Benchmark Letter

June 14, 2019

Dear Health Plans:

This letter provides you with information regarding the posting of 2018 Benchmark Rates. Facility–specific benchmark rates for the period November 1, 2018 through December 31, 2018 are updated and published on the DOH Public Website here.

These benchmark rates were initially posted to the Department of Health's website on December 24, 2018 and then temporarily retracted after the release of the State Fiscal Year (SFY) 2019–20 Executive Budget 30 Day Amendments. Any facility–specific adjustments that have been made since the initial file was posted have been noted in the rate publication file.

As a reminder, these rates are based upon the same methodology and data used in the July 1, 2018 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 increased premiums to Mainstream Managed Care Organizations (MCO) for October 2018 and Managed Long Term Care (MLTC) Partial Capitation plans for November 2018 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 rate schedule regardless of contractual reimbursement terms. This includes any reprocessing that should occur consistent with this adjustment.

Please see the following attachments that outline Benchmark Rate requirements:

  • Attachment A
  • Attachment A–1
  • Attachment A–2
  • Attachment B

If you have any questions regarding the posting of the 2018 Benchmark Rates, please send an email to with Benchmark Rates in the subject line and Coner Petter or Michelle Santos will respond to your inquiry. Questions regarding Managed Care premiums should be addressed to


Daniel Carmody
Bureau of Managed Long Term Care Rate Setting
Division of Finance and Rate Setting
Office of Health Insurance Programs