Missouri opted to collect PDPM HIPPS codes on OBRA assessments with an ARD of 10/1/20 or later. This means that SNFs and NFs in Missouri need to complete additional items on OBRA assessments not combined with a Medicare assessment. Additional items include:

• GG0130 Self-Care items;
• GG0170 Mobility items;
• I0020 and I0020B Primary Medical Condition items;
• J2100 Recent Surgery item. If J2100 is checked yes, J2300-J5000 are to be completed.

Multiple homes have reported their software has not incorporated the additional required items listed above for OBRA comprehensive and Quarterly assessments with an ARD of 10/1/20 or after. They report if they complete the MDS assessments without these items the assessments are rejected by the QIES ASAP system. Some homes report they are able to change a setting in their software themselves that will include these items on OBRA assessments. Some homes report they cannot change the setting in the software themselves, that they must contact their software vendor for this setting change. Most homes that encounter this issue say after their software setting is changed, they must open completely new MDS assessments because the additional items will not be added to the assessment they opened prior to the setting change.

If you are completing an OBRA comprehensive or Quarterly assessment that has an ARD on or after 10/1/20, please ensure the additional items listed above, required to calculate a PDPM HIPPS code, are NOT grayed out in your software. If you discover these items are grayed out, contact your software vendor as soon as possible before continuing with the assessment.

If you have any questions about this issue please contact Stacey Bryan at Stacey.Bryan@health.mo.gov or 573-751-6308. Thank you.

This document was created to assist NHs in Missouri with coding GG0130 and GG170 items on OBRA MDS assessments not combined with a Medicare assessment. All of the guidance contained in this document comes from the Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User’s Manual Version 1.17.1.

A new issue is affecting some inpatient hospital and Skilled Nursing Facility (SNF) claims when an interrupted stay is billed at the end of the month. The system incorrectly assigns edits U5601-U5608 (overlapping a hospital claim). If you billed the interrupted stay correctly, and your claim is rejected, modify your billing so the claim spans past the last day of the interrupted stay:

• Bill two months at a time, or
• Bill a month plus the days in the following month that span the interrupted stay plus 1 day

Adjusting the statement covered from and through dates to encompass the entire interrupted stay will allow your claim to process and pay correctly. Medicare Administrative Contractors will finalize any suspended claims that meet the criteria, so you can make corrections and resubmit your claim.

If we rejected an inpatient hospital claim, the hospital should ask the SNF to modify their claim. Until October 5, a SNF cannot submit an adjustment to a paid claim; they must cancel the paid claim and all subsequent claims in the same stay and resubmit them in sequential order.

CMS will correct the system in the future.

In response to State Medicaid Agency and stakeholder requests, CMS has updated the MDS 3.0 item sets (version 1.17.2) and related technical data specifications. These changes will support the calculation of PDPM payment codes on OBRA assessments when not combined with the 5-day 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.

The changes to the technical data specifications that support these modifications are contained in the Errata v3.00.5 which can be accessed in the file: MDS 3.0 data specs errata (v3.00.5) Final 06-18-2020 in the Downloads section of the MDS 3.0 Technical Information page. Supporting materials including the 1.17.2 Item Change History report and the revised 1.17.2 Item Sets can be accessed in the file: MDS 3.0 Final Item Sets v1.17.2 for October 1 2020 zip, which are also posted in the Downloads section of the MDS 3.0 Technical Information page.

The Department of Social Services (DSS) is required to submit a Medicare Upper Payment Limit (UPL) Demonstration for nursing facilities to CMS at the end of each state fiscal year. Currently, the Missouri nursing facility UPL Demonstration is based on the Medicare Resource Utilization Groups (RUGs) reimbursement system and the associated MDS data. With Medicare’s change in reimbursement to PDPM, CMS has indicated that at some point RUGs calculations will no longer be supported. At that point, or perhaps sooner, the State anticipates transitioning the UPL Demonstration to be based on the PDPM payment methodology that Medicare now uses. DSS will need the additional data items to perform that calculation. This will allow DSS to continue to align the UPL calculation to most closely reflect the Medicare payment methodology. The DSS may also use the additional data for future acuity-based analysis that would require these data elements.

Since Missouri will require the calculation of the PDPM payment codes on the OBRA assessments when not combined with a 5-day SNF PPS assessment, SNFs and NFs in Missouri will need to complete additional items on OBRA assessments when not combined with a 5-day SNF PPS assessment. Additional items include:

• GG0130 Self-Care items;
• GG0170 Mobility items;
• I0020 and I0020B Primary Medical Condition items;
• J2100 Recent Surgery item. If J2100 is checked yes, J2300-J5000 are to be completed.

