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MDS Data Verification Process Hits the Homestretch

We remind member nursing homes that May 7th is the deadline for providers to review and “set the match” verifying that the correct Minimum Data Set (MDS) assessment is matching to each resident who was in the facility on July 29, 2020. This process will be used to calculate Case Mix Index (CMI) adjustments for January 2021 nursing home Medicaid rates. The Department of Health (DOH) asks that providers set the match as soon as possible and submit the required certification by email to MDSBRHCR@health.ny.gov within seven days of setting the match.

The Dear Administrator Letter (DAL) dated March 19th that outlines the timeline of the process is available here, and the revised version dated April 16th is here(Note that the only change to the DAL is the replacement of the sentence “Please ensure your corrections are done by May 7, 2021 in order to meet the certification deadline” with “PLEASE ENSURE YOUR CERTIFICATION IS RECEIVED WITHIN SEVEN CALENDAR DAYS AFTER MATCHING.”)

The verification process does not apply to specialty facilities and units since case mix updates are not currently being made to specialty rates. 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.

If the system selects the incorrect MDS assessment or does not list all residents who should be listed, please contact DOH at MDSBRHCR@health.ny.gov. We remind members that the secure transfer application should be used if a message contains any resident-identifying information. Instructions for using the secure transfer function of the Health Commerce System (HCS) are provided on page 22 of the Department's June 2020 webinar slides.

The final step in the process is the submission of the Operator Certification. Although the deadline for the certification is May 14th, DOH requests that members not delay and submit that form as soon as they have set the match. The certification should be submitted to MDSBRHCR@health.ny.gov with "2020-2 MDS Certification" in the subject line. If you encounter any difficulties, please let us know.

Although the picture date methodology is being used to gather information to calculate the CMI that will be used in January 2021 rates, the State has indicated its intention to try to change the CMI methodology, this time through regulation. The previous attempt to move to a methodology that would base the case mix calculation on all MDS assessments filed (instead of utilizing the picture date approach) was blocked by the State Supreme Court (info here). The prospect and timing of such an intended change that also requires federal approval is not clear. However, it would be prudent to ensure that each assessment done for a Medicaid resident is treated as if it would be used in the CMI calculation. 

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