Day Weighted Resident Rosters

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


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


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




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


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


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


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



Non-OBRA Assessment Assessment

Type


Type and

Reason

None of Above O 00 O/00



PPS (Medicare) Assessment Assessment

Type

Assessment Reason (AA8b)

Type and

Reason

5 day assessment M 1 M/1




Readmission/return assessment M 5 M/5


Other Medicare required assessment M 8 M/8



MDS Tracking Forms Assessment

Type


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


Example Resident Roster



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




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


Summary Page



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




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


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.


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.


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


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


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



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)



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



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



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



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



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)



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



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



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



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


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


Practice Session



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


Practice Session



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


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



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



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



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



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



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



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


Special Care Nursing Facilities

Applies to SCNF unitsRoom numbers of SCNF roomsMDS 2.0 section A2 Room Number


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


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


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


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


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


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


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]

Documents

Day Weighted Resident Rosters