Distinct Days Rule Delayed for Medicaid

LeadingAge New York is pleased that the State will delay the implementation of the Distinct Days of Therapy rule for Medicaid purposes. This rule will NOT be applied when calculating the Medicaid Case Mix Index (CMI) for Jan. 1, 2015 nursing home Medicaid rates. Although DOH did initially apply the rule when assigning RUG categories during the recent July 2014 census roster submission period, they will automatically reverse this for affected residents. DOH intends to post the revised scoring to the Health Commerce System within the next few days. Facilities will not be required to re-upload their census rosters; the changes to scoring will be made by DOH staff.  

The issue revolves around item O0420 of the MDS regarding how therapy is provided to nursing home residents. This item requires that in order to score in the Medium Rehabilitation hierarchy, a resident must receive the appropriate number of minutes of therapy on five distinct days. For the Low Rehabilitation hierarchy, a resident must have the appropriate minutes of therapy over three distinct days. Medicare implemented this change in 2013.    

Please note that this is a temporary delay and that starting with the January 2015 census roster (i.e., July 2015 rates), DOH will implement this change when scoring Medicaid residents to bring the State in line with Medicare rehabilitation rules and definitions.

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