Day Weighted Resident Rosters New Jersey Department of Health and Senior Services AND July-August...
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Transcript of Day Weighted Resident Rosters New Jersey Department of Health and Senior Services AND July-August...
Day WeightedResident Rosters
New Jersey Department of Health and Senior Services
AND
July-August 2010
NJ Department of Health and Senior Services
Background
Proposed regulations N.J.A.C 8:85– Effective July 1, 2010
DHSS contracted with Myers and Stauffer
Case mix rate modelsPoint in time resident rostersDay weighted resident rosters
NJ Department of Health and Senior Services
Resident Roster Training Agenda
Limited to day weighted resident rosters Target audience
– Administrator, Director of Nursing, MDS Coordinator and MDS Data Entry Personnel
How preliminary rosters are created How to review the rosters How to correct the rosters, when appropriate Final resident roster Where to get help MDS 3.0 plans
NJ Department of Health and Senior Services
Preliminary Resident Rosters
MDS data from the NJ Health Facilities Assessment and Survey division
State report sub-directories on the MDS 2.0 submission site
NJ Department of Health and Senior Services
NJ Department of Health and Senior Services
NJ Department of Health and Senior Services
Preliminary Resident Rosters
January 1, 2010 through March 31, 2010 resident roster– Preliminary rosters posted August 5, 2010– Review period through August 18, 2010– Final rosters posted September 1, 2010
April 1, 2010 through June 30, 2010 resident roster– Preliminary rosters posted September 8, 2010– Review period through September 22, 2010– Final rosters posted October 6, 2010
NJ Department of Health and Senior Services
Ongoing Schedule
Resident Roster Quarter
Preliminary Resident Roster Distributed:
Final Resident Roster Distributed:
January 1 – March 31
May 10 for submissions through April 20
June 20 for submissions through May 31
April 1 – June 30 August 10 for submissions through July 20
September 20 for submissions through August 31
July 1 – September 30
November 10 for submissions through October 20
December 20 for submissions through November 30
October 1 – December 31
February 10 for submissions through January 20
March 20 for submissions through February 28
NJ Department of Health and Senior Services
Example Resident Roster
Preliminary Page 1 of 2
Provider Number: 12000Provider Name: SAMPLE FACILITY
Resident Type/ RUG-III Payment
Resident Name ID Reason(s) Group Start Date Field End Date Days Source CMI
Resident 1 10001 Q/05 CA2 04/01/10 04/29/10 29 Medicaid 1.06
Y/02 PC1 04/30/10 A3a 06/30/10 62 Medicaid 0.81
Total days: 91
Resident 2 10002 Q/05 PD1 04/01/10 06/19/10 80 Medicaid 0.89
Y/02 PD1 06/20/10 A3a 06/30/10 11 Medicaid 0.89
Total days: 91
New Jersey MedicaidDay Weighted CMI Resident Roster
For the Quarter 04/01/2010 - 06/30/2010Records Received as of 07/20/2010
NJ Department of Health and Senior Services
MDS 2.0 Type and Reason Codes
OBRA Assessment Assessment
Type
Assessment Reason (AA8a)
Type and
Reason
Admission assessment A 01 A/01
Annual assessment Y 02 Y/02
Significant change in status assessment Y 03 Y/03
Significant correction of prior full assessment Y 04 Y/04
Quarterly assessment Q 05 Q/05
Significant correction of prior quarterly assessment Q 10 Q/10
NJ Department of Health and Senior Services
MDS 2.0 Type and Reason Codes
Non-OBRA Assessment Assessment
Type
Assessment Reason (AA8a)
Type and
Reason
None of Above O 00 O/00
NJ Department of Health and Senior Services
MDS 2.0 Type and Reason Codes
PPS (Medicare) Assessment Assessment
Type
Assessment Reason (AA8b)
Type and
Reason
5 day assessment M 1 M/1
30 day assessment M 2 M/2
60 day assessment M 3 M/3
90 day assessment M 4 M/4
Readmission/return assessment M 5 M/5
14 day assessment M 7 M/7
