Iowa LTC Providers: Minimum Data Set (MDS) / Medicaid Case Mix

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

Iowa DHS and IME issued INFORMATIONAL LETTER NO. 2196-MC-FFS on December 8, 2020.

In response to the Federal Public Health Emergency (PHE), the Centers for Medicare and Medicaid Services (CMS) released COVID 1135 Blanket Waiver on March 1, 2020, that included waiving 42 CFR 483.20 timeframe requirements for completion and submission of MDS assessments until the end of the PHE.

The IME is aware that the Federal PHE and the Federal Blanket Waiver have been extended allowing the extension of the MDS submission due dates. However, in an effort to set rates in a timely manner, per Iowa Administrative Code (IAC) 81.6(4), the IME will be extracting MDS assessment data from the Quality Improvement Evaluation System (QIES) database on the specified dates listed in Table 1.

The dates are provided to allow an extended period of time for nursing facilities to determine if they are able to submit the MDS assessments required to process the Case Mix Index (CMI) used for rate setting for long term care facilities.

If a nursing facility chooses to delay the completion and/or submission of MDS assessments, it may affect the quarterly rate setting and reimbursement rate. When a provider identifies a significant decrease in CMI or none at all due to the impact of COVID on the facility that effects the Medicaid reimbursement rate, the IME encourages providers to utilize an Exception to Policy (ETP) to extend the current rates that have been set or use the ETP process to recalculate rates once CMS lifts the 1135 Blanket Waiver for submission dates.

If you have any questions, please contact the IME Quality Improvement Organization Unit at 1-800-383-1173 or email at casemix@dhs.state.ia.