the 2021 minimum wage surveys to ALP Providers. Once this data is collected and processed, the 2021 ALP rates will then be revised and issued. NYSHFA/NYSCAL CONTACT: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

July 2021 Rate Notice Released

DOH has released a DAL which provides information on the upcoming release of the July 1, 2021 rates.  The rates will include a CMI adjustment based on all MDS assessment data for the time period 10/1/20 through 3/31/21.  The rates are expected to be posted in the near future, and payments will occur in Medicaid cycle #2304 (check release date 11/3/21). NYSHFA/NYSCAL CONTACT: Carl J. Pucci Chief Financial Officer 518-462-4800 x36   Read More

DOH Revises Minimum Wage Survey – Extends Deadline

DOH has revised the 2022 SNF Minimum Wage survey to adapt to recent changes in the NYS labor law. The survey now includes certain upstate areas. The survey deadline has been extended until October 29, 2021. Below is the DOH announcement: “Dear Provider, In light of recent changes to the New York State Labor Law as it pertains to minimum wage, the Department has updated the Nursing Homes Survey. The survey now include areas of the state outside of the five NYC counties, Long Island and Westchester. The link to the nursing homes survey remain the same as in the DAL: https://survey.alchemer.com/s3/6477176/Nursing-Home-Minimum-Wage-Survey-2022  For questions relating to the NH minimum wage survey please send an email to NFrates@health.ny.gov . Please be advised that the due date for the survey has been extended to October 29, 2021. Thank you.” NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

Medicaid Update – September 2021

The Office of Health Insurance Programs of the New York State Department of Health has approved the release of the September 2021 Medicaid Update. Please find the new and improved, interactive issue as a PDF (Portable Document Format) file available to be downloaded at ... Read More

HRSA Phase 4 Distribution Details Released

As announced late last week, HRSA is releasing $25B in its Phase 4 funding distribution of the Provider Relief Fund (PRF). Virtually all Skilled Nursing Facilities and Assisted Living Communities are eligible for Phase 4. The application portal opens on 9/29/21 ... Read More

DOH Monthly Briefing – September 2021

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed: Budget Items
  • Nursing Homes Reform – Internal DOH conversations continue regarding the nursing home reform issues contained in the 2021/22 Executive Budget. Further guidance will be issued.
    • 70/40 Staffing Requirements - NYSHFA once again requested information and updates on the Department’s promulgation of the 70/40 regulations. DOH stated that discussions regarding the 70/40 staffing regulations are currently being held at the Executive level, and thus currently outside of the DOH Rate-Setting division. Accordingly, no further information was given. Although the 70/40 staffing requirements are effective 1/1/22, the 2022 RHCF data utilized for the 70/40 staffing requirement will not be submitted and analyzed until mid to late 2023. As such, financial impacts related to the 70/40 regulations would then be retroactive to 1/1/22.
  • July 2021 Case Mix – DOH has completed its 6-month rolling MDS collection period (Oct 2020 – Mar 2021) utilizing all MDS data points. As you are aware, DOH had advanced this initiative for some time and this rolling collection process will replace the historical 92-day look-back period. As such, NYSHFA has continuously stressed to our members that they treat each MDS as if they were in the historical reimbursement “catchment period.” The 7/1/21 DAL outlined the MDS collection period changes.

NYSHFA has formally requested that DOH defer implementation of the CMI methodology change until January 1, 2022. It is our understanding that the request is presently under consideration by the DOH Executive Team.

