DOH Releases MLTC to FFS Transition Guidance

Carl Pucci and Allison Gold in Finance & Reimbursement

DOH has released a DAL, “Changes in Enrollment into MLTCP and Benefit Announcement” letter outlining the transition from MLTC to FFS, as originally announced in last week’s DOH Monthly Update.

Following CMS’ approval to limit the nursing home MLTCP Plan Benefit to three months for long-term nursing home stays (LTNHS), DOH is requiring the following:

Providers must transmit a list of all residents who are designated as long-term nursing home stays (LTNHS), are enrolled in an MLTCP Plan, and have an active discharge plan to transition to the community to DOH no later than January 28, 2020.

The list should include the following:

  • Name of nursing home
  • Facility contact (name, telephone, email)
  • Transitioning residents name
  • CIN (Client Identification Number)
  • Date of LTNHS designation
  • Name of resident’s MLTCP Plan 

The list of residents with an active discharge plan must be transmitted through the HCS using MLTC Nursing Home shared mailbox by 1/28/20. 

Questions should be emailed to MLTCNH@health.ny.gov. Please also cc the NYSHFA contacts below as NYSHFA will accumulate member questions and concerns for DOH feedback throughout the FFS transition process.

NYSHFA/NYSCAL CONTACTS:

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

Allie Gold, Esq.
Director of Policy & Reimbursement
518-462-4800 x25

DOH Suspends CMI Recoupments

Carl J. Pucci and Stephen Hanse in Finance & Reimbursement

Following up on our meeting yesterday with the State regarding our preliminary injunction, NYSHFA is pleased to report that recoupments have been suspended for provider adjustments associated with the recently released July 1, 2019 rates. Managed Care plans have also been notified that the recently released July 1, 2019 benchmark rates have been removed from the Department of Health website until further notice. Consistent with past practice, the Department will be releasing a Dear Administrator Letter providing notice to nursing homes regarding the timeline for calculation of new July 1, 2019 rates using the prior Case Mix calculation methodology.

Attached is the DOH notice.

NYSHFA/NYSCAL CONTACTS:

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

Stephen B. Hanse, Esq.
President & CEO
518-462-4800 x11

DOH Issues 2019 CRA Rates

Carl J. Pucci in Finance & Reimbursement

DOH has released a DAL which revises the 1/1/19 rates to reflect the actual 2018 Cash Receipts Assessment liability. The 2019 CRA will be effective in upcoming Medicaid cycle #2201 (check release date 11/13/19).

NYSHFA/NYSCAL CONTACT:

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

eMedNY Billing Edit is Removed

Stephen Hanse and Carl Pucci in Finance & Reimbursement

Following NYSHFA discussions with DOH earlier this week, eMedNY has removed the multiple claim submission edit, effective 5/1/19 (see attached). NYSHFA had relayed numerous member concerns regarding the edit to DOH. Any claims that may have been denied from ...

DOH update on the April 2018 MDS Case-Mix Data Collection

Carl J. Pucci and Nancy Leveille in Finance & Reimbursement

NYSHFA participated in a call with the DOH this afternoon, September 26, 2018, following our Town Hall meeting this morning with SNF members. The Department validated the key points discussed on our agenda items from this morning. They are as follows:

On September 17th the DOH issued a DAL stating that it will be collecting MDS data for three census dates (January 25, April 25, 2018 & July 25, 2018) for the January 1, 2019 rates. This initiative is a result of the 2018-19 Enacted State Budget initiative to “rationalize nursing home case mix increases.” Within the 2018-19 Enacted State Budget, the State scored this plan at a $15M all-funds savings. As such, the DOH will be promulgating a methodology in the near future that will be utilized to secure no more than $15M in CMI savings. These funds will be collected in the first quarter of 2019 through the January 1, 2019 rates.

Therefore, the calculations that SNF have been conducting on their MDS scores during the April 25 census date period are very important to review, but the DOH is only looking at this time to capture the $15M that was enacted with the 2018 NYS Budget. They will be determining how to pull the $15M from this period from all SNF collectively.

Their intention is not to bankrupt any SNF, but just to meet the requirement of this year’s budget.

As we have discussed previously with members, DOH is allowing up until Thursday, September 27, 2018 to correct any MDS that may have errors in them for the April 25th census date period. If you have corrections, they need to be submitted as you normally do to CMS. These are corrections that may include missing a diagnosis, treatments, MD orders etc. that were not noted in your original submitted MDS to CMS for that resident. You must follow the directions for corrections noted in the MDS RAI manual Chapter 5 Section 5.7. Additionally, please note the Modification Request Section in Chapter 5 starting on page 5-11 related to the Assessment Reference Dates(ARD). There are very specific limitations for ARD.

The DOH is freezing the MDS data submitted for the census collection date of April 25, 2018 by September 28, 2018 for the purposes of the Medicaid rate setting for this year. Therefore, even though a SNF has the ability to correct MDS or submit missed MDS over a 3-year period, the data collected for the April 25 date is for NYS rate setting purposes and thus are freezing the data for that reason.

If a SNF missed submitting an MDS for a resident, they can submit a late MDS to CMS, but that MDS must begin on the current date that you noted the assessment was missed. Therefore, you cannot set an ARD back to before the April 25, 2018 time period. Consequently, if you missed one, you must start it on the current date. This is also outlined in the MDS RAI manual.

