Why am I having to complete section GG on my quarterly MDS?
We are one year into the Patient Driven Payment Model and, unfortunately, that is not all we have had to deal with. Many states use the MDS and the RUGS system to calculate their Medicaid reimbursement.
Many of you have seen requests from the state to complete section GG on the MDS for state transmission. Others of you may be needing to complete the Other State Assessments (OSA).
As of now, the RUGs system is set to disappear from the MDS on Oct. 1, 2021. This will leave many states without the current system to reimburse for Medicaid. There is not a universal system in place for calculating Medicaid reimbursement. Some states use RUGs for case-mix, and others do not.
I cannot definitively tell you what each state is planning to do. The MDS changes that originally were planned for Oct. 1, 2020, were delayed, as was the implementation of SPADES. I encourage you to reach out to your state associations as well as your state RAI coordinator to receive updates on the individual state requirements for MDS completion.
That said, I still encourage long-term care facilities to review restorative and depression areas on the MDS. While no one is going to get rich by capturing these areas on the MDS, it can improve reimbursement in the lower nursing categories as well as impact case mix for the Medicaid case-mix. More importantly, restorative programs can significantly impact a resident’s quality of life.
These may also be areas impacting your quality measures. Decline in function and depression are consequences of COVID-19 policies that we have had to implement to ensure our residents’ safety.