Data Verification Process for Determining July 2020 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 July 2020 nursing home Medicaid rates. This round is keyed to a Jan. 29th picture date and will use the most recent MDS assessment with an Assessment Reference Date (ARD) between Oct. 29th and Jan. 29th for existing Medicaid residents, and an ARD through Feb. 11th for new residents.
Please note that this process does not apply to specialty facilities and units, since case mix updates are not being made to specialty rates.
Members may recall that beginning with the previous round, DOH is using a streamlined roster process. The slides from the Department’s June webinar describing the process 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 the 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 Oct. 29th and Jan. 29th, even if that resident had been discharged prior to the Jan. 29th census picture date. Providers should identify those residents who were in the facility on the Jan. 29th picture date and ensure that they have complete and correct MDS data on file with CMS. This step must be completed by this Fri., Nov. 27th.
DOH will then update the MDS data posted on the HCS based on an updated extract of federal data. Providers will have from Dec. 2nd through Dec. 31st 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), and Fully Integrated Duals Advantage (FIDA)) when calculating the CMI.
For issues that require DOH assistance, please contact MDSBRHCR@health.ny.gov. Please be sure to use secure transfer if sending any resident-identifying information. Instructions for using the secure transfer function of the HCS are provided on page 22 of the webinar slides. Please note that an enhancement has been added for this round that will allow a provider that has finalized the match to update roster information without having to contact DOH staff to request that it be “unlocked.”
The final step in the process is the filing of the Operator Certification, which will be due on Jan. 8th.
The new roster verification process has no impact on how the CMI is calculated or on the MDS assessments that are used for the calculation. It simply provides a more efficient way for DOH to compile, and for providers to verify, the data that is customarily used for calculating CMI.
Although the State had indicated the intention to combine the roster verification processes that would be used to determine the CMI for both July 2020 and January 2021 rates, they have opted to do the two collections sequentially. Providers should expect the next round to begin soon after this one is completed.
We urge members to review their facility data carefully for accuracy, to submit any needed MDS corrections to CMS by Nov. 27th, and to let us know if they encounter any difficulties with the process.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841