Big Changes Ahead for NY CMI Methodology — Are You Prepared?
The New York State Department of Health (DOH), in collaboration with Myers and Stauffer (M&S), has released details on the next phase of transitioning to a PDPM-based case mix methodology. Celtic Consulting is here to help you stay ahead of the curve.
Key Highlights:
🔹 Two PDPM Components Analyzed to Date:
M&S has reviewed MDS data from Q1 2022–Q1 2024. Only the Nursing and Non-Therapy Ancillary (NTA) components had sufficient data to support analysis.
🔹 Additional MDS Fields Required Starting 6/1/25:
To analyze all five PDPM components, NY SNFs will soon be required to complete three additional MDS fields, even for OBRA assessments:
• I0020 – Primary Medical Condition Category
• J2100 – Recent Surgery Requiring Active SNF Care
• O0400D – Respiratory Therapy
🔹 Interim Case Mix Adjustment Coming Fall 2025:
An interim PDPM methodology based on just the Nursing and NTA components is expected to go live in Fall 2025. This allows for earlier CMI updates while the state collects the additional data.
🔹 Full PDPM Model Expected Fall 2026:
Following additional data collection and industry collaboration, the finalized PDPM methodology is anticipated to be implemented in Fall 2026.
How Can You Best Prepare?
✔️ Start planning for workflow to capture new MDS items
✔️ Evaluate staff training needs to ensure readiness by 6/1/25
✔️ Prepare for an interim rate adjustment based on Nursing + NTA
Celtic Consulting is actively supporting providers through this complex transition. From MDS education to PDPM readiness assessments, we’re your trusted partner in navigating what’s next.
Need help preparing? Let’s talk. Reach out to consultant@celticconsulting.org to schedule a call today!
