DAL - CY2024 Medicaid Fee-For Service Rates

  • Letter is also available in Portable Document Format (PDF)

March 7, 2025

RE: CY 2024 Medicaid Fee-for-Service Notice Rates:
Licensed Home Care Service Agencies (LHCSA – Personal Care),
Consumer Directed Personal Care Assistance Program/ Fiscal Intermediary (CDPAP/FI)
Certified Home Health Agencies (CHHA – Pediatric),

CY 2024 Notice Rates Certification or Appeal and Submission of Adjusted Cost Reports Due Date Is April 21, 2025

Dear Medicaid Provider Administrator:

The initial calendar year 2024 Medicaid Fee-for-Service (FFS) rate computation sheets are now available on the Health Commerce System (HCS) website. These rates are effective January 1, 2024 and were developed based on the data submitted in the 2022 Home Care Cost Reports.

All FFS rates for Personal Care, CDPAP, and Pediatric CHHA services are based on the agencies’ Home Care Cost Report submissions data. As part of the transition to the current cost reporting tool, the Department is allowing providers the opportunity to review their initial rates prior to loading them into eMedNY to confirm the rates are consistent with their cost reporting. Agencies are encouraged to review these initial rate sheets posted on the HCS and either certify acceptance of their rates or appeal them. Note that this will be the final year in which a preliminary appeal period is supported. Starting next year, the Department will consider the transition to the current cost reporting tool complete. Prospective rates (2025 and on) will follow the regulatory requirements for appeals (Section 505.14(h)(7)(iii)(c) of NYCRR 18), opening a 90-day period to appeal once rates have been finalized, approved and loaded into eMedNY. Rate sheet templates are provided as Attachment A and instructions on how to access rate sheets are provided in Attachment B.

Providers may appeal their 2024 rates by logging into the 2022 Tool and accessing the rate certification tab to file an adjusted cost report reflecting changes in schedule 3, 4, 5 and 7 data. The corrections must be electronically certified by either the Operator or Chief Executive Officer of the Agency (Attachment C provides instructions on how to submit the rate certification and adjusted cost report within the 2022 Tool). No certifications will be accepted from accountants or consultants. The Tool can be found on the NYS Department of Health's Home Care Dashboard.

Any certifications, appeals, and submissions of adjusted cost reports must be completed within 45-days. The deadline to file an appeal via the web-based Home Care Tool is the end of business, April 21, 2025.

After the April 21, 2025 deadline, the Department will draw down the certifications and appeals, and any adjusted submissions will be used to re-calculate rates. All rates, initially certified or re-calculated will then go through the standard approval process and be loaded to eMedNY. The 90-day regulatory appeals window (Section 505.14(h)(7)(iii)(c) of NYCRR 18) will then open for any rates that meet the standards as described below:

  • the provider's claim that the rate contains mathematical, statistical, fiscal or clerical errors;
  • the provider's claim that it has incurred new or unanticipated costs for programs or services mandated or approved by the Department and that the cost report that the provider submitted to the Department does not reflect the provider's actual costs for reasons beyond the provider's control; or
  • the provider's desire to obtain a rate that is lower than the rate promulgated by the Department.

For those agencies that did not submit their 2022 Home Care Cost Report, the Department is not able to calculate a 2024 rate until the cost report(s) are submitted. Please be reminded that failure to comply with the reporting requirements of Title 10, Parts 86-1.2, 1.3, 1.6 and 1.7 may result in the implementation of penalties pursuant to Part 86-1.2(c) and Section 12-d of the Public Health Law.

This letter is being sent to the agency contacts who provided their email addresses with their 2022 cost report submissions. Please share this correspondence with any additional agency personnel who may find it useful and who were not included in the original email list.

If you have any questions please contact the Bureau of Nursing Home and Long Term Care Rate Setting at the following e-mail addresses: for CHHAs – CHHA-Rates@health.ny.govor LHCSAs and FIs – PersonalCare-Rates@health.ny.gov.

