January 1, 2019 Rates – CMI Cap Issue

Carl J. Pucci

As noted in the 6/21/2019 NYSHFA Member Mailing, DOH released the January 1, 2019 rates last week. Although the case mix adjustment to these rates properly reflect the July 2018 MDS collection period, it appears that the 5% CMI Cap in place for affected facilities was not updated through January 2019 (i.e., the cap still reflects the July 2018 rate period). DOH estimates that approximately 175 homes were affected.

We are awaiting DOH response on its next steps, which optimally would be a correction prior to the scheduled payment adjustments slated for Medicaid cycle #2184 (check release 7/17/2019). Members should carefully review Line 15 of their 1/1/2019 rate cover sheet, especially if they were affected by the cap constraint during the July 2018 rate period.  DOH should be notified immediately at nfrates@health.ny.gov.


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