Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
A lot of information/clarification regarding the use of the Optional State Assessment (OSA) has been provided this afternoon, ahead of the October 1st implementation of the MDS 3.0 v1.17.1 Item Set and the PDPM classification/reimbursement system. Iowa has long used the RUG-III grouper to provide data for Medicaid state case-mix reimbursement. The State has decided to utilize the OSA Item Set to calculate Medicaid case-mix reimbursement starting October 1, 2019. Here is the information I received this afternoon from the IA MDS Automation Coordinator (bolding and bullets added by me):
Additional Information and Clarification related to the OSA:
- The Other State Assessment (OSA) will need to be completed for any resident, dual eligible and Medicare only that has a Medicare Part A skilled stay greater than 30 days.
- If a resident is discharged from a Medicare Part A skilled stay on day 30 or before, the OSA is not required. If the resident has been in Medicare Part A skilled level of care prior to October 1, 2019 and a 30-day Minimum Data Set (MDS) assessment has already been completed, an OSA is not required for that resident.
- The OSA will adhere to the same timing guidelines as previously used for the 30-day assessment.
- The Assessment Reference Date (ARD) must be set within the range of day 27 through day 33. The OSA must be completed within 14 days after the ARD (ARD + 14 days).
- The OSA must be submitted electronically and accepted within 14 days after completion (completion + 14 days).
- The OSA is completed for state payment purposes only (AO300A) and the assessment type would be Other Payment Assessment (AO300B).
- The OSA is not required for residents that are skilled level of care under a Medicare Advantage plan or other private insurance.
- The OSA is meant to capture the RUG calculations for the Medicare skilled stay. The Omnibus Budget Reconciliation Act (OBRA) assessments will still create a RUG calculation for non-Medicare assessments for the case mix report.
- The OSA cannot be combined with any federally-required assessment.
- The Nursing Facility has the option to complete a quarterly OBRA assessment following the transition from Medicare skilled to Intermediate Care Facility level of care to be captured on the case mix report.
- An OSA is not required when a resident transitions from Medicare skilled to ICF.
All of the above clarifications are a result of discussions held at the State level following the posting of this DHS/IME notification regarding the use of OSA in IA beginning October 1, 2019. The link opens with the PDF notification in the lower left corner of your screen. Click on that PDF to read the initial notification.