Roster Submission Window Opens Oct. 3rd
Nursing homes should make sure to submit any needed corrections to MDS assessments that will be matched to residents listed on the home’s April 25th and July 25th picture date census rosters by Sept. 27, 2018. The Department of Health (DOH) will “freeze” the MDS database on Sept. 28th. Any corrections or updates to MDS assessments should be done in accordance with regulations and RAI manual instructions. If DOH is not able to match a resident listed on the picture date roster with an MDS assessment on file with the Centers for Medicare and Medicaid Services (CMS), that resident will default to the lowest RUG category and be counted as a Medicaid resident. Such defaults are likely to negatively impact Medicaid reimbursement.
Homes will need to upload the rosters between Oct. 3rd and 26th. Roster certifications must be submitted by email by Oct. 31st. The assessment data from the two picture dates will be used to calculate the case mix index (CMI) used in January 2019 Medicaid rates. The Dear Administrator Letter (DAL) notifying providers of picture and upload dates is available here.
Unlike previous years when the CMI reflected in January rates was calculated using MDS assessments associated with the last Wednesday of the prior July, the CMI in the Jan. 1, 2019 rate will be based on two picture dates: April 25th and July 25, 2018. DOH has not determined how data from the two picture dates will be blended nor is it clear whether this methodology will be adopted going forward.
The State is making this change due to continuing concern about case mix growth and to implement a provision included in the enacted state budget that requires an annual CMI-related savings of $15 million. LeadingAge NY is urging DOH to ensure that Medicaid rate decreases driven by this change are mitigated and to share information that would allow providers to budget for the impact as soon as possible.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841