Medicaid Rates & MDS Audits

DOH is currently analyzing the financial impact of updating 1/1/13 Medicaid rates for Case Mix Index (CMI) changes.  The department reports a statewide CMI increase from January 2012 to July 2012 of 1.5 percent.  Upon finding what the statewide cost will be to incorporate the July 2012 census roster-based CMI into 1/1/13 rates, DOH will determine whether to apply a five percent constraint to homes whose Medicaid CMI change exceeded five percent from January 2012 to July 2012.  Whether a constraint is applied or not, the state aims to make rate adjustments by the end of October.

The Office of the Medicaid Inspector General (OMIG) is continuing January 2012 MDS audits of the 300 homes whose CMI increases exceeded five percent from 1/1/11 to 1/1/12 and has selected 250 homes for July 2012 MDS audits using similar criteria.  For homes slated for audit of both MDS submissions, OMIG is performing both audits in one visit when possible.  OMIG has completed most MDS audits in the Capital Region and the Western part of the state and is currently focusing its efforts on Central New York.  The Hudson Valley region is scheduled for the fall with these rounds of audits slated for completion in New York City and Long Island by mid-February of 2014.  Members report that the audit process is fair while OMIG reports that most homes have been good at having the necessary records ready and available making the audits quick and efficient. 

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