Other Medicare required assessment M 8 M/8
NJ Department of Health and Senior Services
MDS 2.0 Type and Reason Codes
MDS Tracking Forms Assessment
Type
Assessment Reason (AA8a)
Type and
Reason
Discharge – return not anticipated D 06 D/06
Discharge – return anticipated D 07 D/07
Discharge prior to completion of initial assessment D 08 D/08
Re-entry R 09 R/09
NJ Department of Health and Senior Services
Example Resident Roster
Preliminary Page 1 of 2
Provider Number: 12000Provider Name: SAMPLE FACILITY
Resident Type/ RUG-III Payment
Resident Name ID Reason(s) Group Start Date Field End Date Days Source CMI
Resident 1 10001 Q/05 CA2 04/01/10 04/29/10 29 Medicaid 1.06
Y/02 PC1 04/30/10 A3a 06/30/10 62 Medicaid 0.81
Total days: 91
Resident 2 10002 Q/05 PD1 04/01/10 06/19/10 80 Medicaid 0.89
Y/02 PD1 06/20/10 A3a 06/30/10 11 Medicaid 0.89
Total days: 91
New Jersey MedicaidDay Weighted CMI Resident Roster
For the Quarter 04/01/2010 - 06/30/2010Records Received as of 07/20/2010
NJ Department of Health and Senior Services
Payment Source
Choices are Medicare, Medicaid or Other Medicare
– MDS 2.0 Section AA8b = 1-5, 7 or 8
Medicaid– MDS 2.0 Section AA7 valid recipient number– + for Medicaid pending is not counted as Medicaid
Other– Not Medicare or Medicaid– SCNF resident
NJ Department of Health and Senior Services
Summary Page
Preliminary Page 2 of 2
Provider Number: 12000Provider Name: SAMPLE FACILITY
RUG-III Days CMI CMI Points Days CMI CMI Points Days CMI CMI PointsGroup (a) (b) (c = a x b) (a) (b) (c = a x b) (a) (b) (c = a x b)SE3 0 2.10 0.00 0 2.10 0.00 0 2.10 0.00SE2 0 1.79 0.00 76 1.79 136.04 29 1.79 51.91SE1 0 1.54 0.00 2 1.54 3.08 0 1.54 0.00RAD 0 1.66 0.00 0 1.66 0.00 0 1.66 0.00RAC 0 1.31 0.00 0 1.31 0.00 0 1.31 0.00RAB 0 1.24 0.00 35 1.24 43.40 0 1.24 0.00RAA 0 1.07 0.00 0 1.07 0.00 0 1.07 0.00SSC 0 1.44 0.00 0 1.44 0.00 0 1.44 0.00SSB 40 1.33 53.20 0 1.33 0.00 0 1.33 0.00SSA 19 1.28 24.32 10 1.28 12.80 0 1.28 0.00
Medicaid Residents Medicare Residents Other Residents
New Jersey MedicaidDay Weighted CMI Resident Roster
For the Quarter 04/01/2010 - 06/30/2010Records Received as of 07/20/2010
NJ Department of Health and Senior Services
Summary Page
BA1 0 0.60 0.00 0 0.60 0.00 0 0.60 0.00PE2 51 1.00 51.00 0 1.00 0.00 0 1.00 0.00PE1 0 0.97 0.00 0 0.97 0.00 0 0.97 0.00PD2 0 0.91 0.00 0 0.91 0.00 37 0.91 33.67PD1 192 0.89 170.88 0 0.89 0.00 19 0.89 16.91PC2 0 0.83 0.00 0 0.83 0.00 0 0.83 0.00PC1 62 0.81 50.22 0 0.81 0.00 0 0.81 0.00PB2 0 0.65 0.00 0 0.65 0.00 0 0.65 0.00PB1 0 0.63 0.00 0 0.63 0.00 0 0.63 0.00PA2 0 0.62 0.00 0 0.62 0.00 0 0.62 0.00PA1 0 0.59 0.00 0 0.59 0.00 0 0.59 0.00BC1 0 0.59 0.00 0 0.59 0.00 0 0.59 0.00
Totals 603 602.52 123 195.32 132 141.36
Weighted Average CMI 0.9992 1.588 1.0709(Total CMI points divided by total days)
Total Facility Average CMI 1.0946
NJ Department of Health and Senior Services
Start Dates
START DATE
Type and Reason Date Field Application
A/01 AB1 (Date of entry) Used when the record is the first record for the resident.
Y/02, 03, 04 A3a (Assessment reference date) Used for all comprehensive assessment records other than Admissions (A/01).
Q/05 or 10 A3a (Assessment reference date) Used for all quarterly and quarterly corrections.
NJ Department of Health and Senior Services
Start Dates
START DATE
R/09 A4a (Re-entry date) Used for all re-entry records.
D/08 AB1 (Date of entry)
A4a (Re-entry Date)
AB1 used when this is the first record for the resident; A4a used when preceded by a re-entry record (R/09).
O/00 A3a (Assessment reference date) Used for other required assessment records.
OM/00/1, 2, 3, 4, 5, 7, 8
AB1 (Date of Entry from D/08 or A/01)
A4a (Re-entry Date)
A3a (Assessment reference date)
AB1 used when a discharge form or admission assessment is available.
A4a used when available.
A3a used when AB1 or A4a are not available.
