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LeadingAge NY Seeks Clarifications on Completion of MDS Section S

The Department of Health (DOH) received approval earlier this year from the Centers for Medicare and Medicaid Services (CMS) to modify Section S of the Minimum Data Set (MDS) Version 3.0 with an effective date of Oct. 1, 2017. LeadingAge NY has asked DOH to issue modified instructions to guide completion of the revised Section S.

The Section S revisions include the following:

  • S0160. Specialty Unit / Facility Reimbursement, or Resident Eligible for Enhanced Reimbursement (Add-On) for AIDS or TBI Conditions. This existing question was modified to add Neurodegenerative Unit – a new type of discrete unit recently authorized in regulations – as a possible response. No other revisions were made.
  • S0185. Discharge to hospital: Healthcare proxy involvement. This question was added to identify residents who are sent to the hospital at the request of someone who has authority to make health care decisions for the resident (e.g., surrogates and proxies under the Family Health Care Decisions Act), although the facility staff do not believe the hospitalization to be medically necessary. The intent is to possibly use the data to adjust the potentially avoidable hospitalization measure in the Nursing Home Quality Pool.
  • S6500. Comfort Care provided in the last 14 days. This question was added to capture residents who are receiving comfort care and no other care or treatments with curative intent. To meet the criteria of this item, the primary goal of comfort care must be to reduce suffering. The intent is to possibly use the data to adjust the long-stay weight loss quality measure in the Nursing Home Quality Pool.
  • S8015. MMIS Identification Number. This question was added to identify the Medicaid managed care plan the resident is enrolled in, if applicable. LeadingAge NY is seeking a master list of MMIS numbers for mainstream Medicaid Managed Care and Managed Long Term Care plans. We are aware that there is a listing of managed care plan ID numbers posted on the eMedNY website but are seeking verification that these plan ID numbers should be used to complete this item. We expect clarification from DOH by mid-week.

DOH previously provided guidance on Question S8055. Primary Payor, which is posted here.

Members that have questions on the Section S revisions should email them to the State RAI Coordinator at Mds3@health.state.ny.us with a copy to me at dheim@leadingageny.org. Most of the questions we have received thus far are in regard to the definition of “comfort care,” where to obtain MMIS numbers for managed care plans, and whether parties other than healthcare proxies should be reflected in the reporting in the discharge to hospital question.

We will keep members posted on the status of needed clarifications.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866