Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
October 12, 2022
Effective Nov. 1, nursing facility providers must complete section GG and related fields before they submit an Omnibus Reconciliation Act assessment with an Assessment Reference Date on or after Nov. 1, 2022.
As part of this change, Texas will no longer require the calculation of an alternate Medicaid billing RUG.
What do providers or their Minimum Data Set software vendors need to do on or before Nov. 1?
- Set the STATE_PDPM_OBRA_CD value to “1 (Yes, perform PDPM calculations for OBRAs)” in their MDS software.
- Remove RUG-IV 48 Group version 1.03 as the setting for MDS Item Z0250, Alternate State Medicaid Billing.
Will these changes affect my Medicaid payment rates?
No. Once this feature is activated, data entered in the applicable MDS fields should not affect OBRA required assessments of resident well-being and will not affect the calculation of the MDS Resource Utilization Group III code used by Texas Medicaid for payment purposes.
Why is HHSC making these changes?
The additional data contained in the applicable MDS fields is vital to compare current RUG III data with Patient Driven Payment Model Data in order to develop future Medicaid payment methodologies. These may include a PDPM type model adapted for use in Texas long-term care.
This advanced notice is intended to allow facilities time to develop their processes, ensure staff are appropriately trained and allow time to work with any software venders as needed.
HHSC will issue a provider letter in the future with more guidance.
Contact your specific MDS software vendor for support.
This notification can be viewed here.