Case Mix in New York State; Big Changes are Here

New York State is on the verge of proceeding with long-awaited direction on Case Mix reimbursement for skilled nursing facilities.  SNF Operators have been functioning under a great deal of uncertainty and lack of clear direction from DOH for the better part of 2 full years.

The quest for an equitable methodology for SNF Medicaid reimbursement has been an issue for many years. New York SNF providers currently face the largest reimbursement deficit in the country at over $56 per day.

According to NYSHFA, “Regulations were published in today’s State Register authorizing DOH to change the Case Mix acuity process for all nursing homes. DOH will utilize a rolling MDS collection period (October 2020 – March 2021) for the upcoming Case Mix adjustment to the July 1, 2021 rates that will capture all MDS assessments completed during that six-month period. This replaces the historical 92-day lookback snapshot methodology.

In addition, the regulations specify the following:

Going forward, October – March will be the collection period utilized for the July Case-Mix Adjustment, and April – September will be the collection period utilized for the January Case Mix adjustment.

The temporary 5% CMI Cap provision will be repealed. That provision had limited any upward or downward CMI adjustments to 5% pending an audit but now DOH acknowledges that this had caused delays of more than three years before rates were finalized. (Note: this does not eliminate or reduce OMIG’s authority to audit MDS data).

NYSHFA has raised concerns that the new methodology has not been approved by CMS. In response, DOH believes that CMS will approve the associated SPA in time for the regulations to be implemented, and accordingly, has determined no changes to the regulation are necessary. NYSHFA will continue to monitor this issue.

It is expected that DOH will issue a DAL with additional MDS submission requirements and timelines prior to the July 1,2021 rate issuance.”

We are grateful to our friends at NYSHFA & Leading Age of New York for their diligence and advocacy for long-term care providers and the residents we serve.  Thank You!

Speech Therapy Service will continue to play an important role in servicing the long-term care population by treating dysphagia and cognitive communicative deficits. It is important to have the proper systems in place to capture the need for therapy and also the corresponding physician order and diagnosis code. Together with trained medical speech therapists passionate about treating long-term care patients, the speech department can play an important role in improving a facility’s case-mix index.