DOH Clarifies 2014-2 MDS Changes

Carl J. Pucci in Finance & Reimbursement

NYSHFA met with DOH yesterday to clarify recent changes to the MDS item O0420, distinct days of therapy.  (See member mailing of 10/9/14).

The changes, which affect low and medium rehab RUG services, stem from a CMS directive put into effect back on October 2013.

NYSHFA had objected to any retroactive changes to the MDS, as certain software vendors had not incorporated the changes in time to affect the January and July 2014 collection cycles.

DOH reiterated that the changes are appropriate but noted that any subsequent CMI adjustments resulting from the revised therapy classification will not affect Medicaid rates retroactively (i.e., July 2014 rates), but would affect the January 2015 rates going forward.  Although a very small number of records are affected statewide (500 out of approximately 108,000), the changes do affect numerous providers statewide to varying degrees.

DOH has committed to dialogue with all software companies, as well as to notify all provider associations and software vendors at the beginning of each federal fiscal year (October 1) of any MDS changes enacted by CMS in order to allow sufficient time for implementation.

NYSHFA will continue to monitor this issue, and members should address specific concerns regarding the MDS scoring to PRImail@health.ny.gov.

NYSHFA CONTACT:

Carl J. Pucci
Director, Finance & Reimbursement
518-462-4800 x36