Transcript Document

Day Weighted
Resident Rosters
New Jersey
Department of Health
and Senior Services
AND
July-August 2010
Background

Proposed regulations N.J.A.C 8:85
–
Effective July 1, 2010
DHSS contracted with Myers and
Stauffer
 Case mix rate models
 Point in time resident rosters
 Day 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
November 10 for
submissions through
October 20
February 10 for
submissions through
January 20
September 20 for
submissions through
August 31
December 20 for
submissions through
November 30
March 20 for submissions
through February 28
July 1 – September
30
October 1 –
December 31
NJ Department of Health and Senior Services
Example Resident Roster
Preliminary
Page 1 of 2
New Jersey Medicaid
Day Weighted CMI Resident Roster
For the Quarter 04/01/2010 - 06/30/2010
Records Received as of 07/20/2010
Provider Number: 12000
Provider Name: SAMPLE FACILITY
Resident Name
Resident 1
Resident 2
Resident
ID
10001
10002
Type/
Reason(s)
Q/05
Y/02
RUG-III
Group
CA2
PC1
Start Date
04/01/10
04/30/10
Q/05
Y/02
PD1
PD1
04/01/10
06/20/10
Field
A3a
A3a
End Date
04/29/10
06/30/10
Total days:
Days
29
62
91
06/19/10
06/30/10
Total days:
80
11
91
Payment
Source
Medicaid
Medicaid
CMI
1.06
0.81
Medicaid
Medicaid
0.89
0.89
NJ Department of Health and Senior Services
MDS 2.0 Type and Reason Codes
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
OBRA Assessment
NJ Department of Health and Senior Services
MDS 2.0 Type and Reason Codes
Non-OBRA Assessment
None of Above
Assessment
Type
Assessment
Reason
(AA8a)
Type
and
Reason
O
00
O/00
NJ Department of Health and Senior Services
MDS 2.0 Type and Reason Codes
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
PPS (Medicare) Assessment
NJ Department of Health and Senior Services
MDS 2.0 Type and Reason Codes
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
MDS Tracking Forms
NJ Department of Health and Senior Services
Example Resident Roster
Preliminary
Page 1 of 2
New Jersey Medicaid
Day Weighted CMI Resident Roster
For the Quarter 04/01/2010 - 06/30/2010
Records Received as of 07/20/2010
Provider Number: 12000
Provider Name: SAMPLE FACILITY
Resident Name
Resident 1
Resident 2
Resident
ID
10001
10002
Type/
Reason(s)
Q/05
Y/02
RUG-III
Group
CA2
PC1
Start Date
04/01/10
04/30/10
Q/05
Y/02
PD1
PD1
04/01/10
06/20/10
Field
A3a
A3a
End Date
04/29/10
06/30/10
Total days:
Days
29
62
91
06/19/10
06/30/10
Total days:
80
11
91
Payment
Source
Medicaid
Medicaid
CMI
1.06
0.81
Medicaid
Medicaid
0.89
0.89
NJ Department of Health and Senior Services
Payment Source


