On May 15, 2020, the Centers for Medicare & Medicaid Services (CMS) updated the Minimum Data Set (MDS) 3.0 item sets (version 1.17.2) to support the calculation of Patient-Driven Payment Model (PDPM) case mix groups on all Omnibus Budget Reconciliation Act (OBRA) assessments. Through this update, CMS has provided states the option to begin requiring and collecting the necessary MDS fields to categorize OBRA MDS assessment submissions within the PDPM resident classification system.
Beginning Oct. 1, 2020, NC Medicaid will require the completion and submission of the 28 MDS item set fields associated with PDPM on all OBRA nursing home comprehensive (NC) and quarterly (NQ) MDS assessment submissions. These additional fields are located in Sections GG, I and J. NC Medicaid believes this is a necessary step to begin evaluating the PDPM classification system and its viability as an alternative for the Resource Utilization Group- III (RUG-III ) classification system that is used today as the basis for the case mix reimbursement system.
Note: the MDS fields necessary for PDPM and RUG resident classification are available on both the standard NC and NQ MDS item sets. Therefore, providers will NOT need to file an Optional State Assessment (OSA) at this time. Please consult with your information technology department for any software changes needed to accommodate this requirement.
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