DOH will not take phone calls requesting changes to a SNF’s case mix at this time. They are going to review the data that is submitted through the normal process: whereby MDS’ are transmitted to CMS and then sent from CMS to the DOH.

NYSHFA also recommended to members this morning, the need to review each MDS before it is submitted to ensure that they are as accurate as possible. NYSHFA encourages SNF to consistently run each residents MDS’ RUG score, prior to submission, to validate you are capturing all the services you provided, not just during the case mix census date timeframes. 

Tomorrow, we will send out via e-mail the taped version of our EXTRA SNF member only Town Hall Meeting from this morning and any additional information we discussed. If you were unable to connect earlier, you will have the ability to listen to the presentation. Our regularly scheduled Town Hall Meetings are on the third Thursday of each month at 11:00 am. NYSHFA sent out the calendar in August for the fall schedule and we email you the Tuesday before each session with its agenda and call-in number. If for some reason you are not aware of our monthly town hall meetings, we ask that you contact Nancy Knapp at Nknapp@NYSHFA.org. to ensure your correct email is on file with us. 

NYSHFA CONTACT: 

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

Nancy Leveille, RN, MS
Executive Director
518-462-4800 x20

CMS Issues FY 2019 SNF PPS Final Rule/Webinar Today!

Carl J. Pucci in Finance & Reimbursement

CMS has issued the 2019 SNF PPS Final Rule, which includes a market basket increase of 2.4%, as previously announced in the Proposed Rule. NYSHFA will calculate the revised SNF PPS rates, effective 10/1/18, over the next few weeks. Additionally, CMS has finalized the Patient-Driven Payment Model (PDPM) which replaces the current RUGS-based SNF PPS. The implementation of PDPM is 10/1/19. Below is the AHCA bulletin which includes links to the Final Rule, the AHCA summary and CMS fact sheet. 

Today, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS- 1696-F] outlining proposed Fiscal Year (FY) 2019 Medicare payment rates and quality programs for skilled nursing facilities (SNFs). The FY19 final rule establishes a market basket increase of 2.4 percent, a figure statutorily mandated by Congress, and will start October 1, 2018.  

Based on changes contained within this final rule, CMS indicates aggregate payments to SNFs will increase in FY19 by $820 million, or 2.4 percent, from payments in FY18 - $30 million less than in the Notice of Proposed Rulemaking. AHCA is exploring potential issues with FY19 rates and impact analysis. At the same time, CMS notes that the overall economic impact of the SNF Value-Based Purchasing Program (VBP) is an estimated reduction of $211 million in aggregate payment to SNFs during FY19. 

Additionally, today, CMS finalized a payment system called the Patient-Driven Payment Model (PDPM) to replace the current RUGs-based SNF PPS. The PDPM is an updated version of the 2017 Advanced Notice of Proposed Rulemaking Resident Classification System Version 1 (RCS-1). CMS notes RCS-1 was revised based on stakeholder input. The implementation date for the final system is October 1, 2019 (FY20) and will be done in a budget neutral manner. 

Of note, AHCA has identified a number of anomalies in various tables throughout the final rule primarily pertaining to the FY19 RUG rates, as well as the FY19 Impact Analysis. AHCA staff and Reimbursement Committee members are in the process of analyzing these and other items that changed from the proposed to the final rule. 

Please find a summary of the final rule herePlease note that an AHCA/NCAL log-in is required to view this document. You can view the FY19 Final Rule here, as well as the fact sheet here. The FY19 SNF PPS wage index will be posted in the coming weeks. 

AHCA will host a member webinar today, August 1 at 3 PM Eastern on the FY19 Skilled Nursing Facility PPS Final Rule. Please plan to join the webinar 15 minutes prior to the scheduled start time by clicking here

You will be asked to enter your display name, email address, and number of people sitting in with you. Once this information has been added, press "Enter Meeting" to join. Please be sure to test your computer in advance here 

Based on changes contained within this final rule, CMS indicates aggregate payments to SNFs will increase in FY19 by $820 million, or 2.4 percent, from payments in FY18 - $30 million less than in the Notice of Proposed Rulemaking. AHCA is aware there are a number of errors in the FY19 rates and related tables. We have begun work to identify the errors and opened dialogue with CMS. Additionally, CMS finalized a payment system called the Patient-Driven Payment Model (PDPM) to replace the current RUGs-based SNF PPS. You can view AHCA's summary of the final rule here. (Please note that an AHCA/NCAL log-in is required to view this document.) 

If you need technical assistance during the webinar, please send a message in the chat or email ahca@commpartners.com. A recording will be available following today's session. 

NYSHFA CONTACT: 

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

January 1, 2018 Rates Posted to HCS

Carl J. Pucci in Finance & Reimbursement

The Department of Health (DOH) has released a Dear Administrator Letter (DAL) regarding the January 2018 rates.

As outlined in the DAL, these rates include an adjustment based on information provided on the minimum wage survey, the second survey related to contract staff minimum wage, a case mix adjustment based on the July 2017 Minimum Data Set (MDS) update, and the attested 2018 capital rates.

Attached is the Dear Administrator announcement, which contains the information regarding the January 2018 Initial Rates. The rate will be in cycle 2122 with the check release date of May 9, 2018.

