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Experts and providers currently are evaluating the latest draft version of the 2020 MDS item sets (v1.18.0) following an unexpected announcement Friday from the Centers for Medicare & Medicaid Services.  

CMS noted in its unveiling that Section G “has been removed from all Federal item sets.” While at least one close observer noted there were rumors that the section might have been eliminated by this year, others said they didn’t expect it to be erased even in the coming regulatory year, which starts Oct. 1, 2020.

Section G notably is now used to calculate quality measures, including those related to function (short-stay function) and Percent of Residents Whose Ability to Move Independently Worsened (long-stay). (Section GG, which was enacted last Oct. 1 with the onset of the Patient-Driven Payment Model, is used only for Medicare Part A residents.)

Section G’s removal could be “good,” according to Jennifer Gross, senior healthcare specialist with PointRight, an analytics company for post-acute and long-term care providers. 

“In one way, the removal of Section G is a good thing; it would reduce the potential for inaccuracies due to confusion related to the different coding definitions between G and GG,” Gross told McKnight’s

“On the other hand, my inner MDS coordinator is worried that ADL assessment and documentation will be inconsistent for those residents who stay on long term. At least now, Section G provides a consistent tracking of ADLs on all residents regardless of the payer. After [Oct. 1, 2020], that goes away,” she added. 

Gross also noted the replacement of the PHQ-9 mood assessment with the PHQ-2 to 9 tool. 

“This change allows you to stop the assessment if the first two questions don’t indicate frequent or daily mood symptoms. I find it hard to believe that depression is over-triggering in nursing homes; will this change screen more residents out?” Gross added. 

Friday’s announcement also took some by surprise. Some observers considered it to be “early” for such a notice. Many more changes are expected before a final set becomes effective Oct. 1.

The American Health Care Association said it’s currently evaluating the draft updates to the MDS item sets to determine the potential impacts of the draft changes on the SNF PPS PDPM payment model, short- and long-stay quality measures, care planning requirements and other payers. 

“This also includes changes that may impact many state Medicaid systems that utilize MDS assessments to determine RUG-based case-mix payment rates,” the organization added in a statement to McKnight’s Friday. 

The pertinent new CMS files can be found in the Downloads section of the MDS 3.0 Technical Information webpage. The agency said Friday morning that the MDS 3.0 Item Set Change History for the October 2020 report also will be posted to this site “shortly.”