Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
The Iowa Department of Human Services (DHS) and Iowa Medicaid Enterprise (IME) issued a joint informational letter dated October 9, 2019 (I received it via email just this afternoon) updating information provided late last month regarding the use of the OSA for IA Medicaid Case Mix. Once you click on that hyperlink, the PDF will load in the lower left of your screen. Click on that to read the 2-page letter.
Key points in the informational letter:
- The IME relies on the resource utilization group (RUG)-III assessment schedules from PPS for calculating case mix for NF residents. In order to continue the rate setting methodology, the IME will require a 30-day OSA for Medicare recipients beginning October 1, 2019. The Medicare assessment allows for the normalization of direct care costs during rebase periods.
- The 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 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.
- There are no changes to the Omnibus Budget Reconciliation Act (OBRA) assessments at this time. NFs should continue to complete OBRA assessments as they do today. The OSA cannot be combined with any federally-required assessment.
- The OSA is meant to capture the RUG calculations for the Medicare skilled stay. The OBRA assessments will still create a RUG calculation for non-Medicare assessments for the case mix report.
- The NF has the option to complete a quarterly OBRA assessment following the transition from Medicare skilled to NF level of care to be captured on the case mix report. An OSA is not required when a resident transitions from Medicare skilled to NF level of care.
Be sure to review the entire letter and share it with the MDS team in your facility.