NYSHFA CONTACT:

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

DOH Revises Owner Equity Withdrawal Requirements

Esq. Stephen B. Hanse and Carl J. Pucci in Finance & Reimbursement

In response to NYSHFA’s concerns regarding the revised Owner Equity DAL and Equity Withdrawal Form issued last August, DOH has agreed to revise the Owners’ Equity Withdrawal requirements as noted below.

Working with the Department, NYSHFA drafted FAQ’s related to our concerns; namely, the treatment of income taxes, salary and wages, fees paid to related companies and the treatment of goodwill. Following the promulgation of these FAQ’s, the DAL and the Equity Withdrawal Form were amended to reflect a majority of our concerns. The FAQ’s are included in today’s HCS posting and will provide specific guidance to members on each issue.

Attached is the Dear Administrator announcement, which contains the HCS menu location of the documents.

NYSHFA CONTACTS:

Stephen B. Hanse, Esq.
President and CEO
518-462-4800 x11

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

DOH Posts 2018 Notice Rates

Carl J. Pucci in Finance & Reimbursement

DOH has posted the 1/1/18 notice rates to the HCS. The rates include an update to the case mix for the July 2017 MDS collection (subject to the 5% cap constraint) and the initial 2018 capital rate (reflecting the appropriate capital attestations recently submitted). Note: the 2018 minimum wage adjustments will be included in the final published January 1, 2018 rates, expected in early January. Attached is the rate DAL with further details.

Please email DOH at nfrates@health.ny.gov with any questions regarding the rate.

NYSHFA CONTACT:

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

2017/18 SNF PPS Revised Rates Posted

Carl J. Pucci in Finance & Reimbursement

As noted in yesterday’s NYSHFA Priority Alert, CMS has made revisions to the regional wage indexes. The corrected 2017/18 SNF PPS rates are now posted to the NYSHFA website. (See “What’s New” as well as Reimbursement - Medicare section).

NYSHFA CONTACT:

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

2017/18 SNF PPS Rates to be Revised

Carl J. Pucci in Finance & Reimbursement

CMS has just released a correction notice to the FY 2018 SNF PPS Final Rule. Regional wage index technical errors have been corrected. For New York, each of the regional wage indexes have increased slightly (0.1%), resulting in a higher PPS rate across all RUG categories.

NYSHFA is in process of recalculating the rates and will reissue them in the next few days. Members should refrain from billing October Medicare claims until the corrected rates are posted.

Below is AHCA’s announcement:

In the final Fiscal Year (FY) 2018 Skilled Nursing Facility Prospective Payment System (SNF PPS), the Centers for Medicare & Medicaid Services (CMS) made an array of calculation errors. The FY 2018 SNF PPS - Final Rule Correction Notice went on display late Friday, September 30  at the Office of the Federal Register's Public Inspection Desk.

This document corrects technical errors related to the wage index and budget neutrality factor provided in the final rule that appeared in the August 4, 2017, Federal Register (82 FR 36530 through 36636) entitled, "Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2018, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, Survey Team Composition, and Correction of the Performance Period for the NHSN HCP Influenza Vaccination Immunization Reporting Measure in the ESRD QIP for PY 2020." Impacts on members are likely to be minimal but will vary based on patient case mix and CBSA.

The corrected final FY 2018 SNF PPS wage index file will be posted here.

Sincerely,

Michael W. Cheek
Senior Vice President, Reimbursement Policy

NYSHFA CONTACT:

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

Minimum Wage Survey Due Wednesday!

Carl J. Pucci in Finance & Reimbursement

A reminder that the DOH minimum wage survey must be completed by tomorrow, Wednesday, August 23, 2017 in order to ensure appropriate reimbursement for the mandated minimum wage increase.

NYSHFA CONTACT:

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

DOH Extends RHCF Filing Deadline to 7/31/17

Carl J. Pucci in Finance & Reimbursement

DOH has extended the 2016 RHCF-4 filing deadline from Monday, July 3, 2017 to Monday, July 31, 2017. DOH will not be approving any extensions past that date.

NYSHFA CONTACT:

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

DOH Issues Bed Hold Guidance

Nancy Leveille and Lisa Volk Carl Pucci in Finance & Reimbursement

DOH will be forwarding the attached guidance to providers regarding the recent elimination of bed hold reimbursement. Pursuant to this guidance, nursing home providers will be required to reserve “the same bed” for a temporarily hospitalized Medicaid patient.

DOH will delay the 4/1/17 bed hold reimbursement cut until emergency regulations are enacted. Thus, facilities will continue to be reimbursed for hospital bed hold as in the past.

DOH will issue further guidance when the emergency regulations are in place.

NYSHFA CONTACTS:

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

Nancy Leveille, RN, MS
Executive Director
518-462-4800 x20

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15

DOH Revises Equity Withdrawal Letter

Carl J Pucci in Finance & Reimbursement

DOH has reissued the January 1, 2017 rate DAL (dated 2/23/17) to include a revised Attachment G which defines Equity Withdrawal requirements. Although similar to the original Attachment G (DAL dated 1/31/17), the revision’s closing paragraph indicates that DOH will be stepping up enforcement going forward.

