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Nursing Homes: Please Review MDS Data ASAP, But No Later Than Aug. 5th

The review process of the Minimum Data Set (MDS) census data that will be used to calculate the Case Mix Index (CMI) for July 2022 nursing home Medicaid rates is underway. Providers have until this Friday, Aug. 5th, 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 (please note new email address) within seven days of pressing the “Submit” button indicating that their MDS data is correct. Certifications must be received by DOH no later than Aug. 12th. The Dear Administrator Letter (DAL) is available here, and the certification form is here. Note that the certification needs to be notarized and submitted by email. The Department of Health (DOH) reports that a bit over a quarter of the homes in the state have completed the review and only about 100 have submitted certifications.

This cycle marks the third time that DOH is using the “new” case mix process that relies on all MDS assessments with Assessment Reference Dates (ARDs) that fall within a six-month period rather than the former picture date approach. The process for verifying submitted MDS data is similar to the one used with the picture data approach but requires no census upload by the facility. 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 2022 CMI, all MDS assessments will be used in the calculation as long as:

  • The ARD is between Oct. 1, 2021 and March 31, 2022;
  • 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 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 no longer applies a temporary constraint limiting the CMI increase or decrease to 5 percent relative to the previous CMI measurement cycle.

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 contact us or reach out to NFMDS@health.ny.gov if you have questions regarding the MDS data verification process.

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