Benchmark Letter

January 17, 2019

Dear Health Plans:

The purpose of this letter is to provide Health Plans with the initial Residential Health Care Facility (RHCF) Benchmark Rates for the period of November 1, 2018 through December 31, 2018. Facility–specific benchmark rates are updated and published on the DOH Public Website here.

These benchmark rates are based upon the same methodology and data used in the July 1, 2018 benchmark rates but take into consideration the following update:

  • 1.5# Across the Board Nursing Home Investment: The State Fiscal Year (SFY) 2018–19 Enacted Budget established a Health Care Transformation Fund as Enacted (State Finance Law – Article 6, Section 92–hh). Part of this Health Care Transformation Fund has been allocated to provide an Across the Board Investment representing an 1.5% increase on the operating component for all New York State nursing homes.

Based on the above changes, the Department will increase premiums to Managed Care Organizations (MCO) to reflect the nursing home benchmark increases of 1.5#. It is the Department's expectation that this adjustment be included in reimbursement to all nursing homes included in the attached benchmark rate schedule regardless of contractual reimbursement terms. This includes any reprocessing that should occur consistent with this adjustment.

Should you have any questions regarding this posting, please email NFRATES@health.ny.gov and Robert Yankowski or Coner Petter will respond to your inquiry. Questions regarding Managed Care premiums should be addressed to MLTCRS@health.ny.gov.

Sincerely,

Daniel Carmody
Director
Bureau of Managed Long Term Care Rate Setting