NYSHFA CONTACT:

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

DOH Issues 1/1/17 Medicaid Rates

Carl J. Pucci in Finance & Reimbursement

DOH is publishing the initial January 1, 2017 Medicaid rates. The rates are expected to be paid in cycle #2059, check date 2/6/17, check release date 2/22/17. The DAL and related attachments outline the primary rate components which include: 

  • Operating Component – direct and indirect pricing component (now 100% fully-phased in).
  • CMI Adjustment– reflects the July 2016 MDS census collection.
    • 5% ceiling/floor cap remains in place pending OMIG MDS audit.
  • Minimum Wage Adjustment– reimburses mandatory minimum wage increases beginning 1/1/17.
    • Reflects SNF wage survey data, adjusted regionally
    • Reimburses direct salary cost increases and related fringe benefits
    • Requires aggregate additional funds be directly associated with statutory minimum wage increases
    • Dependent upon CMS approval
    • Subject to OMIG audit
  • Capital Component – reflects 2015 RHCF costs, as well as approved capital attestations. Pending attestations (if approved) to be incorporated in upcoming rates.
  • Withdrawal of Equity – reminder that Public Health Law requires prior DOH approval via Equity Withdrawal/Transfer of Asset Request form.
  • Rate Appeal Process – facilities have 120 days to file appealable components of the rate.
  • Members are urged to carefully review each DAL attachment to ensure accuracy of their rates, as well as maintaining DOH compliance for both the Minimum Wage and Equity Withdrawal requirements.

Any questions should be referred to nfrates@health.ny.gov

NYSHFA CONTACT:

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

5:00 PM Deadline Today for DOH Minimum Wage Reimbursement Survey

Esq. Stephen B. Hanse in Finance & Reimbursement

As previously communicated by NYSHFA on several occasions, the Department of Health ("DOH") has released a minimum wage survey to determine the financial impact of mandated increases to the minimum wage, beginning on 12/31/16.

Please respond to the wage survey by 5:00 pm today, August 29th, in order to provide facility specific data to the DOH in developing a reimbursement methodology to cover the anticipated costs related to future minimum wage increases for 2017, as well as in future years. 

Failure to complete the survey and respond to the DOH by 5:00 pm today will result in an automatic default to an average wage calculation based on 2014 RHCF data which may result in no additional reimbursement for your facility.

Surveys will not be accepted after 5:00 pm today.

The accompanying DAL contains the survey link.

NYSHFA CONTACT:

Stephen B. Hanse, Esq.
VP & Counsel
518-462-4800 x25

Monday Deadline for DOH Minimum Wage Reimbursement Survey

in Finance & Reimbursement

As previously communicated by NYSHFA on several occasions, the Department of Health ("DOH") has released a minimum wage survey to determine the financial impact of mandated increases to the minimum wage, beginning on 1/1/17.

Please respond to the wage survey immediately in order to assist DOH in developing a reimbursement methodology to cover the anticipated costs related to future minimum wage increases for 2017, as well as in future years. 

Failure to complete the survey and respond to the DOH by 5:00 pm Monday, August 29, 2016 will result in an automatic default to an average wage calculation based on 2014 RHCF data which may result in no additional reimbursement for your facility.

The accompanying DAL contains the survey link.

NYSHFA CONTACTS:

Stephen B. Hanse, Esq.
VP & Counsel
518-462-4800 x25

Monday Deadline for DOH Minimum Wage Survey

Esq. Stephen B. Hanse in Finance & Reimbursement

As previously communicated, the Department of Health ("DOH") has released a minimum wage survey to determine the financial impact of mandated increases to the minimum wage, beginning on 1/1/17. DOH will analyze 12/31/15 payroll data to develop a reimbursement methodology in order to provide funding for these increases.

It is vital that all facilities respond to the wage survey immediately in order to assist DOH in developing a reimbursement methodology to cover the anticipated costs related to future minimum wage increases for 2017, as well as in future years. 

Failure to complete the survey and respond to the DOH by 5:00 pm Monday, August 29, 2016 will result in an automatic default to an average wage calculation based on 2014 RHCF data which may result in no additional reimbursement for your facility.

The accompanying DAL contains the survey link.

NYSHFA CONTACTS:

Stephen B. Hanse, Esq.
VP & Counsel
518-462-4800 x25

DOH Releases Minimum Wage Survey

Carl Pucci and Stephen Hanse in Finance & Reimbursement

DOH has released a minimum wage survey to determine the financial impact of mandated increases to the minimum wage, beginning on 1/1/17. DOH will analyze 12/31/15 payroll data to develop a reimbursement methodology in order to provide funding for these increases.

The accompanying DAL contains the survey link.

It is vital that all facilities respond to the wage survey immediately in order to assist DOH in developing a reimbursement methodology to cover the anticipated costs related to future minimum wage increases for 2017, as well as in future years. Failure to respond to DOH by 5:00 pm Monday, August 29, 2016 will result in an automatic default to an average wage calculation based on 2014 RHCF data which may result in no additional reimbursement for your facility.


NYSHFA CONTACTS:

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

Stephen B. Hanse, Esq.
VP & Counsel
518-462-4800 x25

SNF Transportation Survey Due June 27, 2016

Carl J. Pucci in Finance & Reimbursement

As part of the 2016/17 Executive Budget, DOH will no longer reimburse medical transportation costs through the Medicaid pricing methodology (est. to be between $0.30 - $0.50/day) as it is currently billed by the transportation vendors via Medicaid fee for service. NYSHFA and other associations have communicated the need to continue to reimburse for non-medical transportation costs (i.e.; activities transportation). As a result, DOH is requesting that providers complete a short survey which delineates medical from non-medical transportation costs (required data is from the 2007 RHCF, which is the base year under the current pricing methodology). Attached is the DAL, along with the Excel survey, which is due back Monday, June 27, 2016.

