Dear Administrator: 2007 Revised Rates
March 5, 2007
Dear Administrator:
The purpose of this letter, pursuant to Part 86-2.14 of the Commissioner's Administrative Rules and Regulations, is to inform you of the revisions to your 2007 nursing facility Medicaid rate(s). A copy of the revised Medicaid rate computation sheets for the period January 1, 2007 through December 31, 2007 is enclosed. These are all-inclusive rates for services provided by your facility.
The enclosed rate computation sheets may contain one or more of the following adjustments:
Hotline
A revision to the rates has been made to reflect acceptable "Hotline" item(s) properly submitted during the appropriate time frame. An explanation of what hotline items have been accepted or rejected has been addressed in a separate letter.
Certifications
In accordance with Part 86-2.2(f), lack of respective certifications by both the operator and accountant, as required pursuant to Sections 86-2.5 and 86-2.6 of this Subpart shall render the financial and statistical report incomplete. If your facility still has not submitted an acceptable cost report, the capital component of your rate will be zero.
If your facility did not submit an acceptable 2005 accountant's certification prior to the issuance of the 2007 initial rates but has now properly submitted an acceptable CPA certification during the hotline period, your facility's capital component of the rate has been updated utilizing the acceptable 2005 RHCF cost report for the hotline rate.
Trend Factor
In accordance with Chapter 109 of the Laws of 2006 beginning April 1, 2006 the trend factor attributed to the period January 1, 2006 through December 31, 2006 shall utilize the final U.S. Consumer Price Index (CPI) for all urban consumers, as published by the U.S. Department of Labor, Bureau of Statistics less twenty-five hundredths of a percentage point. The final CPI was determined to be 3.2%; therefore, the final 2006 trend factor incorporated into the 2007 roll factor is 2.95%, and the initial 2007 trend factor is 2.50%.
In the banking calculation, the effect of 3.2% will be utilized for the first three months, and 2.95% will be utilized for the last nine months of the 2006 trend factor.
Universal Precautions
Reimbursement to facilities for their allowable Hepatitis B vaccine expense incurred as a result of complying with OSHA universal precaution requirements continues in the 2007 rate based upon data reported in the 2005 RHCF-2 or RHCF-4, if applicable. The 2007 adjustment is calculated as follows: the lower of the 2005 vaccine expense reported by the facility or the reported number of inoculations given to employees in 2005 multiplied by the facility's average cost per vial capped at $128.50 for a three vial series, divided by estimated 2007 patient days. The per diem is calculated on Schedule IX of the rate sheet and is included on Line 3E of the face page of the rate sheet along with the per diems calculated for OBRA, gloves and measles & rubella.
Measles and Rubella Immunization Adjustment
In accordance with Section 415.25 of Part 415 of Title 10 (Health) of the Official Compilation of Codes, Rules and Regulations of the State of New York all employees are required to be properly immunized against rubella and that all employees born after January 1, 1957 be properly immunized against measles. Reimbursement to facilities for their allowable rubella and measles vaccine expense for rate year 2007 is based upon data reported in the 2005 RHCF-2 or RHCF-4, if applicable. The 2005 reported expenses are divided by estimated 2007 patient days. The per diem is calculated on Schedule IX of the rate sheet and is included on Line 3E of the face page of the rate sheet along with the per diems calculated for OBRA, Hepatitis B and gloves.
Health Retention and Recruitment – Non-Public Facilities
Chapter 1 of the Laws of 2002, which added subdivision 18 of section 2808, and Chapter 82 of the Laws of 2002, Chapter 686 of the Laws of 2003 and Chapter 58 of the Laws of 2005, which amend this subdivision, provide for payments to residential health care facilities (RHCFs) for the recruitment and retention of health care workers. Pursuant to this subdivision, non-public RHCFs shall receive these payments as a reimbursable cost add-on to their rate.
The enclosed rate for your facility, for the period January 1, 2007 through June 30, 2007, includes an adjustment to reimburse you for the portion of the health recruitment and retention monies, which for non-public residential health care facilities amounts to $57,900,000.
Rebasing Transition Adjustment – Effective January 1, 2007
Chapter 109 of the Laws of 2006, Section 2808 of the PHL has been amended to add a new subdivision 2-b. Pursuant to subparagraph (a)(ii) of this section, rates for the periods 2007 and 2008 shall be further adjusted by a per diem add-on amount, as determined by the commissioner, reflecting the proportional amount of each facility's projected Medicaid benefit to the total projected Medicaid benefit for all facilities of the imputed use of the rate–setting methodology set forth in statute for the 2009 rates. For those facilities that do not receive a per diem add-on adjustment, pursuant to this subparagraph, rates shall be further adjusted to include the proportionate benefit, as determined by the commissioner, of the expiration of subdivision 16 of 2808 (Productivity and Efficiency Adjustment) and subdivision 14 of Section 2808 (Administrative and Fiscal Cap). The aggregate total of the rate adjustments made pursuant to Section 2808 shall not exceed $137,500,000 for 2007.
This per diem add-on is not included in the 2007 hotline rates. The Centers for Medicare and Medicaid Services (CMS) has not approved the state plan amendment and therefore, the Department cannot implement this adjustment at this time. As soon as CMS approval is received, revised rates will be processed to include this adjustment.
Trending of Part D offset:
The 2006 Part D offset has been inflated to 2007 using the initial 2007 CPI of 2.50%.
Appeal and PRI Rollovers
If your facility has recently received approved Medicaid rates or changes in case mix, the 2007 rate has been revised to incorporate the rollover of the appeal findings or changes in case mix if applicable.
Appeals
In order to file an appeal with this office, the following information should be provided: When submitting an appeal, please be advised that the New York State Commissioner of Health may consider only those applications for revisions of certified rates, which are set forth in Sections 86-2.13 and 86-2.14. Issues raised in a request for appeal that do not meet the criteria of an acceptable appeal under 86-2.13 or 86-2.14 but rather pertain to the methodology used to promulgate Medicaid rates will be rejected. The Medicaid rate methodology is based on the provisions of Subpart 86-2 and objections to regulatory provisions are not issues that can be resolved through the administrative rate appeal process. The submission of an appeal and any related information associated with the appeal Appeals sent to any address other than the above may not be recognized as an appeal. The 2006 RHCF cost report will be provided through the Health Provider Network (HPN). You will receive information regarding access at a future date. Due to modifications for additional reporting edits necessary to advance the automated calculation of the capital component of the rate and revisions to schedules and exhibits based on GAAP and GAAS issues brought up during the settlement of the accountant's certification, major changes are being made to the RHCF software. It is anticipated that the cost report software will be available on HPN by May 1, 2007. The filing deadline for these reports will be extended until June 30, 2007. If you have any questions relating to the calculation of your 2007 Medicaid rates for Sincerely, Mark H. Van Guysling Assistant Director Division of Health Care Financing Enclosures
Director
New York State Department of Health
943 Corning Tower Building
Empire State Plaza
Albany, New York 12237-0709.
2006 Annual Cost Report
