N.J. Admin. Code § 8:85-3.4

Current through Register Vol. 56, No. 21, November 4, 2024

Section 8:85-3.4 - Resident rosters and case mix index calculation

(a) An NF shall electronically transmit MDS assessment information in a complete, accurate and timely manner.

1. The Department shall provide a Preliminary Resident Roster to an NF based on the NF's transmitted MDS assessment information for a calendar quarter, when that information is transmitted by the 20th day following the end of the calendar quarter.

2. The Department shall provide a Final Resident Roster to an NF based on the NF's transmitted MDS assessment information for a calendar quarter, when that information is transmitted by the end of the second calendar month following the end of the calendar quarter.

3. The Department shall not consider MDS assessment information for the purpose of reimbursement rate calculations under this subchapter for a calendar quarter that is not submitted by the end of the second calendar month following the end of the calendar quarter, except as provided in (a)4 below.

4. The Department may only grant an exception to the electronic MDS assessment transmission due date for the following reasons:

i. A showing by the nursing facility that fraud may have occurred;

ii. An intervening natural disaster making timely compliance impossible or unsafe;

iii. Technical failure of the NF system used to encode and transmit MDS information;

iv. Technical failure of the central MDS data collection system; or

v. A new NF not previously certified by either the Medicare or Medicaid program that can substantiate to the Department circumstances that preclude timely electronic transmission.

(b) The Department shall use the resource utilization group to adjust direct care case mix costs and to determine each NF's direct care rate component.

1. The Department shall adjust a nursing facility's case mix reimbursement rates on a quarterly basis based on the change in case mix of each facility according to the following schedule:

i. Case mix measure obtained from January 1 through March 31 shall be used to adjust rates effective July 1 through September 30 of the same calendar year;

ii. Case mix measure obtained from April 1 through June 30 shall be used to adjust rates effective October 1 through December 31 of the same calendar year;

iii. Case mix measure obtained from July 1 through September 30 shall be used to adjust rates effective January 1 through March 31 of the following calendar year; and

iv. Case mix measure obtained from October 1 through December 31 shall be used to adjust rates effective April 1 through June 30 of the following calendar year.

(c) The Department or its designated contractor shall distribute preliminary and final resident rosters to Class I NFs, Class II NFs and SCNFs according to the following schedule:

Resident roster quarter	Preliminary resident roster distributed	Final resident roster distributed
January 1 through	May 10 for submissions	June 20 for
March 31	through April 20	submissions through May 31
April 1 through June	August 10 for submissions	September 20 for
30	through July 20	submissions through August 31
July 1 through	November 10 for	December 20 for
September 30	submissions through October	submissions through
20	November 30
October 1 through	February 10 for	March 20 for
December 31	submissions through January	submission through
20	February 28

(d) A nursing facility that has an SCNF unit shall notify the Department of the room numbers of the beds in the SCNF unit, so that the residents in these units may be identified separately on the resident roster.

(e) A nursing facility shall review preliminary resident rosters for completeness and accuracy.

1. If data reported on the preliminary resident roster is in error or if there is missing data, NFs shall have two calendar months following the end of the calendar quarter to transmit additional MDS records, inactivations or modifications needed to obtain a correct resident roster.

(f) For each resident roster quarter, the Department shall calculate a Statewide average case mix index and a Statewide average Medicaid case mix index from all final resident rosters from Class I and Class II nursing facilities.

N.J. Admin. Code § 8:85-3.4

New Rule, R.2011 d.121, effective 4/18/2011.
See: 42 N.J.R. 1793(a), 43 N.J.R. 961(c).
Former N.J.A.C. 8:85-3.4, Equalized costs, recodified to N.J.A.C. 8:85-3.5.