Providers should be aware that failure to complete the survey will result in the removal of their entire transportation costs from the direct price.

NYSHFA CONTACT:

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

Rate-Setting Update

Carl J. Pucci in Finance & Reimbursement

Although DOH did not conduct an August rate-setting briefing, they have shared an updated outline of various rate packages, as well as current initiatives presently under way.  Attached is the outline for your review.

In addition, please note the following with respect to key issues:

  • The 2013 CRA Reconciliation calculation posting is still pending per DOH.
  • The July 2014 CMI adjustment and the 5% CMI correction packages slated for cycle 1983 would have a check date of 8/24/15 with a release date of 9/9/15.  These rates should be posted to the HCS by weeks end.
  • As reported earlier, the 2013 and 2014 Quality Pool payments are on hold due to impending litigation.
  • The Capital Streamlining, Energy Efficiency and Advanced Training initiatives are all progressing towards Fourth Quarter 2015 implementation.  NYSHFA is actively involved in current workgroup meetings to best represent members’ interests.


DOH will hold its next briefing in early September, and a full rate-setting update will follow.

NYSHFA CONTACT:

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

2013 Cash Receipts Assessment (CRA) Reconciliation

Carl J. Pucci in Finance & Reimbursement

DOH has informed NYSHFA that the 2013 CRA Reconciliation is going to EmedNY today and will be in Medicaid payment cycle 1981 (check date 8/10/15 with release date of 8/26/15).

It is expected that the revised 1/1/15 rates (updated for the July 2014 CMI) should be processed soon afterward. NYSHFA will post that cycle number as soon as DOH confirms.

 

NYSHFA CONTACT
Carl Pucci
Director, Finance & Reimbursement
518-462-4800 ext.36

Advanced Training Initiative – (RHCF-Schedule P)

Carl J. Pucci and Esq. Stephen B. Hanse in Finance & Reimbursement

As announced in the 2015/16 Executive Budget, funding has been provided for an Advanced Training Initiative (ATI).  Approximately $46M has been approved for the next two state fiscal years (2015/16 and 2016/17) to provide training for certain direct care staff to more readily detect patient decline and thus avoid unnecessary hospitalizations (see attached DOH Public Notice).

NYSHFA met with representatives from the DOH, 1199 and other statewide and regional associations yesterday to discuss the State's preliminary rollout of this initiative.  One of the first key steps in this process will be to ensure an accurate and timely filing of RHCF-Schedule P “Staff Turnover.”  DOH may use Schedule P as a qualifier to measure staff retention, which is seen as a key indicator in the anticipated application process for providers.

Below is the DOH email being sent to all providers.

Dear Administrator:

A $46 Million Advanced Training Initiative (ATI) has been created with the passage of the 2015/2016 NYS Budget.  The ATI is being funded for two years to help provide training to direct care staff to more readily detect and identify patient decline and avoid unnecessary hospitalization.  Staff retention is being considered as a measure for qualifying facilities to submit applications for these funds.  Schedule P of both the RHCF-2 and RHCF-4 report Staff Turnover.  An examination of prior years’ Schedule P reports has shown that some facilities have not completed the schedule, failed to complete the entire schedule, or completed the schedule incorrectly.  Since Schedule P may be a tool used as a qualifier, facilities are reminded to complete the schedule fully and accurately.  Failure to timely and accurately complete this schedule may result in disqualification from participating in the ATI.  The instructions for the completion of schedule P are included with this message and include an important addition:

For column number 777, total number of employees who remained employed through the year from January 1st of the reporting year to December 31st of the same reporting year is to be entered.  The totals reported in each cell of COLUMN 777 CAN NOT BE GREATER THAN the total reported in column 770.  The totals in both column 770 and 777 should include ALL employees regardless of full or part-time status.

Attached are the specific Schedule P instructions.

Any questions can be sent to NFRates@health.ny.gov with the subject line ADVANCED TRAINING INITIATIVE

NYSHFA will continuously provide input to DOH and monitor development of the ATI over the coming months prior to implementation.

NYSHFA CONTACTS:

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

Stephen B. Hanse
Vice President & Counsel, Governmental Affairs
518-462-4800 x25

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...

Universal Settlement Update

Esq. Carl J. Pucci and Stephen Hanse in Finance & Reimbursement

The Universal Settlement process is continuing as the DOH is currently reviewing facility appeal and litigation exclusion lists (NYSHFA has emailed members directly who have not yet responded, as the deadline is next Tuesday, March 31, 2015).

DOH recently provided clarification to certain questions from attorneys and associations as set forth below.  In addition, OMIG is also requiring that facilities submit an “Audit Discontinuation list” (see Q2 listed below).

Facilities must submit their Audit Discontinuation list directly to Richard Zahnleuter, (Director, Bureau of Litigation, DOH) at the following address:  richard.zahnleuter@health.ny.gov by March 31, 2015.

As a reminder, all Universal Settlement background information, including the term sheet, is located at NYSHFA.org (Homepage, under “What’s New”).

Questions and Answers:

OMIG MATTERS

Q1:  Could OMIG reviews, investigations and audits that would be discontinued under US be held in abeyance effective immediately pending execution of the US settlement agreement?

