Tuesday, April 16, 2019

CMS Posts Final MDS 3.0 Item Sets (Version 1.17.1) Effective October 1, 2019

Dan Ciolek

On April 5, 2019, the Centers for Medicare & Medicaid Services (CMS) posted on their MDS 3.0 Technical Information web page the final version of the MDS 3.0 Item Sets (Version 1.17.1) which will be effective October 1, 2019.  These changes will correspond with and support the implementation of the Patient Driven Payment Model (PDPM) that is replacing the Resource Utilization Groups, version four (RUG-IV) model for determining the skilled nursing facility prospective payment system (SNF PPS) per-diem case-mix payment rates for Medicare Part A stays.
In addition, CMS posted a 10 page errata document to correct 21 issues identified in the earlier DRAFT data submission specifications item sets. Specific MDS item changes described are: 
  • One new item (X0570A) was added to account for the new optional state assessment (OSA). 
  • Four existing items were added to additional item sets to support the SNF quality reporting program (QRP) quality measures (QMs).  Specifically, I0100, I0400, and I1500 were added to the NQ, NP, and SP item sets while O0100J1 will be added to the SP item set.  
  • Additionally, item X0600F (correction: entry/discharge reporting) is being added to the new SNF PPS interim payment assessment (IPA) item set to support the MDS correction policy. 
Nine new edits were added, and eight existing edits were revised.  Most of these address how the MDS software would handle the new or revised MDS items listed above or the new MDS assessment types being introduced on October 1, 2019, addressing topics including:
  • How OSA correction assessments are processed
  • How the PDPM grouper will handle Item I8000 duplicate ICD-10-CM codes for the non-therapy ancillary (NTA) case-mix determination
  • How MDS Section GG items impacting PDPM components will be handled for stays of 2 or fewer days versus those with 3 or more days
  • How IPA assessment MDS items related to nutritional approach needs including parenteral/IV feeding that impact the PDPM nursing component case mix determination (K0510A1 and K0510B1), and K0510Z1 are handled when the assessment reference date (ARD) is six or fewer days from the entry date, or when the ARD is seven or more days from the entry date 
  • How the WARNING edits will be generated for SPF PPS Discharge assessments in order to report when the number of concurrent and group therapy minutes combined surpass the 25% per-stay compliance threshold – which is independently determined for each of the physical therapy, occupational therapy, and speech-language pathology disciplines   
None of the changes summarized above represent changes in the underlying PDPM policy for determining resident classification.  Further detail of these new and revised MDS items will be available when CMS issues the MDS Resident Assessment Instrument (MDS-RAI) manual, which CMS has indicated will likely occur as early as May 2019. 

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