Coding instructions for these items on OBRA assessments when not combined with a 5-day SNF PPS assessment will be forthcoming so stay tuned.

On July 17, 2020, CMS revised the MLN Matters Article SE20011 to update information on CDC nursing home patients/residents testing and to add clarifying language to the Skilled Nursing Facility SNF Benefit Period Waiver – Provider Information section. All other information remains the same.

March 19, 2020

CMS is delaying the Minimum Data Set (MDS) 3.0 v1.18.1 release, which had been scheduled for October 1, 2020, in response to stakeholder concerns. The MDS item sets are used by Nursing Home and Swing Bed providers to collect and submit patient data to CMS. This MDS data informs payment, quality, and the survey process.

In December of 2019, CMS posted a draft of the MDS 3.0 item set v1.18.0 and received feedback from our stakeholders. We would like to thank the stakeholders for sharing their concerns regarding the proposed changes to the MDS 3.0 item sets and more specifically the removal of the Section G items from OBRA assessments.

The MDS changes CMS planned for October 1, 2020 will now be delayed. CMS staff are actively engaged in discussions with various stakeholders, regarding the various changes, the impacts of these changes, as well as, the compressed timeline to educate and train facility staff and update software and IT systems.

Please direct any comments or questions regarding the above information to MDSCodinganswers@cms.hhs.gov mailbox.

CMS recently posted the following on their MLN Connects webpage, which can be found at www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-02-27#_Toc33530674.

Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) initial claims that are processed out of sequence are not paying the correct Variable Per Diem (VPD)-adjusted rate. Also, all adjustment claims are not processing correctly. Claims need to process in date of service order for each stay for the VPD to calculate correctly. We will correct this issue in October. In the interim:

• Submit claims in sequence by waiting at least 2 weeks before billing subsequent claims;
• To adjust claims, cancel the initial claim and all subsequent claims in the SNF stay then rebill in sequential order; or, hold adjustments (when allowable) until October when they will process correctly;
• We encourage you to submit a complete bill at the time of entry.

This is a reminder that providers will no longer be able to submit a Social Security Number (SSN)-based Health Insurance Claim Number (HICN) or Railroad Retirement Board (RRB) number on the MDS in item A0600B or on the Medicare claim beginning January 1, 2020. Instead, the Medicare Beneficiary Identifier (MBI) must be used.

For additional details and resources regarding use of the MBI, please refer to the MLN Matters Article to learn how to get and use MBIs.

Due to the holidays, there will not be a Five-Star provider preview report deposited in CASPER for December 2019 and Nursing Home Compare will not be updated on its normal schedule. The next scheduled refresh will occur January 29, 2020.

The MDS QM reports will be updated to reflect measure updates identified in the MDS 3.0 QM User’s Manual v12.1 available at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIQualityMeasures.html, effective October 1, 2019.

Additionally, the previous SNF QRP Percent of Residents with Pressure Ulcers That are New or Worsened (S002.02) has been added to the MDS QM reports and the MDS Provider Preview and Resident-level Preview Report to allow for continued tracking on this measure.

While being updated, the following reports will not be available from the CASPER system:

• MDS 3.0 Facility Level Quality Measure Report
• MDS 3.0 Resident Level Quality Measure Report
• MDS 3.0 Quality Measure Monthly Comparison Report
• MDS 3.0 Facility Characteristics Report (add CMS logo, update privacy statement)

Once the report updates have completed, an additional memo will be sent.

If you have any questions concerning this information, please contact the QTSO Help Desk at help@qtso.com or 1 (888) 477-7876.

A new DRAFT version of the 2020 MDS item sets (v1.18.0) has been posted. This version is scheduled to become effective October 1, 2020. Please note that Section G was removed from all Federal item sets.

The files are located in the Downloads section of the MDS 3.0 Technical Information webpage: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30TechnicalInformation.html.

On November 8, 2019, CMS posted an updated errata (V3.00.3) to their MDS Technical Information webpage (www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/nursinghomequalityinits/nhqimds30technicalinformation.html) for the FINAL version (v3.00.1) of the MDS 3.0 Data Specifications, currently in production. Two issues were identified. One edit, -3941, will be deleted, and one edit, -3965, will be added. These changes will go into production on December 3, 2019. Once in production, these two changes will be retroactive, applying to all assessments with target dates on or after October 1, 2019.