A: OMIG has agreed to suspend, as of Friday, February 27, 2015, pending audits through April 24, 2015 such that no new final audit reports will be issued in the interim. This suspension does not include investigations. However, it does mean that no final audit reports will be issued during this four week moratorium, while we work towards executing the Settlement Agreement.

Q2: Extending the Section 10 concept of an “exclusion list” for pending claims, rate appeals and litigation that would be excluded from US, could OMIG prepare a list that would be tantamount to an “inclusion list” or "audit discontinuation list," meaning a list of OMIG reviews, investigations and audits that OMIG would discontinue when US becomes effective.

A: Although an “inclusion list” for audits or an "audit discontinuation list" is not contemplated by Section 10, Section 10 provides a usable roadmap for handling this subject. The State requests that each nursing home provide, on or before March 31, 2015, an "audit discontinuation list," broken down by items or components that each nursing home believes should be discontinued by OMIG pursuant to Section 11.3. OMIG will then assess the lists and release OMIG's assessments on or before April 15, 2015.

Q3: The above request led to a discussion about whether nursing homes that had made hearing requests in OMIG audit contexts would withdraw their hearing requests.  A number of facilities have outstanding hearing requests concerning OMIG audits. Is it correct that these are neither included within the Settlement nor that they need to be listed on the exclusion list because they are neither rate appeals nor lawsuits (see Term Sheet, Section 11.5)?"

A: Hearing requests based on findings in OMIG audits constitute claims that must be withdrawn, discontinued and released if they fall within the “included” matters set forth in Section 1. However, there may be hearing requests challenging certain matters that are excluded. If that is the case, those matters may continue until adjudicated. It is for this reason that the State requests that the nursing homes include matters that are the subject of a hearing request, which they believe should be excluded from the settlement along with their discontinuation list referenced in response to question #2.

NON-OMIG MATTERS

Q4.: Please describe the difference between Section 8.2 regarding a facility’s Medicaid rate appeals for the initial processing of 12 month cost reports for eligible rebasings, and Section 8.8 regarding a facility’s Medicaid rate appeals for initial base year operations.

A. The difference between Sections 8.2 and 8.8 is technical difference. The State contemplated in Section 8.2 that the initial processing of 12 month cost reports for eligible rebasings would be excluded. The State contemplated in Section 8.8 that any appeals arising from DOH’s initial processing of 12 month cost reports for eligible rebasings would be excluded.

Q5. Attorneys initiated a discussion regarding the use of a cut-off date to finalize the excluded list.  Suggested dates included March 1, 2015, the date that the nursing homes are expected to submit their exclusion list and December 19, 2014, the date the Term Sheet was distributed to the nursing homes.

A: Consistent with Section 10.2 ("Distributees shall identify, as of the effective date of the Settlement Agreement, any existing claims, rate appeals and litigation...,to be excluded ..."), we need to accomplish this process in two steps. March 31, 2015 should be the cut-off date for the first exclusion list. It will be necessary to revisit the exclusion list again a few days prior to execution of the Settlement Agreement to obtain an interim supplementation to make sure that all excluded matters are indeed identified.

Q6: There was a request that a process for negotiating A/R balances and debt repayment plans with the homes be identified.

A: DOH and OMIG have nearly completed the calculation of the updated A/R figures and will provide the figures to the Associations. Consistent with Section 4.8, please direct any request for a meet and confer on A/R balances and/or debt repayment plans to Matt Leonardo at matthew.leonardo@health.ny.gov. Such requests must be received by March 31, 2015 and such meetings will be set up between April 1 and April 15, 2015.

Q7: A concern was raised that some nursing homes may have filed a rate appeal seeking a cash receipts assessment reconciliation. In that event, should the nursing home put the rate appeal on the exclusion list, and if the nursing home does not put the rate appeal on the exclusion list, will the nursing home still be able to receive the benefit of the reconciliation?

A: Yes, the nursing home should put the rate appeal seeking a cash receipt assessment reconciliation on the exclusion list. The State contemplated that cash receipt assessments would be excluded matters specifically so that those nursing homes that had filed such rate appeals would not lose them through US.

Q8: What would occur if a nursing home intentionally left a "negative" rate appeal off of the nursing home's exclusion list.

A: The sixth Whereas clause provides that the State desires "to settle any claims or counter claims it may have against the Facilities State relating to the prior reimbursement methodology , unless specifically excluded as set forth in this Settlement Agreement ...." If the "negative" rate appeal falls within an excluded category in Sections 8 or 9, then the State reserves the right to process the "negative" rate appeal.

Q9: Why should facilities be required to affirmatively identify as 'excluded' any rate appeals or litigation that pertain to rate periods after 12/31/11, with the exception of the very limited types identified in Section 1.2 (i)-(iv) of the Term Sheet ?

A. There is no need for facilities to do so, provided that it is expressly understood that any rate appeals or litigation that pertain to the matters identified in Section 1.2(i)-(iv) of the Term Sheet are included, regardless of time period.

Q10: Please provide an update on discussions with CMS.

A. We (DOH) have had several discussions with CMS and have formally presented the proposal for approval. The most recent conference call occurred on February 26, 2015. We are expecting written comments from CMS very shortly. We expect that CMS will act expeditiously, as we have impressed upon CMS the dependent nature of US on CMS' approval and the need to execute US as quickly as possible.

