In September 2023, the New York State Department of Health (DOH) notified nursing facilities (NFs) of the DOH’s effort to clear a backlog of certain outstanding rate appeals that remain open in the Electronic Appeals System. The deadline for participating in the DOH’s effort, which was originally extended from October 30, 2023, to January 8, 2024, has been further extended to January 16, 2024, to allow NFs additional time to consider new guidance from the DOH regarding appeals filed by prior ownership.
To participate in the process, a NF’s appeal must be listed on the “Open Appeals Listing” tab of the Open Appeals Impact Workbook. NFs in New York State should review the listing and verify whether any of their open appeals are eligible and evaluate whether and how to respond before the January 16 deadline. The DOH requires that any response include a completed Open Appeal Impact Workbook and an Open Appeals Attestation. The DOH discourages any attempt to modify the workbook or attestation forms and will purportedly refuse to consider any responses that include changes to the forms.
It is unclear whether extensions will be granted upon request or whether late submissions will be considered. In its September 2023 webinar concerning this process, the DOH stated that failure to respond means the DOH “cannot handle your appeal” and that those appeals may remain open. The DOH’s response was ambiguous concerning whether and when it will address any eligible appeals for which no response is provided.
The DOH advised that any questions regarding this process should be sent to NFRATES@health.ny.gov with “NH Appeals Processing Forms” in subject line, and that any questions regarding access to the Electronic Appeals System should be sent to rhcf-hcs@health.ny.gov.
If you have any questions regarding the content of this alert, please contact Michael Scott-Kristansen, special counsel, at mscott@barclaydamon.com, or another member of the firm’s Health & Human Services Providers Team.