DOH Monthly Briefing – November 2025
DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed:
1/1/2026 Notice Rates
The corrected 1/1/26 notice rates were posted on the Health Commerce System (HCS) application (Healthcare Financial Data Gateway) under the heading of “2026 Notice Rates” on November 3, 2025.
The all-inclusive rates provided on the Gateway include the following components:
- Operating Component: The non-specialty rates reflect the pricing methodology as prescribed by Title 10, Part 86-2.40 of the Commissioner’s Administrative Rules and Regulations. The 2026 minimum wage adjustments will be added prospectively.
- Capital Component: The capital component of the 2026 notice rates is based upon the facility’s 2024 certified cost report, as well as the latest approved financing arrangements. The 5% and additional 10% reductions implemented with the State Fiscal Year 2021-22 and 2024-25 Enacted Budgets are now incorporated into the capital schedule at the bottom labeled “Total (95%) and Total (Additional 10% Reduction), respectively.”
The annual capital attestation filing is due by COB Wednesday, 12/3/25. All facilities are required to submit an attestation.
Federal Share of $285M Rate Increase
The federal share of one-time investments was recently approved by CMS. The state share of the additional $285m increase to nursing homes enacted in the 2024/25 Budget was processed in Medicaid cycle #2458 (check release date 10/16/24). DOH announced that the federal share of the $285M will be included in Medicaid cycle #2517 (check release date 12/3/25). See attached 11/12/25 DAL with further information. DOH noted that the ALP component was fully paid this past spring, as CMS had approved the related SPA much earlier.
The 2025-26 State share of one-time investments is contingent on the MCO Tax (see below).
MCO Tax
DOH’s Executive staff are reviewing the November 14th CMS Guidance letter as noted in yesterday’s NYSHFA member mailing. CMS’ letter included timelines for closing certain MCO provider tax loophole provisions. New York’s state fiscal year (SFY) runs from April 1st till March 31st. New York allocated $440M in SFY 2025-26 and $385M in SFY 2026-27 from its MCO tax for nursing homes; and $15M in SFY 2025-26 and $15M in SFY 2026-27 from its MCO tax for assisted living program providers. CMS’ letter is promising in that (1) the language of the preliminary guidance letter seems to keep the SFY 2025-26 MCO tax funding intact; and (2) CMS’s letter further states that the 2026 date “is the minimum transition period that may be available,” and that additional time may be provided to states (up to the 3 fiscal year maximum allowed under OBBBA) depending on the language that is ultimately included in CMS’ final rule. NYSHFA is continuing to work with AHCA and New York’s congressional delegation on this matter and will provide updates as the issue progresses.
Case Mix Freeze
The final enacted State Budget froze the case mix date effective July 1, 2023 until full implementation of the PDPM case mix methodology is developed. The SPA was approved by CMS, effective April 1, 2024. NYSHFA successfully obtained a stipulation of settlement with DOH and the Attorney General’s office to recalculate and pay the Medicaid rates from 1/1/24-3/31/24 with a case mix adjustment based on the MDS submissions for the period from 4/1/23-9/30/23 as required by law in effect at the time. The calculations have been completed and are expected to be paid by 12/31/25. The settlement will be for NYSHFA members who participated in the lawsuit.
PDPM
Myers and Stauffer are now analyzing the quarterly MDS data set from July – September 2025. DOH reported positive results in analyzing this data, and can now review all scoring and weighting options for the PDPM transition. DOH and Myers and Stauffer will reconvene with NYSHFA as soon as the revised data model becomes available.
ATI
DOH announced that the annual ATI survey will be released in the upcoming weeks, and will include additional training options.
Appeals
The second stage of historic appeals have been processed and are in executive review.
NHQI
DOH is planning on updating the NHQI data within the next few weeks.
MDS Audits
OMIG reported that the 2018 MDS audits for all statewide regions are complete. The 2019 audits will be focused on the Central New York region.
NYSHFA | NYSCAL CONTACTS:
Stephen B. Hanse, Esq.
President & CEO
518-462-4800 x.11
Carl J. Pucci
Financial Consultant
518-462-4800
Kristin A. DeVries, MA, MPP
Director of Government Relations
518-462-4800 x.14
