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Case-mix Delays, Transportation Discussed at Monthly DOH Meeting

At a May 10th meeting with LeadingAge New York and other associations, Department of Health (DOH) officials acknowledged ongoing concerns about delays in making case-mix index (CMI) adjustments to nursing home rates. DOH attributed the delays to their own rate setting processes, facility roster submission and validation delays, and protracted OMIG audits.

DOH discussed a possible alternative to the current system which could eliminate the need for facilities to submit and validate roster information, and for the Department to process these submissions. Under the proposal, DOH would use a “midpoint” method instead of the census date snapshot by collecting all MDS records for the given period; identifying and scoring the MDS assessment that is closest to the midpoint date for each unique resident, and calculating an average CMI score of all Medicaid residents.  The CMI adjustments could be performed twice a year as they are now or more/less frequently. DOH agreed to our request to run a comparison of the CMI results from the current roster system to the results of this new method and to share it with us. In the meantime, LeadingAge NY is seeking member input on this proposal.

DOH also updated the group on the removal of base year transportation costs from the direct component of nursing home rates, as authorized in the 2016-17 State budget. LeadingAge NY had expressed concerns that the base year costs include activities- and other non-medical transportation services, which should not be removed because they are not duplicate payments. DOH reviewed the transportation cost data submitted by facilities in Schedule 8C of the 2007 cost reports and found evidence of missing/bad data. DOH suggested two options: (1) use the available Schedule 8C data to try to factor out non-medical transportation costs; or (2) survey facilities using a tool like Schedule 8C to obtain the data. DOH agreed to provide us with a draft of the survey, and seeks our input on the available options.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8383, ext. 128