DOH Posts Universal Settlement Exclusion Request Reviews
The Department of Health (DOH) has re-posted facility-specific lists showing their evaluation of facility-submitted listings of appeals excluded from the universal settlement. An accompanying Dear Administrator Letter (DAL) dated August 17 is posted as well. The DOH e-mail notification that includes instructions on accessing the information on the Health Commerce System (HCS) is copied below.
Each facility should find a “Report of Universal Settlement Exclusion Requests” that lists the individual appeals homes submitted as excluded from the Universal Settlement. The listing indicates whether each exclusion request was accepted or not. Homes with exclusion requests that DOH did not accept may submit additional documentation showing why they should be appropriately excluded to DOH by Sept. 11, 2015. (Please note that in the DOH letter reproduced below that they list a date of Aug, 31. However, we have confirmed directly with DOH that the correct date is Sept, 11.) Homes that did not submit any exclusions will see a notice stating that “no rate sheets were found”. We know of several instances of homes that submitted lists that see the “no rate sheets” indicator. If your home is in this situation, please let us know immediately.
Although the DAL indicates that litigation exclusion and OMIG audit discontinuation request reviews will be forthcoming, some of the listings currently posted include litigation. We will seek clarification of what is still forthcoming and let members know.
We urge all members to access their exclusion request lists promptly, to submit documentation if needed and to contact us with questions. If your facility submitted a list but no longer has access to the HCS, please contact Matt Leonardo (matthew.leonardo@health.ny.gov) to obtain your exclusion review list.
Background information on Universal Settlement exclusions is available here.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841
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From: doh.sm.BLTCR.NF.RATES <nfrates@health.ny.gov>
Date: August 20, 2015 at 3:53:41 PM EDT
Subject: Universal Settlement Exclusion
SENT 08/20/2015 3:45p
Dear Administrator:
One of the steps necessary for moving forward with Universal Settlement is the identification of excluded rate appeals. If you have not submitted rate appeal exclusion requests to the Department by this time, all of your facility’s rate appeals shall be included in Universal Settlement pursuant to Section 10 of the Term Sheet.
The Department has processed the rate appeal exclusion requests it has received from your facility. The Department’s response to these requests is now available on the Health Commerce System. If you disagree with any of the rejected exclusion requests attached, the Department is willing to reconsider its determination provided that you send to the Department additional information to supplement your original appeal exclusion request that you believe will help demonstrate why any of the rate appeals rejected for exclusion above should be approved from exclusion under categories enumerated in Section 9 of the Term Sheet.
Supplementary materials must be submitted to Matt Leonardo at matthew.leonardo@health.ny.gov no later than August 31, 2015 [LeadingAge NY note: please see corrected date listed above].
If you do not submit such supplemental information by that date, the Department's determination to reject the rate appeal exclusion request shall be final.
The Department appreciates the efforts that all of the facilities have expended in order to effectuate Universal Settlement.
PLEASE NOTE: If no exclusion request was received from you facility, no reports will be listed.
Thank you.
To access the Universal Settlement Determinations:
1. Log into the HCS at
https://commerce.health.state.ny.us/hcs
2. Under the MY APPLICATIONS heading, find “NH Rate Sheets 4/2009-Forward”
3. Select your facility.
4. Select Universal Settlement Exclusion Notice
The DAL and all rate sheets are available from this link.