Nursing Home Census Roster

Nursing home members are reminded to upload their July 30, 2014 census roster via the Health Commerce System (HCS) by Friday, Oct. 17.  This information is used to adjust Medicaid rates for resident acuity.  Homes that encounter situations that require DOH staff intervention should contact DOH using the PRIMail@health.ny.gov email.  Although a response from DOH may take several days, all situations are eventually addressed.   

Last week DOH issued a clarification regarding a 2013 CMS change in how therapy days are counted.  It appears that some MDS software programs are not taking the change into account when calculating RUGs for Medicaid residents.  As a result, some homes have seen discrepancies between the RUG scores assigned by DOH and those assigned by their own MDS software.  Per DOH policy, New York State adopts CMS changes to its Medicaid RUG scoring methodology. 

Homes seeking corrections from DOH should review the discrepancies to ensure that they are not driven by this CMS change regarding distinct therapy days.  The notice DOH sent on the issue is copied below.

Contact:  Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841 

---------------  

From: "Baker, Linda (HEALTH)" <linda.baker@health.ny.gov>
Subject: 2014-2 MDS Clarification of New CMS Item

Dear Administrator/HPN Coordinator:

In October 2013 CMS instituted a new item to help clarify the classification criteria for rehabilitation RUGs categories which adds Item O0420, Distinct Days of Therapy, to count the calendar days of therapy needed to be classified into the Low and Medium rehab RUG categories.

The former system added together the days of therapy to determine the number of days a resident received to qualify for the Medium or Low Rehab categories.  Adding together the days of therapy was not the original intent to score residents.  Therefore in October 2013 CMS clarified the Medium and Low rehab therapies to include the use of new item O0420 to count the distinct days of therapy.

It is the Department’s policy to apply all CMS rule changes, item updates and rule interpretations and the Department has therefore applied item O0420 (Distinct Days of Therapy) to the scoring process.  This change to the scoring was included beginning January 2014 collection and will remain in effect for future collection cycles.

Questions regarding the MDS and scoring for reimbursement may be sent to PRIMail@health.ny.gov