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The purpose of this memo is to notify providers about changes to the item set fields required to be completed for the minimum data set (MDS) assessment submissions, effective immediately. DMAS will require the completion and submission of specific MDS fields associated with PDPM on all stand-alone Omnibus Budget Reconciliation Act (OBRA) nursing home comprehensive (NC) and quarterly (NQ) assessment submissions. These additional fields are located in Sections GG (Functional Abilities and Goals), I (Active Diagnoses) and J (Health Conditions). DMAS will use the PDPM information collected on the MDS to evaluate the viability of the PDPM classification system for potential Medicaid reimbursement in the future. DMAS currently uses the resource grouping utilization “RUG-IV Grouper 48 codes” to reimburse Medicaid Fee-For-Service claims.  This new framework will allow DMAS to generate a side-by-side comparison between the existing RUG-IV Grouper 48 codes and the new PDPM codes concurrently to understand the variance.   PDPM data will only be used for informational purposes, and will not impact Medicaid reimbursement. DMAS will continue to use RUG-IV Grouper 48 to reimburse Medicaid Fee-For-Service claims.

MDS item set fields necessary for PDPM and RUG IV resident classification are available on both the standard NC and NQ MDS item sets. Therefore, providers will not need to file an Optional State Assessment (OSA) at this time. Please consult with your information technology department for any software changes needed to accommodate this requirement.

For MDS 3.0 Technical Information, please visit

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30TechnicalInformation

For technical questions, please email Diana Marsh at diana.marsh@vdh.virginia.gov.

For reimbursement questions, please email NFPayment@dmas.virginia.gov.

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