NJ Department of Health and Senior Services
General Rules
Selection of MDS records– Inactive records are not used– Only the latest modification of a record is used
A. Day of admission included; day of discharge is not
B. Days are counted from the first day of the quarter until the next assessment or the end of the quarter or discharge
C. Assessments active for no more than 113 days
NJ Department of Health and Senior Services
General Rules
D. Start date for admission assessments (A/01) whose ARD is greater than 14 days is the ARD
E. Hospital bed hold days are not included
F. Home visits, temporary therapeutic leave and hospital observational stays less than 24 hours are included
NJ Department of Health and Senior Services
Rules for Special Situations
G. Admission preceded by an assessment that is not a discharge or reentry record is counted from the ARD date and not the AB1 admission date
NJ Department of Health and Senior Services
Rules for Special Situations
H. Discharge prior to completing initial assessment (D/08)– If not preceded by an assessment, no
clinical data is available– Assume SSB if discharge status was
deceased or transferred to a hospital (R3a = 5, 7 or 8)
– Assume CB1 if discharge status was any other reason (R3a = 1, 2, 3, 4, 6 or 9)
NJ Department of Health and Senior Services
Rules for Special Situations
I. Discharge prior to completing initial assessment (D/08)– If preceded by an assessment, that RUG is
used until the day prior to the discharge date
NJ Department of Health and Senior Services
Rules for Special Situations
J. Discharge prior to completing initial assessment (D/08)– If preceded by another D/08 with the same
admission date Days start from the admission date to the day before the
first discharge date Days from the second discharge start with the second day
following the first discharge date or from the reentry date if a reentry record precedes the second discharge to the day before the second discharge date
Default BC1 group for days exceeding 14 days
NJ Department of Health and Senior Services
Rules for Special Situations
K. Discharge prior to completing initial assessment (D/08)– Series of D/08 with different admission dates
For each record, days start from the admission date to the day before the next discharge date
If the admission date for a following D/08 overlaps the previous discharge date, the days for the second discharge start with the second day following the previous discharge date
Default BC1 group for days exceeding 14 days
NJ Department of Health and Senior Services
Rules for Special Situations
L. Discharge return anticipated (D/07) or discharge return not anticipated (D/06)
– When a series of D/07 or D/06 are submitted, the earliest discharge date in the series stops the count of days
M. Re-entry record (R/09) – Restarts the counting of days beginning on the re-entry date
(A4a)– RUG used is from the preceding assessment unless the re-
entry is followed within 14 days by another assessment in which case the RUG from the following assessment is used
NJ Department of Health and Senior Services
Rules for Special Situations
N. Re-entry record (R/09) – When the 113-day maximum is exhausted and no
subsequent assessment or discharge occurs, the remaining days counted for the quarter are counted as BC1.
O. Re-entry record (R/09)– When discharge records (D/06 or 07) are the only
records preceding or following the re-entry or no records precede or follow the re-entry, BC1 is assigned beginning on the re-entry date (A4a)
NJ Department of Health and Senior Services
Rules for Special Situations
P. Re-entry record (R/09) – When the re-entry record is within 14 days of
the end of the quarter and is followed within 14 days by another assessment, the RUG from the subsequent assessment is used beginning on the re-entry date
NJ Department of Health and Senior Services
Rules for Special Situations
Q. Medicare 5 Day (OM/00/1) as the first assessment– If subsequent assessment is the admission
assessment, the days counted for the RUG obtained from the 5-day are from the admission date through the day prior to the assessment reference date on the admission assessment
NJ Department of Health and Senior Services
Rules for Special Situations
R. Medicare 5 Day (OM/00/1) as the first assessment– If subsequent record is a discharge prior to
completing initial assessment, the admission date from the discharge records starts the count of days for the 5-day record through the day prior to the discharge date
NJ Department of Health and Senior Services
Rules for Special Situations
S. Medicare 5 Day (OM/00/1) as the first assessment– If subsequent record is a discharge 06 or 07,
the count of days for the 5-day record starts at the date of reentry (A4a) on 5-day if available or the assessment reference date through the day prior to the discharge date
NJ Department of Health and Senior Services
Practice Session
Type/ RUG-III Payment
Reason(s) Group Start Date Field End Date Days Source CMI
AM/01/1 SSA 05/22/10 AB1 05/31/10 10 Medicare 1.28
OM/00/7 RAB 06/01/10 A3a 06/18/10 18 Medicare 1.24
OM/00/2 RAB 06/19/10 A3a 06/30/10 12 Medicare 1.24
Total days: 40
NJ Department of Health and Senior Services
Practice Session
