Mary Madison, RN, RAC-CT, CDP
Clinical Coordinator – Briggs Healthcare
Late afternoon on Friday, September 11, 2020, the Iowa Department of Human Services and the Iowa Medicaid Enterprise announced (INFORMATIONAL LETTER NO. 2162-MC-FFS) the state’s methodology for Medicaid case-mix calculation for reimbursement purposes.
Effective October 1, 2020, Iowa Medicaid will begin collecting the PDPM payment codes on all OBRA assessments (v1.17.2). These additional data elements are necessary for the IME to begin modeling and planning for a potential transition to PDPM for future rate setting methodology. CMS has communicated the Resource Utilization Group (RUG) system will not be supported indefinitely. Therefore, the IME would like to be proactive in gathering data to allow adequate time to evaluate next steps.
This MDS version will still require the Optional State Assessment (OSA) to be completed for ongoing quarterly case-mix reimbursement for any resident, dual eligible and Medicare only, which has a Medicare Part A skilled stay greater than 30 days.
The item set beginning October 1, 2020, will include MDS fields on the OBRA assessments that will allow Medicaid to begin collecting data to comply with the CMS Upper Payment Limit requirements and allow for a potential PDPM transition while continuing RUG reimbursement. Since the PDPM items will appear on the OBRA MDS, providers will not need to submit separate MDS assessments in order for the state to collect the PDPM data.
Contact information is provided at the end of this Informational Letter should you have questions or need additional information.