Nursing Homes Must Complete Roster Match by July 17th
We remind members that the process for verifying and correcting Minimum Data Set (MDS) data that the Department of Health (DOH) will use to adjust January 2020 nursing home Medicaid rates for acuity is coming to a close. Homes have until Fri., July 17th to verify or correct the information on the Health Commerce System (HCS) for those residents who were in the facility at midnight on July 31, 2019, and to set the match. Once the data is validated and the “Set Facility Match” button is activated, homes have 14 days to make any final corrections. However, providers should make sure that final changes are completed and the required certification form is filed by July 24th.
After the 10-day period during which providers had the opportunity to submit additional or corrected MDS information to the Centers for Medicare and Medicaid Services (CMS), DOH downloaded the updated federal file and used it to update the MDS data reflected on the HCS. This initiated the two-week validation period that comes to a close on July 17th. The Dear Administrator Letter (DAL) that lays out the schedule is available here, and the slides used by DOH to outline the new process are here.
Indications from members and information from DOH suggest that the new, streamlined approach that DOH developed is operating as expected. While the process reduces the number of instances where DOH staff intervention is required, providers should reach out to DOH for Assessment Reference Date (ARD) changes, to add residents who were in house but are not listed, to add or remove a resident after matching is completed, or to make changes to a finalized file. For 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 in the new process, DOH provides a list of ALL residents for whom a facility filed an MDS assessment during the specified period. Homes are then required to identify and select only those residents who were in house on the July 31, 2019 picture date, verify the MDS data for only these residents, and click on the “match” box for each of these residents when ready to confirm the resident information. 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 Case Mix Index (CMI).
We remind members that the new 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.
We urge members to familiarize themselves with the webinar slides, to review their facility data carefully for accuracy, to file the certification by July 24th, and to let us know if they encounter any difficulties with the process.
As reported previously, DOH will be issuing January 2020 rates in two waves. The first wave will feature an update to the capital component and reflect minimum wage funding updates, but will not include a CMI update. These first wave rates are currently under review with the Division of the Budget (DOB). Once the roster process is complete and DOH calculates the CMI, January 2020 rates will be reissued to reflect the updated CMI. Providers should also expect to receive April 1, 2020 rates that will incorporate the State Budget provisions reducing the capital component by 5 percent. Soon after the current roster verification process is complete, DOH will initiate the same process for establishing the CMI to be used in July 2020 rates, which is expected to rely on a Jan. 29, 2020 picture date.
Please contact us if you have questions or if you encounter difficulties in resolving any roster discrepancies with DOH.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841