Wednesday, May 22, 2019

CMS Issues MDS 3.0 RAI Manual Updates that include Significant PDPM- Related Changes

Dan Ciolek

On May 20 the Centers for Medicare and Medicaid Services (CMS) issued an early release of several files associates with the MDS 3.0 RAI Manual v1.17 that contains many updates including information related to the Patient Driven Payment Model (PDPM), both which are effective on October 1, 2019.  CMS indicates that “this early release is being provided in response to stakeholder feedback.” CMA also encourages providers to check back to the MDS-RAI webpage prior to October 1, 2019 for a final posting which may contain additional updates.  Specific files on the CMS site that are applicable to the PDPM implementation include:
  • MDS 3.0 RAI Manual v1.16 October 1, 2018 – Which is a single PDF file of the entire RAI manual for use as an electronic version with bookmarks that you can click on to take you to each section of the manual.
  • MDS 3.0 RAI Manual v1.16 and Change Tables October 2018 – Which is a traditional set of zip files of the RAI manual and the change tables that crosswalk the changes made to this year’s manual. Note: This is the same material as the first item above, except there are separate files for each chapter or subchapter.
  • MDS 3.0 RAI Manual v1.16 Replacement Manual Pages and Change Tables October 2018 – Which includes replacement pages for this year’s manual changes for those who want to update their existing paper-based manual with just the pages that have changed. It also includes the change tables that crosswalk the changes made to this year’s manual.
  • MDS Forms (Item Sets) v1.16.1 October 2018 – Which included two folders separate the v1.16.1 MDS forms (MDS item sets) into those used in long term care facilities (SNFs and NFs) and those used in swing bed facilities.
  • MDS RAI Manual Appendix B – Which includes updated contact lists for the state and regional RAI/MDS contacts. 
Specific Chapters in the new MDS-RAI manual updates related to PDPM to pay particular attention to are Chapter 2- which addresses the new PDPM-related MDS assessments and assessment schedule, and Chapter 6 – which addresses the new PDPM resident classification process for the PDPM payment model.  Other changes related to the new PDPM MDS Items, such as the new diagnosis items in Section I, surgery type in section J, as well as the new PDPM HIPPS codes in Section Z should also be looked at closely. 

AHCA has also included a link to the CMS MDS-RAI files webpage on the AHCA PDPM Academy and AHCA PDPM Resource Center web pages.   

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