Four Due Dates Upcoming for Nursing Home Members
Nursing home members are facing four important deadlines in the upcoming month, several of which are associated with potentially significant financial implications. Given increased financial staff turnover and the possibility of key staff being on vacation, members may want to ensure that they have the necessary reporting interface permissions in place for backup staff.
Medicaid Cost Reports Now Due Aug. 8th
On July 22nd, the Department of Health (DOH) announced a further extension of the due date for the Medicaid Residential Health Care Facility (RHCF) Cost Report. The report along with certifications and any related party financial reports are all now due by Aug. 8th. The original due date of July 11th had been extended to July 25th and has now been further extended to Aug. 8th. With the extensions, it becomes less likely that DOH will offer further flexibilities, so we urge members who have not yet filed to do so by the established date.
Review MDS Data to Be Used for Calculating Acuity (CMI) Adjustments for July 2022 Rates by Aug. 5th
Earlier that same week, DOH kicked off 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. Providers have until Aug. 5th to review the data posted on the Health Commerce System (HCS) to ensure that the correct payer and special population information is reflected. Homes must email the signed and notarized certification to NFMDS@health.ny.gov (new 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.
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 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.
Please Identify MLTC-Enrolled Residents Working Toward Return to Community by Aug. 5th
Also on July 22nd, DOH distributed a DAL and associated materials for the next batch disenrollment of long-stay nursing home residents from Partially Capitated MLTC plans back to Medicaid FFS. This is scheduled for an effective date of Oct. 1, 2022 and marks the seventh such batch disenrollment.
Currently, DOH is working with Partially Capitated MLTC plans to identify members who are in a long nursing home stay who meet the criteria for disenrollment. DOH is asking nursing home providers to use the distributed template to list long-stay MLTC-enrolled residents who are actively working toward a return to the community. Homes are asked to email the list to DOH no later than Aug. 5th. The DAL is here.
Next Quarterly Payroll-Based Journal Data Submission Due by Aug. 14th
Payroll-Based Journal (PBJ) data submissions covering April 1st through June 30, 2022 must be finalized with the Centers for Medicare and Medicaid Services (CMS) by Aug. 14th. PBJ submissions have been the basis for calculating the staffing domain of the Five-Star Quality Rating System for several years, and they are now being used to compute staff turnover and weekend staffing rates currently being displayed on Nursing Home Compare. Starting next week, CMS expects to incorporate these measures into the Five-Star calculation.
In addition, this marks the first quarter of PBJ data that New York State plans to utilize to measure compliance with State staffing level requirements and assess penalties. Only data that are successfully submitted by the deadline are used in Five-Star calculations, and inaccurate or missing submissions can result in a home being assigned a single star for the staffing domain for one quarter.
Members should be certain that their homes are accurately reflecting in their reporting the requirement that they have a registered nurse (RN) on site for at least eight consecutive hours, seven days per week. The latest version of the PBJ Policy Manual and related resources are available for download at the bottom of the dedicated CMS PBJ webpage here. The user guide for uploading data through the CMSNet Secure Access Service is available here.
The following information may be of interest to staff new to PBJ reporting and highlight areas of concern identified by CMS that may warrant special attention to ensure accurate reporting:
Meal Breaks. Meal breaks must be subtracted from PBJ-reported time regardless of whether staff worked through lunch or actually took the break. When reporting, you must deduct the time allotted for meals from each employee’s daily hours.
RN Staffing. Providers should ensure that they are meeting the requirement to have an RN on site for at least eight consecutive hours, seven days per week; that their reporting accurately reflects the hours; and that they are able to readily provide necessary documentation to back up the reporting.
Varying Roles and Universal Workers. While reporting is based on primary roles, CMS recognizes that staff may completely shift their primary role in a given day, and in those cases, facilities can change the designated job title and split the staff member’s hours into two separate job roles during a shift if warranted. For facilities that use universal care workers, a reasonable methodology must be used to separate the time that the universal care worker spends performing their primary role from their time that is spent performing other activities. The PBJ Frequently Asked Questions (FAQs) provide further examples.
High, Low, and Fluctuating Hours. CMS and their contract auditors appear to focus on reporting that indicates unreasonably high or low work hours, large variations in weekday versus weekend staffing, as well as low weekend staffing.
Calendar Day Reporting. Staff hours must be reported on a calendar day basis. Providers are required to split shifts that straddle midnight into individual calendar days. For example, if an employee works a shift that starts at 11 p.m. and ends at 7 a.m., one hour would need to be reported for day 1 and the remaining six hours for day 2. CMS has indicated its understanding that employees may be paid per shift and not per calendar day and will consider this when conducting audits.
Training Time. Hours for staff who are attending training (either on site or off site) and are not available to perform their primary role, such as providing resident care, should not be reported. If another staff member is called in to fill in for staff participating in training, the hours for the replacement employee should be reported.
Staff Identifiers. With CMS seeking to incorporate turnover rates into the Five-Star Quality Rating System later this year, providers should ensure that the systems they have in place to identify individual workers, including contract staff, are working and that continuity was preserved if providers updated or changed their worker identifier systems.
CMS recommends that providers take advantage of the verification resources after uploading their data to ensure a successful submission.
Once the data is uploaded, the system will remind the user to:
- Check the My Submissions page. This feature will show the status of the zip file.
- Check the Certification and Survey Provider Enhanced Reporting (CASPER) application for a system-generated PBJ Final File Validation Report (FFVR) within 24 hours. If no FFVR appears, run a PBJ Submitter FFVR to check your file for errors.
- Run the PBJ 1702D (by Employer) or 1703D (by Job Type) Reports to verify that the submitted quarterly PBJ data accurately reflects your records.
Information from CMS describing the various PBJ reports providers may access, including general and detailed MDS census reports, is available here.
Because daily census is an important component of the PBJ staffing calculation and is derived from MDS submissions, providers should ensure that MDS assessments, including discharge records, are filed in a timely way. Please note that accurate and timely PBJ reporting also has implications for the facility's Nursing Home Quality Initiative (NHQI) score calculation.
The current PBJ Manual (dated November 2018) is available here, and an accompanying FAQ document is here.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841