DOH Monthly Briefing – July 2025

DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed:

1/1/2025 Notice Rates

The revised 1/1/25 rates are posted on the Health Commerce System (HCS) application (Healthcare Financial Data Gateway) under the heading of “2025 Initial NH Rates”.

The all-inclusive rates provided on the Gateway will be processed in Medicaid rate cycle #2499 (check release date 7/30/25), and 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, with the 2025 minimum wage adjusted to $16.50 per hour in NYC, Nassau, Suffolk, and Westchester regions and $15.50 per hour for the remainder of the state.
• Capital Component: The capital component of the 2025 notice rates is based upon the facility’s 2023 certified cost report, and reflects accepted attestations received during the preview period. 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.

The deadline to file a rate appeal is 10/24/25.

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 has provided a link to the CMS SPA in response to provider’s detailed questions. NYSHFA is working with our congressional delegation and has submitted a letter to CMS seeking expedited SPA approval of the required federal share of Medicaid funding.

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 will be completed by 9/30/25 and paid by 12/30/25. The settlement will be for Petitioner’s who participated in the lawsuit.

Managed Care Organization (MCO) Tax

NYSHFA has been actively working with New York’s Republican Congressional Delegation with regard to securing support for the maximum three fiscal year transition period allowed for in the “One Big Beautiful Bill” for New York’s MCO tax before it is eliminated pursuant to the provisions of the “One Big Beautiful Bill.” A three fiscal year transition period would enable providers to secure the full amount of the Medicaid funds allocated for providers under the MCO Tax in SFY 2025-26 and SFY 2026-27. To this end, attached, for your information, is a copy of a letter Rep. Lawler delivered today to Secretary Kennedy and Administrator Oz at NYSHFAs request seeking the full three-year transition period as allowed by the law.

Additionally, NYSHFA recently submitted comments (see attached) to Dr. Oz, CMS Administrator, regarding CMS’s proposed rule concerning MCO taxes. Specifically, NYSHFA has requested that New York be granted at least a two-year transition period to secure the full amount of Medicaid funds allocated for providers under the MCO Tax in SFY 2025-26 and SFY 2026-27.

PDPM

DOH is scheduling internal conversations by EOM, and then will follow-up with the Associations to discuss next steps and areas of collaboration. MDS data is being analyzed to ensure consistency. DOH had no response regarding the status of the three additional MDS data elements that were required effective 6/1/25.

2024 RHCF Software

The revised 2024 RHCF software on the Health Commerce System (HCS) corrected a minor system issue with schedule 17 (part III). The filing deadline is Thursday, July 31, 2025.

2024 Appeals

The 2024 appeals are currently under executive review. DOH anticipates final processing to occur sometime during the fourth quarter of 2025.

2025 Benchmark Rates

The Benchmark rates will be updated as soon as the 2023 CRA updates are complete (see below). This will avoid a subsequent Benchmark rate update occurring within a very short period of time.

2023 Cash Receipts Assessment (CRA) Reconciliation

DOH has completed its data work and is in final executive review prior to being issued.

2023/24 2% Penalty

The processing of the updated 2% penalties for 2023/24 rates will take place in Medicaid cycle #2498 (check release date 7/23/25). DOH released a DAL on 7/11/25 which revised the 30-day appeal filing due date to 8/10/25.

2024/25 IGT Letters

DOH did not give a timetable for release , as IGT is currently under review. The normal IGT communication process with facilities will occur once approved.

MDS Audits

OMIG reported that the 2018 MDS audits for all statewide regions are complete. The 2019 audits are now underway in Queens and shortly will commence in the Rochester and Syracuse areas.

NYSHFA | NYSCAL CONTACT:

Stephen B. Hanse, Esq.
President & CEO
518-462-4800 x.11

Carl J. Pucci
Financial Consultant
518-462-4800

Kristin A. DeVries, MA, MPP
Director of Government Relations
518-462-4800 x.14