  • 1/1/21 Rates – The 1/1/21 rates were revised to reflect the July 2020 MDS submission as well as the 2021 minimum wage add-on (per the 8/19/21 DAL). Operating/Capital rate adjustments should be reflected in Medicaid cycles #2296/2297 (check release dates 9/8/21 and 9/15/21). Present litigation issues have delayed some provider rate postings to the HCS. DOH continues to work on completing rate postings, both to individual providers on the HCS, as well as in aggregate on the DOH website.
  • 7/1/21 Rates – The 7/1/21 rates would include a revised case mix which does utilize the 6-month rolling MDS collection period (as outlined above). The rates are currently under Executive review. Expect issuance sometime during early October (following the normal DOB approval process).
  • Capital Preview Rates – DOH is working to establish a timeframe for the fall issuance of the capital preview rates. DOH, per regulation, will continue to impute the 90% occupancy requirement with respect to the capital rates.
Provider Restoration Payments CMS has approved the additional 1% restoration SPA (which had been previously utilized to fund the Universal Settlement payments.) DOH expects to combine the additional 1% restoration, the “traditional” 1% restoration (which will include the “doubling up” for previous retroactive periods) and the 2020 NHQI into one lump-sum package. The rate package is currently under Executive review. Providers should expect issuance sometime during 4th Quarter 2021. As such, this should result in a 3% lump sum restoration payment (prior to any offset due to NHQI.) NHQI – The 2020 NHQI calculation, utilizing the 2019 MDS data is nearing completion. The normal provider feedback period will occur over the next few weeks. Work will then commence on the 2021 NHQI calculation (utilizing the 2020 MDS data). NYSHFA/NYSCAL CONTACT: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

HHS to Release Additional Provider Relief Funding

HHS will be releasing $25.5B in new Provider Relief Funding (PRF) for healthcare providers affected by the COVID-19 pandemic (including $8.5B for rural providers.) The Phase 4 funding will be based on providers lost revenues and COVID-related expenses for the period 7/1/20 through 3/31/21. The application portal will open on 9/29/21. In addition, HHS is also releasing additional information regarding Phase 3 funding and will offer providers an opportunity for reconsideration should their initial Phase 3 funding be incomplete or incorrect. HHS also is granting an additional 60-Day grace period for PRF reporting obligations (from the initial 9/30/21 deadline.) Below is the announcement that NYSHFA received earlier today with further details. We will also be providing additional information from AHCA as it becomes available. Today, the Biden-Harris Administration announced that the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is making $25.5 billion in new provider relief funding available for healthcare providers affected by the COVID-19 pandemic.  This funding includes $8.5 billion in American Rescue Plan Act (ARPA) resources for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients and $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic. Consistent with the requirements included in the Coronavirus Response and Relief Supplemental Appropriations Act of 2020, PRF Phase 4 payments will be based in part on providers’ lost revenues and coronavirus-related expenditures between July 1, 2020 and March 31, 2021.  As part of the Biden-Harris Administration’s ongoing commitment to equity, Phase 4 will reimburse smaller providers—who tend to operate on thin margins and often serve vulnerable or isolated communities—for their lost revenues and COVID-19 expenses at a higher rate compared to larger providers.  Phase 4 will also include bonus payments based on the amount of services providers furnish to Medicaid/CHIP and Medicare patients, who tend to be lower income and have greater and more complex medical needs.  HRSA will price these bonus payments at the generally higher Medicare rates for Medicaid/CHIP patients to ensure equity for those serving low-income children, pregnant women, people with disabilities, and seniors.  Similarly, HRSA will make ARPA rural payments to providers based on the amount of Medicaid/CHIP and Medicare services they provide to patients who live in rural areas as defined by the HHS Federal Office of Rural Health Policy.  As rural providers serve a disproportionate number of Medicaid/CHIP patients, rural patients have disproportionately greater and more complex medical needs, and rural communities have been hit particularly hard by the pandemic, the ARPA rural payments will also generally be based on Medicare reimbursement rates.  In order to expedite and streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application.  The application portal will open on September 29, 2021.  To promote transparency in the PRF program, HHS is also today releasing detailed information about the methodology utilized to calculate Phase 3 payments.  Providers who believe their Phase 3 payment was not calculated correctly according to this methodology will now have an opportunity to request a reconsideration.  Further details on this Phase 3 reconsideration process are forthcoming.  Additionally, in light of the challenges providers across the country are facing due to recent natural disasters and the Delta variant, HHS is announcing today a 60-day grace period to help providers come into compliance with their PRF reporting obligations if they fail to meet the September 30, 2021 deadline for the first PRF Reporting Time Period.   While the deadlines to use funds and the Reporting Time Period will not change, HHS will not initiate recoupment or similar enforcement actions for noncompliant providers during this grace period. For more information about eligibility requirements, the documents and information providers will need to complete their applications, and the application process for Phase 4 and ARPA Rural payments, visit: https://www.hrsa.gov/provider-relief/future-payments NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

