NH Census Rosters Due
Data that will be used to adjust nursing home Medicaid rates for acuity for the first half of 2014 are now being collected on the Health Commerce System (HCS). Homes must submit their July 2013 census roster by Friday, Oct. 25. DOH instructions on the process are copied below. Members and DOH report that the process is going smoothly, but please let us know if you encounter difficulties or errors.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841
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Sent by DOH on 07/26/2013
Dear Nursing Home Administrator:
As a reminder, the next census date for MDS collection is July 31, 2013. The upload period for this census date begins October 7, 2013 and continues through October 25, 2013.
All MDS data for residents on the census roster should be submitted and accepted by CMS no later than September 27, 2013.
After competing a review of assessments which have been filed for the last few assessment periods, the Bureau of Long Term Care Reimbursement is clarifying the assessments to be used for Medicaid reimbursement purposes. Following the rules as stated in the MDS 3.0 RAI Manual, assessments which are not requiredby either the state or CMS will not be accepted for NYS Medicaid reimbursement. From Chapter 5 of the RAI Manual:
Required MDS records are those assessments and tracking records that are mandated under OBRA and SNF PPS.
Assessments that are completed for purposes other than OBRA and SNF PPS reasons are not to be submitted, e.g., private insurance, including but not limited to Medicare Advantage Plans....
Furthermore, BLTCR would like to reiterate the guidelines for Significant Change Assessments:
Guidelines for When a Change in Resident Status in not Significant: Note: this is not an exhaustive list:
• Discrete and easily reversible cause(s) documented in the resident’s record and for which the Interdisciplinary Team (IDT) can initiate corrective action (e.g., an anticipated side effect of introducing a psychoactive medication while attempting to establish a clinically effective dose level. Tapering and monitoring of dosage would not require a SCSA)
• Short-term acute illness, such as a mild fever secondary to a cold from which the IDT expects the resident to fully recover.
• Well-established, predictable cyclical patterns of clinical signs and symptoms associated with previously diagnosed conditions (e.g., depressive symptoms in a resident previously diagnosed with bipolar disease would not precipitate a Significant Change Assessment).
• Instances in which the resident continues to make steady progress under the current course of care. Reassessment is required only when the condition has stabilized.
• Instances in which the resident has stabilized but is expected to be discharged in the immediate future. The facility has engaged in discharge planning with the resident and family, and a comprehensive reassessment is not necessary to facilitate discharge planning.
Any questions regarding case mix or the MDS as it impacts reimbursement should be directed to PRIMail@health.state.ny.us.
Other resources:
• MDS 3.0 RAI Manual (Effective May 20, 2013): http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html
• Open Door Forum (CMS calls for providers): http://www.cms.gov/OpenDoorForums/25_ODF_SNFLTC.asp
• CMS Technical information page, which includes jRaven, etc.: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30TechnicalInformation.html
• MDS 3.0 submission resources (MDS 3.0 and Vendors): https://www.qtso.com CASPER Helpdesk: 1.800.339.9313
*MDS 3.0 training schedule and registration:
http://www.albany.edu/sph/cphce/mds.shtml
• Section Q: http://www.medicaid.gov/search.html?q=Section%20Q
• NYS MDS 3.0 Requirements, including Sections S & Z: http://www.health.state.ny.us/forms/#M
• SNF PPS FY2012 Updates & Clarifications (Nov. 3, 2011): http://www.cms.gov/SNFPPS/03_RUGIVEdu12.asp#TopOfPage
• Medicare Administrative Contractor (MAC, formerly known as Fiscal Intermediary. Contact for reimbursement and eligibility questions): http://www.ngsmedicare.com/wps/portal/ngsmedicare
Phone #:1.888.855.4356
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Resident Assessment Unit
Bureau Of Long Term Care Reimbursement
One Commerce Plaza - Room 1430
99 Washington Avenue
Albany, NY 12210
Phone: 518-474-1057
FAX: 518-402-5392
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On the UPLOAD PAGE of the HCS
- The JULY 2013 upload period will run from October 7, 2013 through October 25, 2013. Please be sure to have your data uploaded during this time period. The database was frozen using data received from CMS dated September 30, 2013.
- Providers are reminded to check all Section S items for accuracy and make changes where appropriate
- Providers should ensure that all changes are saved as part of the web page.