Sincerely,

Laura Rosenthal, Director
Bureau of Nursing Home and
Long Term Care Rate Setting
Division of Finance and Rate Setting
Office of Health Insurance Programs

Enclosures:

  1. Login to HCS: https://commerce.health.state.ny.us/public/hcs_login.html
  2. Under "My Applications" select Healthcare Finance Data Gateway (or go to "My Content" from the top line menu, then All Applications to search for the application under "C" for CHHA) CHHA or "P" for Personal Care);
  3. Click on the Publications Tab;
  4. Under Organization Type, select either "Home Health Agencies" or "Personal Care" from the drop down menu;
  5. Under Collection, select either "2024 CHHA Pediatric Notice Rate Sheet", "Personal Care Rate Reports" or "CDPAP Rate Reports" from the drop down menu;
  6. Under Package, select "2024 Notice Rates" from the drop down menu:
  7. Under Organization, select your agency, then click Search;
  8. Next select Download checkbox to save the Dear Administrator Letter and rate sheet pdf files as necessary.
Please note: If you have problems accessing your HCS account due to the expiration of your password, please contact the Commerce Accounts Management Unit (CAMU) at 1-866-529-1890.

Steps to accept or appeal the Medicaid FFS rates in the 2022 Home Care Cost Report Tool:

Step 1:Navigate to the Home Care web-based Tool page at the following link: Home Care Dashboard https://desoto.certisphere.com/doh/HomeCareDashboard.html . Once you enter the link, please select the "2022" option (shown below) and click "Go."

Step 2:Enter your username (email address) and password to log in to the Tool. If you forgot your password, please click the "Forgot Password?" link on the Web-based Tool log-in page. You will then receive an email containing the step_s to reset your password. If you have any other difficulties logging in, please send an inquiry to the KPMG Home Care Cost Report mailbox at us-advrisknyshc@kpmg.com.

Step 3: Once you have successfully logged in, you will be prompted to select your agency using the drop-down menu as shown below. Click the drop-down option, select the applicable agency, and click "Select organization."

Step 4:Navigate to the "Rate Certification" tab pictured below. Please review the information within this tab carefully. Then, enter the name, title, and e-mail address of the executive-level individual completing the certification and use the multiple-choice option to accept or appeal the 2024 Medicaid reimbursement rate(s) calculated by the Department. You may include an explanation for your acceptance or appeal within the text box provided.

Step 5: Submit your rate certification or appeal by clicking the "Submit" button.

Step 6 (Optional): If you would like to indicate the specific rate(s) for which you agree or disagree to retain as a reference within the cost report web-based tool, you may complete the table(s) below in the bottom of the tab. Note that one table will appear for each entity type (CHHA, LHCSA, FI) that your agency operates. For example, if your agency operates LHCSA and FI entities, two tables will appear (one for LHCSA rates and one for FI rates).

Step 7 (for agencies that appeal their rate):After the rate appeal has been submitted, you must navigate to the "Adjusted Cost Report Schedules" tab in the Tool (see image below). This tab will be unlocked for your agency to make changes to Schedules 3, 4, 5, and 7. Note that the information from your agency’s original cost report submission will be copied into this tab, so that you can efficiently execute the adjustments to your original submission.

Once edits are complete, you will need to review the certification at the top of tab to verify the accuracy and completeness of the adjusted data, enter the name and title of the official certifying and submitting the adjusted cost report, and click the "Submit Adjustments" button (shown in image below). Note that the Adjusted Cost Report is required to be certified and submitted by an officer of the agency or member of the agency’s senior management team.

If the adjusted cost report was successfully submitted, you will see a "submitted" stamp in place of the previous "submit adjustments" button. The adjusted cost report data will be used by the Department to calculate new 2024 rate(s). Please note that the adjusted cost report must be submitted within 45 days of receiving the "Dear Administrator Letter" from the Department. If the Adjusted Cost Report is not submitted within these 45 days, the original 2022 Cost Report and the current 2024 rate(s) will be considered final.