Medicaid Update – August 2021

The Office of Health Insurance Programs of the New York State Department of Health has approved the release of the August 2021 Medicaid Update. Please find the new and improved, interactive issue as a PDF (Portable Document Format) file available to be downloaded at ... Read More

SNF 2022 PPS Final Rule

As announced last Friday, CMS has issued the final rule for SNF Prospective Payment System (PPS) for Fiscal Year 2022. Highlights of the rule include ... Read More

CMS Issues FY 2022 SNF Final Payment Rule

Please see announcement of the 2022 SNF Final Payment Rule. AHCA and NYSHFA will provide an-in depth review of the Rule early next week. Today, the Centers for Medicare & Medicaid Services (CMS) issued the final rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2022 update. We are still analyzing the rule, but upon initial review, highlights are:
  • Market Basket update is 1.2 percent based upon updated data resulting in $411 billion in additional SNF funds in FY 2023.
  • CMS will not implement any PDPM payment model parity adjustment in FY 2022. After consideration of stakeholder feedback, the agency determined that there is currently inadequate data. This issue and whether there will be any delay or phase in necessary will be revisited in next year’s FY 2023 proposed rule.
  • SNF QRP: CMS finalized the following measure changes as proposed.
    • New: SNF Healthcare-Associated Infections Requiring Hospitalization Quality Measure Beginning with the FY 2023 SNF QRP.
    • New: COVID-19 Vaccination Coverage among Healthcare Personnel Measure Beginning with the FY 2023 SNF QRP.
    • Revised: Transfer of Health Information to the Patient – Post-Acute Care Measure Beginning with the FY 2023 SNF QRP.
  • SNF VBP: CMS finalized the updated VBP policies as proposed.
    • SNFs with a low-volume (<25 eligible stays) in FY 2020 will receive no payment adjustment, while all others will receive a 0.8 percent payment reduction.
AHCA/NCAL will conduct a more in-depth review and share any further details and/or resources to assist members in the coming days. Until then, if you have any questions, please contact Mike Cheek. NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

MLTC to FFS Transition Update

DOH is once again conducting a “Batch Process” disenrollment to continue implementation of the MLTC to FFS implementation process. DOH is requesting that providers transmit a listing of residents who are designated L-T Nursing Home Stay (LTNHS), are enrolled in an MLTC plan, and who have an active discharge plan to transition to the community. The list must be submitted to DOH no later than Friday, August 6, 2021. This additional batch process will disenroll residents now meeting the above criteria that were not included in the previous disenrollment periods which have occurred. These newly disenrolled members will be converted to Medicaid FFS, effective October 1, 2021. Attached is the DOH DAL with further information. Also attached below are supporting file documents to be utilized in support of the resident listing to be provided to DOH.   Questions should be emailed to DOH.sm.MLTCNH@health.ny.gov. NYSHFA/NYSCAL CONTACT: Carl J. Pucci Chief Financial Officer 518-462-4800 x36   Read More

DOH Monthly Briefing – July 2021

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed: Budget Items
  • Nursing Homes Reform – Internal DOH conversations continue regarding the nursing home reform issues contained in the 2021/22 Executive Budget. Further guidance will be issued.
 
    • 70/40 Staffing Requirements - NYSHFA has repeatedly requested information and updates on the Department’s promulgation of the 70/40 regulations. A representative from the DOH stated that the 70/40 staffing regulations are currently being developed and the State expects to issue draft regulations during the last two weeks in August, followed by a 60-day public comment period. Although the 70/40 staffing requirements are effective 1/1/22, the 2022 RHCF data utilized for the 70/40 staffing requirement will not be submitted and analyzed until mid to late 2023. As such, financial impacts related to the 70/40 regulations would then be retroactive to 1/1/22.
 
