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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).


Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

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