Tuesday, May 19, 2020

CMS Issues Limited MDS Updates to OBRA Assessments for Medicaid Case Mix States Using PDPM

Dan Ciolek

In response to State Medicaid Agency and stakeholder requests, the Centers for Medicare and Medicaid Services (CMS) has updated the MDS 3.0 item sets (version 1.17.2) and related technical data specifications. These changes will be effective October, 1 2020 and will support the calculation of Patient Driven Payment Model (PDPM) payment codes on Omnibus Budget Reconciliation Act (OBRA) assessments when not combined with the 5-day Skilled Nursing Facility Prospective Payment System (SNF PPS) assessment, specifically the OBRA comprehensive (NC) and OBRA quarterly (NQ) assessment item sets, which was not possible with item set version 1.17.1. This will allow State Medicaid Agencies to collect and compare RUG-III/IV payment codes to PDPM ones and thereby inform their future payment models. In other words, these changes will only impact providers in states where the state requires the reporting of PDPM HIPPS codes on OBRA assessments for Medicaid purposes.

Below is a table summarizing the changes to the MDS OBRA item sets effective October 1, 2020 (highlighted in yellow and italicized:


The changes to the technical data specifications that support these modifications (used primarily by software vendors) are contained in the Errata v3.00.4. CMS has indicated to AHCA that additional training resources related to these changes will be made available prior to implementation, particularly for Medicaid-only providers in states that may not be familiar with the PDPM MDS coding requirements. 

Providers should confirm with your State Medicaid Agency if your State will be requiring the calculation of the PDPM payment codes on the OBRA assessments when not combined with a 5-day SNF PPS assessment.

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