  • July 2021 Case Mix – DOH has issued guidance for its 6-month rolling MDS collection period (Oct 2020 – Mar 2021) utilizing all MDS data points. As you are aware, DOH has been advancing this initiative for some time and this rolling process will replace the historical 92-day look-back period. As such, NYSHFA has continuously stressed to our members that they treat each MDS as if they were in the historical reimbursement “catchment period.” The 7/1/21 DAL outlined the MDS collection period changes. Members should be reviewing their census data currently, as all changes are due by 7/23/21. Final MDS certifications are due by 7/30/21. The DOH webinar held last week and related Q&A’s will be posted to both the HCS and he DOH website in the near future.
 
  • 7/1/21 Rates – Following completion of the MDS collection period (see above) the 7/1/21 rates will be immediately developed. Expect issuance sometime during mid to late September (following the normal DOB approval process).
Provider Restoration Payments CMS has approved the additional 1% restoration SPA (which had been previously utilized to fund the Universal Settlement payments.) DOH expects to combine the additional 1% restoration, the “traditional” 1% restoration (which will include the “doubling up” for previous retroactive periods) and the 2020 NHQI into one lump-sum package. Providers should expect issuance sometime during 4th Quarter 2021. As such, this should result in a 3% lump sum restoration payment (prior to any offset due to NHQI.) 2020 RHCF Deadline Extended The deadline for the 2020 RHCF has been extended to Friday, August 20, 2021. In order to ensure sufficient time to complete the necessary reviews for the capital attestation process, there will be no further extensions beyond that date. Members should ensure appropriate access and active connection to the HCS prior to submitting the RHCF and applicable certifications. NHQI The 2020 NHQI calculation, utilizing the 2019 MDS data is nearing completion. The normal provider feedback period will occur over the next 4 – 6 weeks. Work will then commence on the 2021 NHQI calculation (utilizing the 2020 MDS data). Residual Equity With the conclusion of the litigation, DOH will be restoring residual equity for the named litigants for the period 4/2/20 through 10/7/20. Effective 10/8/20, going forward, the residual equity will then be removed from the rates. The rate package will then move on to DOB for approval. OMIG MDS Audits OMIG confirmed that the 2016 MDS audits are now complete. OMIG has a majority of 2017 MDS audits currently in fieldwork and nearing their exit conferences. NYSHFA/NYSCAL CONTACT: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

MDS Collection – July 2021 Slide Deck

The NYS DOH held a webinar on Wednesday, July 7 regarding changes to the MDS collection period. Key points are listed below. See slides attached. These slides as well as the Q & A from the webinar will also be posted on the HCS ... Read More

PRF Reporting Portal Open

The Provider Relief Fund (PRF) Reporting Portal is now open for reporting fund usage for the period from 4/10/20 through 6/30/20. Providers receiving payments in excess of $10,000 during this time period have until September 30, 2021, to submit their initial report. HRSA has scheduled a webcast for next Thursday, 7/8/21 at 3:00 pm to provide technical assistance on the reporting requirements. Attached is the AHCA summary which includes updated PRF reporting requirements, Data entry workbook, FAQs, Information user guide and Registration user guide. NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

2022 Mortgage Database Review

DOH is requesting that providers review the database of reimbursed mortgage and bond issuances in advance of issuing the 2022 Capital Preview rates. Attached is the DAL and applicable database form which should be utilized only if applicable to your facility. The mortgage database information is due by COB Friday, July 16, 2021. NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

Case Mix Regulations Adopted

Regulations were published in today’s State Register authorizing DOH to change the Case Mix acuity process for all nursing homes. DOH will utilize a rolling MDS collection period (October 2020 – March 2021) for the upcoming Case Mix adjustment to the July 1, 2021 rates that will capture all MDS assessments completed during that six-month period. This replaces the historical 92-day lookback snapshot methodology. In addition, the regulations specify the following:
  • Going forward, October – March will be the collection period utilized for the July Case Mix Adjustment, and April – September will be the collection period utilized for the January Case Mix adjustment.
  • The temporary 5% CMI Cap provision will be repealed. That provision had limited any upward or downward CMI adjustments to 5% pending an audit but now DOH acknowledges that this had caused delays of more than three years before rates were finalized. (Note: this does not eliminate or reduce OMIG’s authority to audit MDS data).
NYSHFA has raised concerns that the new methodology has not been approved by CMS. In response, DOH believes that CMS will approve the associated SPA in time for the regulations to be implemented, and accordingly, has determined no changes to the regulation are necessary. NYSHFA will continue to monitor this issue. It is expected that DOH will issue a DAL with additional MDS submission requirements and timelines prior to the July 1,2021 rate issuance. NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

