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Data Verification Process for Determining January 2021 Case Mix Is Underway

The Department of Health (DOH) has circulated the Dear Administrator Letter (DAL) listing the timeline for the next round of Minimum Data Set (MDS) census roster verification. This process will be used to calculate Case Mix Index (CMI) adjustments for January 2021 nursing home Medicaid rates. This round is keyed to a July 29, 2020 picture date and will use the most recent MDS assessment with an Assessment Reference Date (ARD) between April 28th and July 29, 2020 for existing Medicaid residents, and an ARD through Aug. 11th for new residents.

Please note that this process does not apply to specialty facilities and units, since case mix updates are not currently being made to specialty rates.

This cycle marks the third time that DOH is relying on a streamlined process. The slides from the Department’s June webinar describing the approach are available here, and the full archived webinar is here. (Please note that while the information in the presentation is correct, the dates shown on the slides are not updated and still indicate the schedule from a prior collection period.)

The first step in the process requires nursing homes to review the list of residents that DOH has posted on the Health Commerce System (HCS) and submit any additional or corrected information to the Centers for Medicare and Medicaid Services (CMS) if necessary and appropriate. This list includes any resident whose MDS had an ARD between April 28th and July 29, 2020, even if that resident had been discharged prior to the July 29th census picture date. Providers should identify those residents who were in the facility on the July 29th picture date and ensure that they have complete and correct MDS data on file with CMS. This step must be completed by April 5th.

DOH will then update the MDS data posted on the HCS based on an updated extract of federal data. Providers will have from April 8th through May 7th to verify that the correct MDS assessment is being matched to each resident and “set the match.” While providers are required to do this for all residents in house on the picture date, regardless of payer, DOH will only use Medicaid residents (Medicaid, Medicaid Pending, Medicaid Managed Care, Managed Long Term Care (MLTC), Program of All-Inclusive Care for the Elderly (PACE), Medicaid Advantage Plus (MAP)) when calculating the CMI.

We remind members to be sure to use secure transfer when communicating with DOH about any resident-identifying information. Instructions for using the secure transfer function of the HCS are provided on page 22 of the webinar slides.

The final step in the process will be the submission of the Operator Certification by email, which will be due by May 14th.

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