DOH Rate-Setting Update

Carl Pucci in Finance & Reimbursement

DOH conducted its monthly rate-setting update earlier this week. The topics discussed included the following:

2015 Rates (7/14 CMI)

The January 2015 rates, which are being revised to incorporate the July 2014 case mix, are being sent to Division of Budget (DOB) within the next two weeks. Estimated processing through eMedNY should be in mid-to late June.

Case Mix Audits

The 2012 OMIG audits affecting the July 2012 and January 2013 rates are now complete and being sent to DOB. Expected payment adjustments (including the lifting of the 5% CMI cap for clean 2012 audits) should again be mid- to late June.

The 2013 OMIG audit data has now reached Department of Health (DOH) rate setting, who will analyze prior to sending to DOB.

Quality Pool

2013 Quality Pool has been approved by DOB and is being sent to eMedNY. We are awaiting the cycle number from DOH. Work continues on the 2014 Quality Pool, which has been approved by CMS.

Cash Receipts Assessment (CRA)

Work is being completed on the 2013 CRA. Rate setting will be sending to DOB, and will inform the associations of a cycle number once rates are approved. Facilities will remain on the 2010 CRA base (i.e., payment per diem) through 2014 and 2015 (both 2014 and 2015 will be reconciled individually as the data becomes available). Beginning in 2016, the base will be updated to the most recent year reconciled (ie: 2013), which should smooth out reconciliation impacts.

Universal Settlement (US)

Please refer to yesterday’s member mailing for update.


CMS has requested additional information, and has specific questions as to the extent of benefit residents would experience with a state takeover of NAMI collections. NYSHFA will continue to assist DOH in providing information to CMS to support this important initiative.

Capital Streamlining

A meeting has been set to discuss the capital streamlining policy, including the capital calculation override process, CPA certification attestation, and OMIG compliance guidelines for facilities.

Shared Savings

A meeting has been set to discuss various statues, DOH proposals, policies, eligibility, etc. This proposal requires CMS approval. More details to follow as the DOH workplan is rolled out.

eMedNY Initiative

Multiple discussions with NYSERDA have taken place in order to move the initiative forward. An energy audit pilot program is expected to encompass approximately six months from start to finish. The 2015/16 Executive Budget does contain start-up funding.


The Advanced Training initiative ($46M) work is underway, with specific qualifications being defined. DOH will seek edits to various cost report schedules (i.e., Schedule P-Staffing), as needed to develop qualifications.

NYSHFA will keep members informed of these issues as they develop.


Carl J. Pucci
Director, Finance & Reimbursement
518-462-4800 x36