Preparing for Nursing Home Case Mix Changes
Document, capture, and record resident needs, characteristics, and services in an accurate and holistic way, and you will be on the path to success no matter what the acuity measurement methodology might be. That was a key message from HealthPRO Heritage presenter Kristy Yoskey during last Wednesday’s (Aug. 23rd) LeadingAge NY member webinar on the changes coming to how case mix is measured for Medicaid rate-setting purposes in NY’s nursing homes.
The well-attended session, recorded and available to members here, started with an outline of what is known about the case mix freeze that the Department of Health (DOH) is expected to implement as the State transitions away from Resource Utilization Group (RUG)-III and toward a Patient-Driven Payment Model (PDPM) methodology that would resemble what is currently used to determine Medicare Part A rates. Minimum Data Set (MDS) assessments with Assessment Reference Dates (ARDs) from April 1st through Sept. 30, 2023 will be used to determine the case mix reflected in January 2024 rates, after which the State will no longer have ready access to data that would allow residents to be categorized into RUGs. The case mix in those January 2024 rates is likely to be frozen and remain until the new methodology is implemented.
The second part of the session focused on clinical matters, stressing that ensuring or establishing sound practices for completing and checking assessments will serve nursing home providers well whatever reimbursement methodology may be in place. Data submitted during the freeze may very well be analyzed and used, so for those in a RUG-III mindset, the time to focus on the comprehensive clinical needs and characteristics of the residents, from rehab to nursing to non-therapy ancillaries, is now. A review of completed MDS assessments to ensure that documented services are accurately coded, especially for residents in lower scoring categories, may be time well spent. The discussion of these and other coming changes will continue at the LeadingAge NY Financial Professionals Conference on Sept. 11th-13th, which will feature a preconference intensive on the financial implications of the soon-to-be-updated MDS along with a myriad of other practical and strategic sessions, including a presentation by the Office of the Medicaid Inspector General (OMIG) on the new self-disclosure requirements.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841