How providers respond to an update of MDS item sets 3.0 (version 1.17.2) will largely depend on what their state Medicaid agency will require under the new format, one payment expert emphasized Tuesday. 

“That’s the first step in this entire release of information,” Leah Klusch, RN, BSN, FACHCA, executive director of The Alliance Training Center, told McKnight’s

Leah Klusch
Leah Klusch

“But, again, we do not have a master list of the states who are going to participate in this so this is an interim select change that’s going to be driven by state reimbursement policy under Medicaid,” she added. 

The update, which was announced this week by the Centers for Medicare & Medicaid Services, supports the calculation of Patient Driven Payment Model payment codes on OBRA assessments when not combined with a five-day SNF PPS assessment. In response, state agencies are going to have to declare if it will require providers to use PDPM data for comparisons and payment, according to Klusch. 

“If the answer is no, then you’re not going to worry about these different assessments. You’re going to continue, I believe, with assessments pretty much the way they are now,” she explained. “But if your state is going to require the PDPM data to be included on your legitimate Medicaid caseload, then you’re going to have to start at the beginning.” 

Klusch recommended that if states require providers to use PDPM data that they should look at the comprehensive and quarterly assessments since those contain the most active assessment activities. She also noted that there will be a conversion process for providers and they’ll also have to assess if changes need to be made to the data-formulation process. 

“We’ll have some rather significant adjustments on our Medicaid cases and it’s going to take I’m sure a lot more time to get MDS’ done on Medicaid cases than it is today,” Klusch said. 

Providers and experts should hold off on interpreting the changes until they see “preliminaries of the manual.” She noted that the latest update isn’t draft documents but rather “straight, effective 10/01/2020 final copies,” and it will be critical for providers to find differences between the update and previous versions. 

“With any change like this, we have to make sure that the assessment process that we’re doing now is compliant and is accurate to the manual that we’re working with now,” Klusch said. 

“We still have to make sure that we’re collecting the data today according to the manual that was released last October 1. We have a lot of facilities that are still working on that. Don’t get excited and move ahead to this new set until you’re sure that you’re getting your data onto the MDS accurately today,” she added.