DOH Releases 2020 RHCF Software

DOH has released the 2020 RHCF Cost Report software on the HCS. Attached is the DAL with further details. Members should ignore the DAL reference to an attached schedule, as DOH has acknowledged this was in error. Note: the RHCF filing deadline is Tuesday, July 20, 2021. NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

DOH Monthly Briefing – May 2021

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed: Budget Items
  • Nursing Homes Reform – internal conversations continue regarding various nursing home reform issues contained in the 2021/22 Executive Budget. Further guidance will be issued.
  • July 2021 Case Mix – DOH will be issuing regulations for its 6-month rolling MDS collection period (Oct 2020 – Mar 2021) utilizing all MDS data points. As you are aware, DOH has been advancing this initiative for some time and this rolling process will replace the historical 92-day look-back period. As such, NYSHFA has continuously stressed to our members that they treat each MDS as if they were in the historical reimbursement “catchment period.” DOH will issue a formal notice of this change to providers prior to July 1, 2021.
January 2021 Case Mix The current MDS certifications are due this Friday, May 14, 2021. A large number of providers have yet to certify their MDS submissions. A digital certification is needed to set the Medicaid rates and should be submitted to MDSBRHCR@health.ny.gov. DOH will break the rates into two separate packages, if needed, in order to process the 1/1/21 case mix adjustment. Facilities who are not certified may fall into the second rate package and could face a delay in their 1/1/21 revised rates. Additional 1% Restoration DOH continues work to advance the State Plan Amendment for the additional 1% restoration. A financing package has been sent to DOB for their approval. Upon approval, funding would be via a lump-sum payment vs. rate adjustment. NYSHFA will provide further details once DOH finalizes the payment methodology. 2020 RHCF Deadline DOH anticipates release of the RHCF software within the next two weeks and will provide a 60-day response time for filing. Further details via a DAL will be forthcoming. OMIG MDS Audits OMIG confirmed that the 2016 MDS audits are now complete. OMIG has a majority of 2017 MDS audits currently in fieldwork and nearing their exit conferences. ADHC – 2020 Reporting Requirements With ADHC closures on 3/18/20 due to COVID, NYSHFA requested guidance on the 2020 census reporting requirement. DOH will review internally and respond at a later date. NYSHFA/NYSCAL CONTACT: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

CMS to Re-release Medicare Advantage Disenrollment Guidance

CMS will be re-releasing guidance for SNF’s regarding resident disenrollment from Medicare Advantage Plans, initially released in 2015. Attached is AHCA’s bulletin which includes a summary of the initial guidance. AHCA will also develop a webinar and template to capture any additional information that is released. NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

CMS Issues FY 2022 Proposed Payment Rule

CMS has issued the 2022 SNF Prospective Payment Rule, which when finalized in the upcoming months, will become effective on 10/1/21.  The Proposed Rule included a market basket increase of 1.3% (approximately $444M nationwide).  Members should note the Proposal’s possible adjustment/recalibration of the PDPM Model due to increased spending since its enactment on 10/1/19.  (See the AHCA summary link ppgs 6-8) in the attached overview of the Proposed Rule.  AHCA/NYSHFA will keep members updated throughout the upcoming CMS comment period as the Proposed Rule is finalized. NYSHFA/NYSCAL CONTACT: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

