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