NYSHFA CONTACTS:


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

Stephen B. Hanse, Esq.
Vice President & Counsel, Governmental Affairs
518-462-4800 x25

DOH Posts 2012 CR Assessment Reconciliation

Carl J. Pucci in Finance & Reimbursement

DOH has posted the 2012 Cash Receipts Assessment Reconciliation to the HCS system.  Below is the announcement from DOH, as well as the corresponding DAL.

The reconciliation will be part of Medicaid cycle 1959 (check date of 3/9 and release date of 3/25).

NYSHFA will provide a full rate-setting update in tomorrow’s member mailing.

From: doh.sm.BLTCR.NF.RATES [mailto:nfrates@health.ny.gov]
Sent: Wednesday, March 04, 2015 9:53 AM
Subject: 2012 Cash Receipts Assessment Per Diems

TO ALL NURSING HOME HCS COORDINATORS:

This is to inform the administrator of your facility that the 2012 Cash Receipts Assessment rate sheets for your facility effective January 1, 2012 and along with the associated Dear Administrator letter is now available on the Health Commerce System (HCS). To access, please follow these instructions:

Go to Website - https://commerce.health.state.ny.us

Security Screen - enter your “HCS” id and password

Health Commerce System Welcome Page - select "NH Cash Receipts Assessment" under the heading "My Applications"

“2012 Cash Receipts Assessment Reconciliation” the drop-down list under "Nursing Home Rates Selection List"

Identify your facility in the drop-down list under "Nursing Home Selection List" and then select "SHOW REPORTS"

NYSHFA CONTACT:

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

Medicaid Managed Care Transition to Start February 1st

Esq. Stephen B. Hanse and Carl J. Pucci in Finance & Reimbursement

DOH has confirmed CMS approval of the Transition of Nursing Home Benefit to Managed Care.

The transition timeline is noted as follows:

NYC Boroughs – February 1, 2015
Long Island/Westchester – April 1, 2015
Rest of NY State – July 1, 2015

DOH will be conducting a webinar next Thursday, January 22, 2015 at 10:00 a.m. to present the transition overview and address previously submitted stakeholder questions.  Click here to register.

DOH will establish bi-weekly workgroup meetings to address implementation issues.  In addition to Associations, MCOs and other consumer advocates, the workgroup will be open to individual Providers with specific transition issues.

NYSHFA will continue to address specific member concerns via the workgroup platform, as well as specifically with the DOH as issues arise.

NYSHFA CONTACTS:

Stephen B. Hanse, Esq.
Vice President & Counsel, Governmental Affairs
518-462-4800 x25

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

Universal Settlement Vote

Carl J. Pucci in Finance & Reimbursement

A reminder that the voting deadline to indicate participation in the Universal Settlement is this Friday, January 9, 2015.  All Universal Settlement documents are located at NYSHFA.ORG, see “What’s New” (on the home page.)  The link to access the survey is https://www.surveymonkey.com/s/Universal_Settlement_Participation_Survey_I.

A Frequently Asked Questions document is being finalized and will be posted to the website as soon as it is finalized.

Note:  As of today, 385 out of 392 responses have been in favor of the settlement ...

Universal Settlement Update

Carl J. Pucci in Finance & Reimbursement

An agreement has been reached between New York State officials, DOH and legal counsels representing nursing homes on the terms of an $850M Universal Settlement, which includes most pending Medicaid appeals as well as reimbursement related litigation.  Owners and/or their designated representatives should have received facility-specific impacts of the settlement last week.  NYSHFA and other provider associations conducted an informational webinar on 12/29/14 and it has been archived and is available (along with all supporting documents related to the settlement) at NYSHFA.ORG (under “What’s New”.)  A set of Frequently Asked Questions (FAQs) is presently being compiled from both the webinar as well as questions sent directly to the Associations.  The FAQs will also be posted to our website as soon as finalized. Owners and/or designated representatives are reminded to access the Universal Settlement Participation Survey and respond to the questionnaire no later than Friday, January 9, 2015.

We encourage members to carefully review all supporting documents and consult their respective legal counsel and/or accounting firms for further guidance.

Please contact NYSHFA with any facility-specific requests regarding either settlement amounts or possible DOH receivable offsets.

Best wishes for a Happy New Year!

NYSHFA CONTACT:

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

Managed Care Transition Delayed Until 2/1/15

Carl J. Pucci in Finance & Reimbursement

Dear MRT Listserv subscribers:

The Phase-In Schedule for the transition of the Nursing Home Benefit and Population into Medicaid Managed Care and Managed Long Term care has been revised as follows:

Phase 1- February 1, 2015

New York City – Bronx, Kings, New York, Queens, and Richmond counties       

Phase 2- April 1, 2015

Nassau, Suffolk and Westchester counties       

Phase 3- July 1, 2015

Albany, Allegany, Broome, Cattaraugus, Cayuga, Chautauqua, Chemung, Chenango, Clinton, Columbia, Cortland, Delaware, Dutchess, Erie, Essex, Franklin, Fulton, Genesee, Greene, Hamilton, Herkimer, Jefferson, Lewis, Livingston, Madison, Monroe, Montgomery, Niagara, Oneida, Onondaga, Ontario, Orange, Orleans, Oswego, Otsego, Putnam, Rensselaer, Rockland, St. Lawrence, Saratoga, Schenectady, Schoharie, Schuyler, Seneca, Steuben, Sullivan, Tioga, Tompkins, Ulster, Warren, Wayne, Washington, Wyoming,  and Yates counties       

October 1, 2015

All counties - voluntary enrollment in Managed Long Term Care, Fully Integrated Duals Advantage and Mainstream Medicaid Managed Care becomes available to individuals residing in nursing homes who are in fee-for-service Medicaid    

As the three-way contract for FIDA indicates, voluntary and passive enrollment for eligible individuals in nursing homes will take place on or after August 1, 2015. More information will be forthcoming on the exact timeline.

