Data Verification Process for January 2021 CMI Calculation Begins
The Department of Health (DOH) has announced the timeline for the Minimum Data Set (MDS) data verification process that will be used to calculate the Case Mix Index (CMI) acuity adjustment in the January 2021 Medicaid rates. The State is using a July 29, 2020 “picture date,” which will encompass MDS assessments back to April 28, 2020. For new admissions, DOH will use MDS assessments through Aug. 11, 2020.
As outlined in the Dear Administrator Letter (DAL) available here, homes have until March 24th to submit or correct any missing MDS data with the Centers for Medicare and Medicaid Services (CMS) for the initial DOH download. Once the Department downloads the MDS database, providers will have from March 26th to April 5th to review the data and submit any other necessary and appropriate MDS updates to CMS. At that point, DOH will re-extract the database. Homes will have from April 8th to May 7th to verify that the correct MDS assessment is matched to each resident in house on the picture date. As always, homes are required to match MDS assessments to all residents who are in the facility on the picture date, although only Medicaid residents (Medicaid fee-for-service (FFS), Medicaid managed care – Managed Long Term Care (MLTC) and mainstream, Program of All-Inclusive Care for the Elderly (PACE)/Medicaid Advantage Plus (MAP), Medicaid pending) are used in the CMI calculation. Administrator certifications are due no later than May 14th.
Please note that the MDS assessment catchment period includes a time period when MDS submission waivers were in place and many homes were being significantly impacted by the pandemic. Any member that has a concern that the pandemic may have impacted their MDS submissions in a way that would result in an unrepresentative CMI calculation is asked to contact us as soon as possible.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841