Type/ RUG-III Payment
Reason(s) Group Start Date Field End Date Days Source CMI
Q/05 PD1 04/01/10 04/19/10 19 Other 0.89
Y/02 PD2 04/20/10 A3a 05/26/10 37 Other 0.91
D/07 05/27/10 05/27/10
R/09 SE2 06/02/10 A4a 06/11/10 10 Other 1.79
Y/03 SE2 06/12/10 A3a 06/30/10 19 Other 1.79
Total days: 85
NJ Department of Health and Senior Services
Practice Session
Type/ RUG-III Payment
Reason(s) Group Start Date Field End Date Days Source CMI
Y/02 CB1 04/01/10 A3a 04/04/10 4 Medicaid 1.07
Y/02 BC1 04/05/10 05/08/10 34 Medicaid 0.59
Q/05 PC1 05/09/10 A3a 06/30/10 53 Medicaid 0.81
Total days: 91
Y/02 = A3a (ARD) of 12/12/2009
Q/05 = A3a (ARD) of 05/09/2010
NJ Department of Health and Senior Services
Review of Preliminary Roster
Determine if all residents in the facility at any time during the quarter are listed on the Resident Roster
Considerations if missing– Verify that most recent assessment or the
admission assessment was transmitted– Verify that re-entry tracking form was transmitted– Verify that assessment wasn’t rejected by the MDS
2.0 submission system– Verify that resident identifying information is correct
NJ Department of Health and Senior Services
Review of Preliminary Roster
Determine if resident is only listed onceConsiderations if resident listed multiple
times– One or more of the resident assessments or
tracking forms has been transmitted with inaccurate data
– Contact the state MDS automation helpdesk to merge resident records in the CMS MDS Collection System
NJ Department of Health and Senior Services
Review of Preliminary Roster
Determine if resident’s assessments and tracking forms are accounted for on the roster
Considerations if records are missing– Submit missing assessments or tracking
forms, if applicable
NJ Department of Health and Senior Services
Review of Preliminary Roster
Determine if the start and end dates are accurate
Considerations if inaccurate dates were coded– Submit modification of the assessment or
tracking form using the accurate date
NJ Department of Health and Senior Services
Review of Preliminary Roster
Determine if each Medicaid resident is correctly identified as Medicaid for any non-Medicare assessment days
Considerations if Medicaid payment source not accurate– Review Section AA7 Medicaid No. for
accuracy and submit a modification, if appropriate
NJ Department of Health and Senior Services
Review of Preliminary Roster
Review the roster for days assigned a BC1 code
Considerations if BC1 is assigned– If appropriate, submit any missing
assessments or tracking forms or complete any modifications of previously transmitted records, when possible
NJ Department of Health and Senior Services
Review of Preliminary Roster
Review the assumed RUG attributed to a Discharge prior to completing initial assessment (D/08)
Considerations if incorrect RUG– Review the discharge status in R3a for
accuracy and submit a modification of the D/08, if appropriate
NJ Department of Health and Senior Services
Special Care Nursing Facilities
Applies to SCNF unitsRoom numbers of SCNF roomsMDS 2.0 section A2 Room Number
NJ Department of Health and Senior Services
Final Validation Reports
Fatal record errors mean the assessment or tracking form was rejected
Warning error – assessment completed late
Warning error – inconsistent record sequence
Warning error – a new person has been created in the database of the CMS MDS system
NJ Department of Health and Senior Services
Final Resident Rosters
Posted in the same directory as the preliminary resident rosters
Recommended that you save the report or print the report for future reference
NJ Department of Health and Senior Services
Case Mix Rate
Four rate components– Direct care rate component
Case mix adjustedNon-case mix adjusted
– Operating and administrative price– Fair rental value allowance– Provider tax pass through per diem
NJ Department of Health and Senior Services
Direct Care Rate Component
Case MixInflated Cost Per Diem $80.24Facility Average Medicaid CMI 1.03Cost Report Period CMI 1.02Ratio 1.0098Ratio Times Inflated Cost Per Diem $81.03
Case MixInflated Cost Per Diem $80.24Facility Average Medicaid CMI 0.98Cost Report Period CMI 1.02Ratio 0.9608Ratio Times Inflated Cost Per Diem $77.09
NJ Department of Health and Senior Services
Adjustment Schedule
Case Mix Measure Obtained on the Following Dates
Preceding the Rate Period: Used to Adjust Rates
Effective:
January 1 – March 31 July 1 – September 30
April 1 – June 30 October 1 – December 31
July 1 – September 30 January 1 – March 31
October 1 – December 31 April 1 – June 30
NJ Department of Health and Senior Services
MDS 3.0
New resident roster rules New resident roster manual Crosswalk from MDS 3.0 to MDS 2.0 items to be
used to calculate a RUG category Rosters will still be located on the MDS 2.0
submission site July through September resident roster quarter will
be created using a combination of MDS 2.0 and MDS 3.0 records
NJ Department of Health and Senior Services
Help
Resident roster manual – www.nj.mslc.com\downloads
Questions regarding a specific resident roster should be addressed by calling the Helpdesk number listed on the resident roster (800) 763-2278
Questions regarding today’s training – [email protected]