DOH Asks Nursing Homes to Submit Additional MDS Data Points
(May 27, 2025) In a Dear Administrator Letter (DAL) issued last week, the Department of Health (DOH) requested that nursing homes complete three optional items on Medicaid (i.e., Omnibus Budget Reconciliation Act (OBRA)) quarterly Minimum Data Set (MDS) assessments. These items are needed to assign a complete Patient-Driven Payment Model (PDPM) Health Insurance Prospective Payment System (HIPPS) code (i.e., Medicare payment code) for non-Medicare residents. The ability to assign a full HIPPS code will allow Myers and Stauffer, the firm with which the State has contracted for assistance in updating the methodology used to adjust nursing home Medicaid rates for resident acuity, to complete their data analysis. DOH asks that providers begin including these items on all MDS assessments no later than June 1st.
We have reached out to members as well as several MDS software vendors seeking to verify that the State’s June 1st request does not pose a problem should a software update be required. While we have heard just two concerns, please let us know if you encounter any impediments. DOH assured us that they would try to assist as needed. The DAL is here. Our previous article with background on the issue is available here.
This also provides an important opportunity for members to review their internal procedures to ensure that their assessments are accurately capturing not only the dynamics critical for care planning and quality outcomes, but also those that may result in lost reimbursement if not appropriately identified and documented. While the exact contours and timeframes related to the replacement Medicaid case mix methodology are not known, it seems almost certain to include the nursing categories utilized in Medicare PDPM reimbursement. Members would do well to ensure that key MDS staff are well versed in the Medicare reimbursement methodology, and that nursing staff involved in completing assessments of Medicaid residents are aware of Medicare reimbursement principles. We invite members to reach out with questions.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841