AGING AND DISABILITY SERVICES ADMINISTRATION
2006 NH "Dear Administrator" Letters
September 12, 2006
ADSA: NH #2006- 023
IDENTIFYING PAYER SOURCE ON THE MDS
Dear Nursing Facility/Home Administrator:
The Thurston County Superior Court recently approved a settlement in the class action lawsuit known as Regency Pacific v. DSHS (Cause No. 05-2-00450-6). The lawsuit concerned the use of Minimum Data Set (MDS) information on Medicaid eligibility in the calculation of the Case Mix Index (CMI) for nursing facilities.
As part of the settlement, the Department has agreed to do two things: 1) implement a set of “business rules” for use by facilities in completing the MDS and designating residents who are eligible for Medicaid; and 2) conduct training sessions throughout the state to advise the nursing facility industry regarding the completion of the MDS relative to these “business rules.” Of course, the facilities themselves remain responsible for ensuring they comply with federal and state laws regarding completion of the MDS.
A schedule of the training sessions, including locations, dates and times, is enclosed. We strongly encourage you to have the appropriate staff members from your facility attend one of these sessions. An additional training schedule is enclosed for your MDS Coordinator.
The training sessions will be presented by two employees of the Aging and Disability Services Administration.
Allen Miller is a Cost Reimbursement Analyst in the Projects and Payments Section of the Office of Rates Management, Management Services Division. His presentation will include:
- How to read a RUG report. What are the different sections of a RUG report? What is the difference between the preliminary and final RUG reports?
- How to indicate payer source. What are the differences between items AA7 and A7A? What do the “business rules” mean?
- Defaults. What are the most common defaults? How do they impact the facility’s CMI?
Shirley Stirling is the MDS Automation Coordinator, Residential Care Services Division. Her presentation will include the following topics:
- How to make MDS corrections. What all Medical Records staff and MDS coordinators need to know about MDS corrections.
- ‘Duplicate’ Clients. What are duplicate clients? Why are they a problem? How can I get rid of them?
- National Provider Identifier (NPI). Why do it now? When will it be mandatory for payment? Does it seem overwhelmingly complicated to apply for one? Who should really be filling out this form?
Correct completion by the facility of the MDS is necessary for the correct calculation of the facility’s CMI. In turn, a correct CMI is needed for the correct calculation of the facility’s Direct Care component rate. Currently, the Direct Care component rate accounts for approximately 55% of the overall daily rate.
Whenever possible, we strongly encourage car pooling. We look forward to seeing you at the training sessions.
Sincerely,
Bonnie M. Hawkins, Acting Chief
Office of Rates Management