Thank you,
The Medicaid Redesign Team

NYSHFA CONTACT:

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

Capital Restructuring Financing Program RFA Application Extension

Esq. Stephen B. Hanse and Carl J. Pucci in Finance & Reimbursement

The Capital Restructuring Financing Program (“CRFP”) Request for Applications due date has been extended from the current deadline of December 22, 2014 to February 20, 2015. As recently reported, NYSHFA/NYSCAL previously requested an extension in the due date to allow providers additional time to submit CRFP applications. More information, including updated documents, are expected to be released by the Department of Health within the next week. More information on the CRFP can be found at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/capital_restructuring_financing_program.htm.  Additionally, questions may be directed to crfp@health.ny.gov.

NYSHFA CONTACTS:

Stephen B. Hanse, Esq.
Vice President & Counsel, Governmental Affairs
518-462-4800 x25

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

DOH Posts 2015 Medicaid Rates

Carl J. Pucci in Finance & Reimbursement

DOH has just posted the 2015 operating capital and rates on the HCS system.  As noted in the bulletin below, members should carefully examine their rates, as the deadline for error notifications is December 2, 2014...

DOH Posts 2015 Capital Rates

Carl J. Pucci in Finance & Reimbursement

DOH has posted the 1/1/15 Capital Rates on the Health Commerce System (HCS).  This initial preview of the rates gives facilities additional time in advance of the normal 11/1/14 posting in order to verify the accuracy of their capital rate.  Members should compare their 2015 Schedule VI - Property Costs to their 2013 RHCF reported costs and immediately alert DOH of any discrepancies.

Below is the DOH notice:

TO ALL NURSING HOME ADMINISTRATORS:

This is to inform you that the Medicaid Capital rates for your facility effective January 1, 2015 are now available on the Health Commerce System (HCS).  All rate inquiries should be addressed to BVAPR@health.ny.gov  with the subject heading “opcert/facility name” 2015 Preliminary Capital.  To access, please follow these instructions:

Go to Website - https://commerce.health.state.ny.us

Security Screen - enter your “HCS” id and password

Health Commerce System Welcome Page - select "NH Rate Sheets 4/2009-Forward" under the heading "My Applications"

Nursing Home Rates - 4/1/2009 and Forward screen - select "2015 Nursing Home Preliminary Capital Rates" from the drop-down list under "Nursing Home Rates Selection List"

Identify your facility in the drop-down list under "Nursing Home Selection List" and then select "SHOW REPORTS"

NYSHFA CONTACT:

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

Case Mix Update

Carl Pucci in Finance & Reimbursement

DOH informed NYSHFA earlier today that the January 2014 CMI update (affecting the 7/14 rates) will go to DOB next week.  The revised rates are expected to be processed and paid in mid to late September.  As soon as NYSHFA obtains a Medicaid cycle number and payment date, we will inform members...

CR Assessment Filing Postponed

in Finance & Reimbursement

DOH is postponing the April 2014 Cash Receipts Assessment report filing due date from May 16, 2014 to June 16, 2014.  Thus, both the April and May reports will now be due on that date.

Attached is the notice from DOH, along with contact information for related questions...

CMS Releases Proposed Rule – Medicare PPS Rates to Increase 2%

Carl J. Pucci in Finance & Reimbursement

CMS has just released its 2014/2015 proposed rule which will increase Medicare SNF payments by approximately 2%, effective 10/1/2014.  This net increase will add approximately$750M annually to SNF providers.  The proposed rule will now be open for public comment for the next 60 days prior to CMS issuing its final rule.  Attached is the AHCA synopsis of the rule, as well as various CMS links with further details.

Members should note that CMS is updating its Wage Index with the intent to more accurately measure paid wages throughout the country.  AHCA has indicated that approximately 63% of providers should see no change, 15% would see related increases, and 22% related decreases as a result (phasing in over a two-year period.)


AHCA will provide further analysis, as well as a website tool which will reflect the Wage Index methodology and related provider impacts sometime next week.


NYSHFA will begin analysis of the proposed rule as well, and provide updates going forward.

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


 

DOH Delays Managed Care Transition

Carl J. Pucci in Finance & Reimbursement

DOH has just notified stakeholders that the transition to Medicaid Managed Care has once again been delayed until June 1, 2014.  DOH needs the additional time in order to respond to outstanding CMS issues related to the transition.

Attached is the revised policy document which has been modified to reflect the new date (see page 2, table 1).  Note the FFS benchmark rate transition period will also be extended three years respectively for downstate and upstate counties ...

Managed Care Update

Carl J. Pucci in Finance & Reimbursement

DOH presented its’ Medicaid Managed Care webinar yesterday (following the DOH meeting held last week with downstate providers and associations.)


The webinar followed previous Managed Care briefings focusing on the OHIP policy document, which remains the blueprint for the transition from a Fee For Service (FFS) to Managed Care environment.


DOH, at the outset of the webinar ...