Choices are Medicare, Medicaid or Other
Medicare
–

Medicaid
–
–

MDS 2.0 Section AA8b = 1-5, 7 or 8
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
New Jersey Medicaid
Day Weighted CMI Resident Roster
For the Quarter 04/01/2010 - 06/30/2010
Records Received as of 07/20/2010
Provider Number: 12000
Provider Name: SAMPLE FACILITY
RUG-III
Group
SE3
SE2
SE1
RAD
RAC
RAB
RAA
SSC
SSB
SSA
Medicaid Residents
Days
CMI
CMI Points
(a)
(b)
(c = a x b)
0
2.10
0.00
0
1.79
0.00
0
1.54
0.00
0
1.66
0.00
0
1.31
0.00
0
1.24
0.00
0
1.07
0.00
0
1.44
0.00
40
1.33
53.20
19
1.28
24.32
Medicare Residents
Days
CMI
CMI Points
(a)
(b)
(c = a x b)
0
2.10
0.00
76
1.79
136.04
2
1.54
3.08
0
1.66
0.00
0
1.31
0.00
35
1.24
43.40
0
1.07
0.00
0
1.44
0.00
0
1.33
0.00
10
1.28
12.80
Other Residents
Days
CMI
CMI Points
(a)
(b)
(c = a x b)
0
2.10
0.00
29
1.79
51.91
0
1.54
0.00
0
1.66
0.00
0
1.31
0.00
0
1.24
0.00
0
1.07
0.00
0
1.44
0.00
0
1.33
0.00
0
1.28
0.00
NJ Department of Health and Senior Services
Summary Page
BA1
PE2
PE1
PD2
PD1
PC2
PC1
PB2
PB1
PA2
PA1
BC1
Totals
0
51
0
0
192
0
62
0
0
0
0
0
0.60
1.00
0.97
0.91
0.89
0.83
0.81
0.65
0.63
0.62
0.59
0.59
603
Weighted Average CMI 0.9992
(Total CMI points divided by total days)
Total Facility Average CMI
0.00
51.00
0.00
0.00
170.88
0.00
50.22
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
0
0
0
0
0
0
0
602.52
123
0.60
1.00
0.97
0.91
0.89
0.83
0.81
0.65
0.63
0.62
0.59
0.59
1.588
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0
0
0
37
19
0
0
0
0
0
0
0
195.32
132
0.60
1.00
0.97
0.91
0.89
0.83
0.81
0.65
0.63
0.62
0.59
0.59
0.00
0.00
0.00
33.67
16.91
0.00
0.00
0.00
0.00
0.00
0.00
0.00
141.36
1.0709
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)
AB1 used when this is the first record for the
resident; A4a used when preceded by a reentry record (R/09).
A4a (Re-entry Date)
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)
AB1 used when a discharge form or
admission assessment is available.
A4a (Re-entry Date)
A4a used when available.
A3a (Assessment reference date)
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 reentry 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/
Reason(s)
RUG-III
Group
Start Date
Field
End Date
Days
AM/01/1
OM/00/7
OM/00/2
SSA
RAB
RAB
05/22/10
06/01/10
06/19/10
AB1
A3a
A3a
05/31/10
06/18/10
06/30/10
Total days:
10
18
12
40
Payment
Source
CMI
Medicare
Medicare
Medicare
1.28
1.24
1.24
NJ Department of Health and Senior Services
Practice Session
Type/
Reason(s)
RUG-III
Group
Q/05
Y/02
D/07
R/09
Y/03
PD1
PD2
SE2
SE2
Start Date
04/01/10
04/20/10
05/27/10
06/02/10
06/12/10
Field
A3a
A4a
A3a
End Date
Days
Payment
Source
04/19/10
05/26/10
05/27/10
06/11/10
06/30/10
Total days:
19
37
Other
Other
0.89
0.91
10
19
85
Other
Other
1.79
1.79
CMI
NJ Department of Health and Senior Services
Practice Session
Y/02 = A3a (ARD) of 12/12/2009
Q/05 = A3a (ARD) of 05/09/2010
Type/
Reason(s)
Y/02
Y/02
Q/05
RUG-III
Group
CB1
BC1
PC1
Start Date
04/01/10
04/05/10
05/09/10
Field
A3a
A3a
End Date
04/04/10
05/08/10
06/30/10
Total days:
Days
4
34
53
91
Payment
Source
Medicaid
Medicaid
Medicaid
CMI
1.07
0.59
0.81
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 once
 Considerations 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 units
 Room numbers of SCNF rooms
 MDS 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 adjusted
 Non-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
Inflated Cost Per Diem
Facility Average Medicaid CMI
Cost Report Period CMI
Ratio
Ratio Times Inflated Cost Per Diem
Case Mix
$80.24
0.98
1.02
0.9608
$77.09
Inflated Cost Per Diem
Facility Average Medicaid CMI
Cost Report Period CMI
Ratio
Ratio Times Inflated Cost Per Diem
Case Mix
$80.24
1.03
1.02
1.0098
$81.03
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]
NJ Department of Health and Senior Services