DOH Monthly Briefing – March 2021

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed: January 1, 2021 Rates (Capital Only) The 1/1/21 Capital rates will be updated and adjustments will be in upcoming Medicaid cycle #2273 (check release date of 3/31/21) (attached is the DAL). The July 2020 MDS timeline (which will adjust the case mix for the upcoming 1/1/21 operating rates) has yet to be determined. DOH is testing the validity of MDS submissions to CMS during the May to July 2020 catchment period prior to issuing the submission timeline. Advanced Training Notice (ATI) The ATI payments will now be issued in upcoming Medicaid cycle #2272 (check release 3/24/21) vs. originally scheduled Medicaid cycle #2273 (3/31/21). Additional 1% Restoration DOH continues work to advance the State Plan Amendment for the additional 1% restoration. A financing package has been sent to DOB for their approval. Upon approval, funding would be via a lump-sum payment vs. rate adjustment. NYSHFA will provide further details once DOH finalizes the payment methodology. 2020 RHCF Deadline DOH anticipates release of the RHCF software in early May with a 90-day turnaround for filing, most likely in mid-July. Further details will be announced at a later date. 2017-19 Rate Appeals The rate appeals for 2017-19 are approved and will be slated in an upcoming Medicaid cycle to be announced. Both capital and operating appeals will be processed, subject to the statewide budgetary appeals cap. DOH will separately notify facilities whose rates are impacted by the appeal changes. OMIG MDS Audits OMIG confirmed that the 2016 MDS audits are now complete. OMIG has a majority of 2017 MDS audits near completion (i.e., exit interview stage) as well as a number of facilities either under way or pending notification. NYSHFA/NYSCAL CONTACT: Carl J. Pucci Chief Financial Officer 518-462-4800 x36 Read More

DOH is continuing its efforts to transition designated MLTC plan residents to Fee for Service (FFS). Previously, DOH had conducted a “batch process” disenrollment (June 2020 and September 2020). Today, DOH announced a third batch ... Read More

DOH Monthly Briefing – January 2021

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed:  January 1, 2020 Rates (Revised) The revised 1/1/20 rates, which will contain the updated case mix reflecting the 7/31/19 census picture date, are moving through executive review. Once the 1/1/20 rates are approved, the 4/1/20 rates will automatically be updated as well as for case mix. July 1, 2020 Rates The 7/1/20 rates will be finalized now that the January 2020 MDS collection process has been completed. The goal is to release the 7/1/20 rates by the end of the state fiscal year (3/31/21). January 1, 2021 Rates  There were no updates regarding revisions to the initial 1/1/21 rates. DOH was uncertain when the July 2020 MDS submission process would begin, which would affect the case mix adjustment to the 1/1/21 rates. Since the above noted 7/1/20 rates will be the priority during first quarter 2021, the revised 1/1/21 rates most likely will be delayed until at least the second quarter 2021.  Additional 1% Restoration DOH is working to advance the State Plan Amendment for the additional 1% restoration. A financing package has been sent to DOB for their approval. Upon approval, funding would be via a lump-sum payment vs. rate adjustment. NYSHFA will provide further details once DOH finalizes the payment methodology. Advance Training Initiative (ATI) NYSHFA once again requested information with respect to future ATI funding opportunities. The ATI training initiative survey package is being finalized which will call for training proposals as in previous years. DOH is expected to release a DAL to providers that qualify for ATI funding within the next week or so, and indicated there will be a short turnaround time allowed for eligible providers to complete their training survey. NYSHFA has also requested a facility-specific data summary of eligible providers, which DOH agreed to provide. 2% Quality Penalty (QP) The 2% QP is moving through DOB, however, no timetable was given with respect to issuance. Once finalized, those providers affected will see an adjustment retroactive to their 1/1/20 rates. OMIG MDS Audits OMIG confirmed that the 2016 MDS audits are now complete. OMIG has a majority of 2017 MDS audits near completion (i.e., exit interview stage) as well as a number of facilities either under way or pending notification. NYSHFA/NYSCAL CONTACTS: Carl J. Pucci Chief Financial Officer 518-462-4800 x36   Read More

2021 Medicare Part B Schedule

Attached is the 2021 Medicare Part B fee schedule, effective 1/1/21 through 12/31/21. To identify the fee amount for your facility, please locate the appropriate CPT/HCPCS code and match it to the respective facility location column. Read More
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