DOH Monthly Briefing – March 2025
DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed:
PDPM Transition Update
DOH is undergoing preliminary stage work and has contracted with Myers & Stauffer (M&S) to provide data collection and analysis, impact modeling, and outreach training, among other things. A 5-year contract between the DOH and M&S was approved on 7/29/24 with DOH for $31,875,000 through 4/14/29.
NYSHFA inquired about shared data analysis and modeling efforts and initiatives and requested the opportunity to meet with DOH and M&S as soon as possible, which DOH had committed to. As a result of this request, NYSHFA and other associations met with DOH and M&S on 10/30/24. At this meeting, initial groundwork and implementation plans were discussed. M&S will be utilizing the 2022 RHCF data to develop the transition to PDPM. M&S discussed potential phase-in approaches (either via a plus/minus corridor, or a gradual blending of old/new Medicaid rates). M&S projects a Fall 2025 timeline for completion.
DOH has received approval of the Data Use Agreement (DUA) from CMS and data analysis is now ongoing. Next steps regarding the transition will be outlined in a formal update and shared with the associations in the near future. DOH then anticipates a follow-up discussion with stakeholders and again reiterated their commitment to ongoing collaboration during the transition to PDPM. When questioned regarding meeting the potential timeline for PDPM transition, DOH deferred to the upcoming update, which will provide further guidance on timing of the transition.
NYSHFA had previously expressed its concerns to the Executive and DOH regarding the State’s transition to PDPM. Additionally, among other things, NYSHFA sent a letter to the Commissioner of Health on 8/22/24 outlining NYSHFA’s issues and concerns regarding the State’s transition to PDPM.
Case Mix Freeze
The final enacted State Budget froze the case mix date effective July 1, 2023 until full implementation of the PDPM case mix methodology is developed. The SPA was recently approved by CMS, effective April 1, 2024. NYSHFA is litigating this matter.
2024 Capital Appeals
The 2024 Capital appeal rate package is nearing completion and should be released in the near future.
1/1/2025 Notice Rates
The notice rates are posted on the Health Commerce System (HCS) application (Healthcare Financial Data Gateway) under the heading of 2025 Notice Rates.
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 2025 minimum wage adjustment will be added prospectively.
- Capital Component: The capital component of the 2025 notice rates is based upon the facility’s 2023 cost report, as well as the latest approved financing arrangement(s).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).”Additionally, residual equity is no longer included in the capital rates.
- DOH noted that updates to the initial 1/1/25 rate package are complete and are now under executive review.
Federal Share of one-time investments
The federal share of one-time investments is still pending CMS SPA approval. 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 noted that CMS is currently not “taking meetings” and that the SPA approval process has slowed due to the federal legislative changes that have occurred. DOH has provided a link to the CMS SPA in response to provider’s detailed questions.
2024/25 2% Supplemental Payment
The 2% supplemental payment ($140M) will be processed in upcoming Medicaid cycle #2481 (check release date 3/18/25). The supplemental payment is subject to recoupment for any provider liabilities to the state. A reminder that the 2% supplemental payments are not subject to the cash receipts assessment.
Managed Care Organization (MCO) Tax
The MCO tax approved in the FY2024-25 Enacted State budget will require additional legislation to effectuate the allocation of these monies toward the State’s Medicaid spending. DOH indicated that this is being discussed in the context of the FY2025-26 State Budget negotiations. The legislative language from last year’s State Budget only called for the authorization to tax MCOs and did not include an allocation plan. The MCO tax is now in the early stages of legislative negotiation.
2023 Cash Receipts Assessment (CRA) Reconciliation
DOH has completed its data work and should be releasing the 2023 CRA reconciliation in the very near future.
2023 Nursing Home Quality Pool (NHQP)
The results of the 2023 NHQP have been finalized. A DAL was issued to providers on 1/2/25, which provided their specific Nursing Home Quality Initiative Results. DOH will also be posting the results to its website once the data file is publicly available.
MDS Audits
OMIG reported that the 2018 MDS audits for all statewide regions are complete. There were 214 summation letters, 2 terminations, and 113 final audits completed. OMIG anticipates approximately 255 NH MDS audits for 2019, which are underway in the Capital District, Buffalo, North Country, Westchester, and NYC regions.
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
