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  1. Day WeightedResident Rosters New Jersey Department of Health and Senior Services AND July-August 2010

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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 Ongoing Schedule

  7. Example Resident Roster

  8. MDS 2.0 Type and Reason Codes

  9. MDS 2.0 Type and Reason Codes

  10. MDS 2.0 Type and Reason Codes

  11. MDS 2.0 Type and Reason Codes

  12. Example Resident Roster

  13. 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

  14. Summary Page

  15. Summary Page

  16. Start Dates

  17. Start Dates

  18. 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

  19. 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

  20. 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

  21. 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)

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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)

  27. 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

  28. 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

  29. 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

  30. 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

  31. Practice Session

  32. Practice Session

  33. Practice Session Y/02 = A3a (ARD) of 12/12/2009 Q/05 = A3a (ARD) of 05/09/2010

  34. 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

  35. 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

  36. 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

  37. 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

  38. 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

  39. 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

  40. 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

  41. Special Care Nursing Facilities • Applies to SCNF units • Room numbers of SCNF rooms • MDS 2.0 section A2 Room Number

  42. 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

  43. 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

  44. 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

  45. Direct Care Rate Component

  46. Adjustment Schedule

  47. 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

  48. 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 – pahelpdesk@mslc.com