Minimum Data Set (MDS) changes effective October 1, 2023

Bulletin

August 17, 2023, 4:53PM

To:

Nursing Facility, Specialized Care, and Hospice Service Providers; Commonwealth Coordinated Care (CCC) Plus Managed Care Organizations (MCO)

From:

Cheryl J. Roberts, Director

The purpose of this bulletin is to address MDS Assessment changes. Effective October 1, 2023 Centers for Medicare and Medicaid Services (CMS) will no longer have Section G in the MDS. Providers must use the Optional State Assessment (OSA) to generate a Resource Utilization Group (RUG) billing code for DMAS claims payment.

Completing the OSA

The OSA must be completed in accordance with Omnibus Budget Reconciliation Act of 1987 (OBRA) assessment scheduling. The purpose of the OSA is to generate a Virginia Medicaid RUG-IV billing code for DMAS claims payment. Providers are not required to assess members earlier than their normal scheduled MDS assessment due to the addition of the OSA effective October 1, 2023. Please see the DMAS Nursing Facility Provider manual and CMS MDS Manuals for more specific guidance.

Software Requirements

Software setting requirements for RUG-IV Grouper 48 will remain the same. However, the transition to the OSA will require providers to work with their software vendor to ensure current RUG-IV Grouper 48 settings are incorporated into the OSA correctly. Any software updates will need to be completed prior to completing an OSA. Please work with the MDS coordinator at VDH for technical assistance.

Resources:

CMS OSA and Resident Assessment Instrument (RAI) manual downloads

Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual | CMS

Nursing Facility Manual Chapter 5 and Chapter 11 (Appendix F)

Nursing Facilities | MES (virginia.gov)

MDS Coordinator

MDS.help@vdh.virginia.gov

DMAS Helpline

1-800-552-8627

PROVIDER CONTACT INFORMATION & RESOURCES

Virginia Medicaid Web Portal Automated Response System (ARS)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

https://vamedicaid.dmas.virginia.gov/

Medicall (Audio Response System)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

1-800-884-9730 or 1-800-772-9996

Acentra Health

Service authorization information for fee-for-service members.

https://dmas.kepro.com/

Provider Appeals

DMAS launched an appeals portal in 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal.

https://www.dmas.virginia.gov/appeals/

Managed Care Programs

Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), and Program of All-Inclusive Care for the Elderly (PACE). In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider. The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals.

Medallion 4.0

http://www.dmas.virginia.gov/#/med4

CCC Plus

http://www.dmas.virginia.gov/#/cccplus

PACE

http://www.dmas.virginia.gov/#/longtermprograms

Magellan Behavioral Health

Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members.

www.MagellanHealth.com/Provider

www.magellanofvirginia.com, email: VAProviderQuestions@MagellanHealth.com,or

Call: 1-800-424-4046

Provider Enrollment