2011 Capital Rate Sheets Available

DOH has posted nursing home 2011 capital rate sheets to the Health Commerce System (HCS).  In an accompanying Dear Administrator letter (DAL) (attached below), DOH notes that while the capital rate sheets are available for homes that file the RHCF-4 cost report, the capital component calculations for hospital-based RHCF-2 filers are not yet completed and will not be available until the 2011 rates are published.  The DAL warns that the capital amount for any home without a properly filed and certified 2009 cost report will be zero, and that any home with a related party that has not filed the required related company financial statements by the time the 2011 rates are published will receive no capital reimbursement.

Based on recent opinions from the Department’s Division of Legal Affairs, the capital component is considered preliminary and, as such, is not subject to appeal at this time.  However, homes that note errors in their capital rate sheet are urged to notify DOH of the nature of the error by e-mail to NFRATES@health.state.ny.us with the wording “2011 Preliminary Capital Rate for FACILITY NAME” in the subject line.  DOH will endeavor to address major errors prior to publication of the 2011 rates.  Homes will also have 120 days to file appeals once the final rates are published.

Along with the DAL, DOH also posted a spreadsheet showing bottom line rates.  These rates represent the 2011 capital (2010 capital for RHCF-2 filers) combined with the same operating component used in the rates that DOH made available in early September.   Please keep in mind that the posted rates reflect an operating component based on the January 2009 CMI and as such fail to adjust for facility-specific CMI changes since January 2009 as well as the potentially significant increase in scale-backs due to statewide CMI growth.  The total scale-back reflected in the posted rates is approximately $250 million, while the statewide CMI growth of roughly 7 percent in 2009 may increase the scale-back to an estimated $525 starting with July 2009 rates.        

The DOH e-mail announcing the availability of the rates and how to access them is copied below.  We recommend that members review their capital rate sheets carefully.  Should you find significant errors, please copy us in on your communication to DOH.

Contact:  Darius Kirstein, dkirstein@nyahsa.org, 518-449-2707 ext. 104

TO ALL NURSING HOME HPN COORDINATORS:
This is to inform the Administrator of your facility that a Dear Administrator letter providing draft preliminary information about your residential health care facility Medicaid reimbursement rate for the period commencing January 1, 2011 is now available on the Health Commerce System. To access, please follow these instructions:

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

2. Security Screen - enter your user id and password

3. NYSDOH HCS Health Commerce System screen - under "My Applications" select "NH Rate Sheets 4/2009-Forward"

4. Scroll down to the Nursing Home Rates - 4/1/2009 and Forward screen - select "2011 NURSING HOME RATES Jan 1" in the drop-down list under "Nursing Home Rates Selection List"

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

NOTE:

If "NH Rate Sheets 4/2009-Forward" does not appear under "My Applications" in number 3 above, follow these instructions instead:

3. NYSDOH HCS Health Commerce System screen - click on "HCS applications"

4. scroll down to view the list of application names and click on "Nursing Home Rate Sheets 4/1/2009 and Forward"

5. scroll down to the online access request form and follow the instructions

6. once approval is granted for you to access this area, you should be able to navigate to the area by following the first set of instructions above.