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Nursing Homes Must Review MDS Data by June 7th

The window to review Minimum Data Set (MDS) information that will be used to calculate the Case Mix Index (CMI) for July 2023 nursing home Medicaid rates has started. Providers have until June 7th to review the data posted on the Health Commerce System (HCS) to ensure that MDS assessments that should be included are captured and that the correct payer and special population information is reflected.

Homes must email the signed and notarized certification to NFMDS@health.ny.gov within seven days of pressing the “Submit” button indicating that their MDS data is correct. Certifications must be received by the Department of Health (DOH) no later than June 14th. The Dear Administrator Letter (DAL) is available here. The certification form is here. Note that the certification needs to be notarized and submitted by email to NFMDS@health.ny.gov (note that the DOH confirmation email may list an outdated email address).

The case mix setting process relies on all MDS assessments with Assessment Reference Dates (ARDs) that fall within a six-month period rather than the former picture date approach. Providers need to navigate to the appropriate section of the HCS (for a refresher, see slides 18-20 of the 2021 DOH presentation posted here) and review the list of assessments with ARDs within the catchment period. As in previous MDS verification cycles, providers will be able to update the payer status, the specialty unit indicator, as well as the special population flag (i.e., Dementia, BMI, TBI). Note that any changes made using the drop-down menus are meant to ensure that the information reflected is accurate at the time of the ARD of the assessment in question.

For purposes of establishing the July 2023 CMI, all MDS assessments will be used in the calculation as long as:

  • The ARD is from Oct. 1, 2022 through March 31, 2023;
  • Medicaid is the payer at the time of the ARD;
  • The assessment provides sufficient information to generate a Resource Utilization Group (RUG) score.

Additionally:

  • All MDS assessments meeting the criteria above submitted to CMS by May 18, 2023 will be used in the calculation, including those filed for residents who have since been discharged.
  • The CMI will be calculated by averaging all of the RUG score weights for assessments that meet the criteria above.
  • Assessments are not day-weighted. In other words, the RUG score weights from all assessments meeting the criteria above will be summed and divided by the total number of assessments filed.

Consistent with prior practice, the following payers are included in the CMI calculation: Medicaid fee-for-service (FFS), Medicaid pending, Medicaid Managed Care, and Managed Long Term Care (MLTC), including Programs of All-Inclusive Care for the Elderly (PACE) and Medicaid Advantage Plus (MAP).

DOH is accepting questions at NFMDS@health.ny.gov but reminds providers to use the secure transfer application addressed to BLTCRMDS Group if sending resident-identifying information (instructions for using secure transfer appear on page 24 of the 2021 DOH slide presentation). Please let us know if you encounter any issues with the process.

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