Providers’ responses to an update of MDS item sets 3.0 (version 1.17.2) will largely depend on what their respective state Medicaid agencies will require under the new format, a payment expert said.
“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,” Leah Klusch, RN, BSN, FACHCA, executive director of The Alliance Training Center, told McKnight’s.
The update, which was announced in mid-May 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 they will require providers to use PDPM data for comparisons and payment, Klusch noted.
“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,” she counseled.
Klusch recommended that if states require providers to use PDPM data, 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 [assessments] 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 added.
