New Regulation

The regulation governing MDS has been updated; please see following link.

Public Health Law

• The January and July census dates have been eliminated.
• The 5% constraint on case mix index changes from one period to the next has been eliminated.
• The Case Mix Index (CMI) calculation will be based on an average of all Medicaid assessment for a six-month period.
• The July 21 CMI will include ALL assessments submitted to CMS from October 1, 2020, through March 31, 2021.
• The MDS Certification form has been amended and continues to be required.
• Failure to submit or to certify may result in penalties of up to $2,000 per day as per Public Health Law §12

Previous MDS Process

• The MDS collection was based on a specific census date in January and July.
• The MDS data included ONLY assessments with an ARD:
  • within 92 days prior to the census date
  • and within 13 days post census date.
• DOH extracted and scored assessment data from CMS
• DOH posted ONLY the assessment closest to the census date on the HCS.
• NHs were required to review their data on HCS for completeness.
• NHs could:
  • view and change certain data prior to matching.
  • make and save changes to HCS data prior to matching.
  • select and match residents on the HCS.
• Matching and correcting residents´ information was done in one step.
• NHs were required to certify to the data matched on the HCS.

July 2021 MDS Process

• ALL Medicaid assessments within a 6-month period will be used.
• The case mix index will be calculated using an average of ALL valid assessments for the period.
• NHs must ensure all assessments are submitted to CMS timely and accurately.
• There will no longer be a reminder to submit data to CMS prior to the extraction.
• Once extracted, the data will be scored and then posted on the HCS for facilities to review.
• The facility specific Case Mix Index will be calculated the same way it has been in the past, except now there are more data points.
  • The sum of all MEDICAID RUG weights for a facility
  • Divided by the number of assessments

Example for Facility Case Mix Index Calculation

• Resident 1 - 1.07
• Resident 1 - 1.13
• Resident 1 - 0.88
• Resident 2 - 1.01
• Resident 2 - 1.71

• RUG total is 1.07+1.13+0.88+1.01+1.71=5.8
• Facility Specific Case Mix Index is 5.8 / 5 = 1.16
• If there are no changes, the facility can immediately press the "Submit" button.
• If there are changes, facilities will be able to modify the BMI, TBI, and Dementia categories as well as payor source and approved specialty programs, and then press the "Submit" button.
• Once the HCS file is submitted, consistent with prior practice, the facility is required to submit certification.
• Effective with the July 2021 rates, there will no longer be a 5% constraint on case mix index changes.

July 2021 MDS Timeline

Instructions to View/Update HCS File

Steps to review DOH File on HCS:

• Login to the MDS for NF Reimbursement section of the HCS
• Click on View /Submit MDS Census Records
• Select the NH opcert
  • (where applicable - if a NH only have access to one facility it will be visible. If the NH have access to more than one facility you will need to select a facility)
• Click Continue
• Select Assessment Period: 2021-1 Open
• Click Next
  • The steps listed above are consistent with previous collections, the steps that follows are new beginning with this MDS Census Collection.
• Click on the View/Match Residents to view the list of ALL residents

• DOH NH File Will Open.
  1. HCS will show all resident with an ARD between October 1, 2020, and March 31, 2021.
  2. NH will review the data.
  3. NHs will be able to update payer source, Dementia, BMI and the specialty indicator before or after submitting their file.
  4. After review is complete press the “Back To Top" button at the end of the page.
  5. Select “Save Changes" button
  6. NHs MUSTsubmit the file by pressing the “Submit" button.

There will be multiple assessments for each resident, as shown here.

Check the update box in far-right column and save changes

Contact the Department at MDSBRHCR@health.ny.gov If secure communication is required (i.e.: Protected Health information), please use secure communication (guidance below):

1. Log into the Health Commerce System
2. Under the My Applications (left side if the page) select Secure File Transfer 2.0
3. Select Launch Secure File Transfer 2.0
4. Select Send Package
5. In the TO: box enter BLTCRMDS Group
6. Complete the SUBJECT box
7. In the NOTE: box please describe the issue
8. Attach any file you feel is needed for clarity.
9. Select SEND