Friday, September 3, 2010
Summarized from information provided during the CMS August 24, 2010, RUG-IV national call. These explanations focus on the 5-day and 14-day assessments, but the same rules apply for all of the scheduled PPS assessment types.
The PowerPoint handout from the call is posted on https://www.cms.gov/SNFPPS/02_Spotlight.asp and contains the detail about the options. A second set of handouts from the call provides detailed information about the ARD windows permitted for each assessment for each option.
The transcript of the call as well as the audio recording are expected to be posted on the CMS website.
All of the options have their pros and cons. They are summarized in the PowerPoint document from the CMS call.
Option 1 - No Substitution
5-day assessment payment block (days 1-14) overlaps September to October
·Use MDS 2.0 5-day assessment to cover the days through Sept. 30 with RUG-III
·Use MDS 3.0 5-day assessment to cover the remainder of the days with RUG-IV
·Use MDS 3.0 14-day assessment to cover applicable days with RUG-IV if skilled coverage continues
Example
· Part A day 1 = 9/27/10
· 5-day assessment covers 9/27 to 10/10
· MDS 2.0 5-day pays for 9/27-9/30 (4 days)
· MDS 3.0 5-day pays for 10/1-10/10 (10 days)
· If resident remains skilled, MDS 3.0 14-day picks up on 10/11
14-day assessment payment block (days 15-30) overlaps September to October
· Use MDS 2.0 14-day assessment to cover the days through Sept. 30 with RUG-III
· Use MDS 3.0 14-day assessment to cover the remainder of the days with RUG-IV
· Use MDS 3.0 30-day assessment to cover applicable days (days 31-60) with RUG-IV if skilled coverage continues
Example
·Part A day 1 = 9/12/10
·14-day assessment covers 9/26-10/11
·MDS 2.0 14-day assessment covers 9/26 – 9/30 (5 days)
·MDS 3.0 14-day assessment covers 10/1 – 10/11 (11 days)
·If resident remains skilled, MDS 3.0 30-day assessment picks up on 10/12
Option 2 – MDS 3.0 for MDS 3.0
5-day assessment payment block (days 1-14) overlaps September to October
· Use MDS 2.0 5-day assessment to cover days through Sept. 30 with RUG-III
· Use MDS 3.0 14-day assessment to calculate RUG-IV group to cover
o Remaining days from 5-day payment block AND
o Payment block for 14-day assessment (as long as Part A coverage continues)
Example
·Part A day 1 = 9/27/10
·5-day assessment covers 9/27 to 10/10
·MDS 2.0 5-day pays for 9/27-9/30
·MDS 3.0 14-day assessment covers 10/1 – 10/26 (10 days from the 5-day payment block + the 16 days for the 14-day payment block) as long as Part A coverage continues
14-day assessment payment block (days 16-30) overlaps September to October
· Use MDS 2.0 14-day assessment to cover days through Sept. 30 with RUG-III
· Use MDS 3.0 30-day assessment to calculate RUG-IV group to cover
o Remaining days from 14-day payment block AND
o Payment block for 30-day assessment (as long as Part A coverage continues)
Example
·Part A day 1 = 9/12/10
·14-day assessment covers 9/26-10/11 (16 days)
·MDS 2.0 14-day assessment pays for 9/26-9/30 (5 days)
·MDS 3.0 30-day assessment pays for
o Remaining days in 14-day payment block,10/1 – 10/11 (11 days) AND
o Payment block for 30-day assessment (days 31-60, 30 days)
Option 3 – Substitute MDS 3.0 for MDS 2.0 (don’t do MDS 2.0 at all)
5-day assessment payment block (days 1-14) overlaps September to October
· Use MDS 3.0 5-day assessment to cover all 14 days
o Calculates RUG-III for days through September 30
o Calculates RUG-IV for days in October
· Use MDS 3.0 14-day assessment to calculate RUG-IV group to cover starting day 15 of Part A stay (as long as Part A coverage continues)
Example
· Part A day 1 = 9/27/2010
· MDS 3.0 5-day assessment covers all 14 days of the 5-day payment block (days 1-14)
o 9/27-9/30: RUG-III
o 10/1-10/10: RUG-IV
· MDS 3.0 14-day assessment covers regular 16-day payment block starting 10/11 (as long as Part A coverage continues)
14-day assessment payment block (days 15-30) overlaps September to October
· Use MDS 3.0 14-day assessment to cover all 16 days
o RUG-III for days through September 30
o RUG-IV for days in October
· Use MDS 3.0 30-day assessment to calculate RUG-IV group to cover starting day 31 of Part A stay (as long as Part A coverage continues)
Example
· Part A day 1 =9/12/10
· MDS 3.0 14-day assessment covers all 16 days of the 14-day assessment payment block (days 16 through 30)
o 9/26-9/30: RUG-III
o 10/1-10/11: RUG-IV
· MDS 3.0 30-day assessment covers regular payment block (days 31-60) as long as Part A coverage continues
Default Option (LOL - NOT an option)
· When the Part A stay ends 10/1/1- to 10/4/10, the facility may opt not to complete required PPS assessment and bill the default rate instead
· Discharge assessment still required under OBRA requirement (does not pertain to payment)
The PowerPoint handout from the call is posted on https://www.cms.gov/SNFPPS/02_Spotlight.asp and contains the detail about the options. A second set of handouts from the call provides detailed information about the ARD windows permitted for each assessment for each option.
The transcript of the call as well as the audio recording are expected to be posted on the CMS website.
All of the options have their pros and cons. They are summarized in the PowerPoint document from the CMS call.
Option 1 - No Substitution
5-day assessment payment block (days 1-14) overlaps September to October
·Use MDS 2.0 5-day assessment to cover the days through Sept. 30 with RUG-III
·Use MDS 3.0 5-day assessment to cover the remainder of the days with RUG-IV
·Use MDS 3.0 14-day assessment to cover applicable days with RUG-IV if skilled coverage continues
Example
· Part A day 1 = 9/27/10
· 5-day assessment covers 9/27 to 10/10
· MDS 2.0 5-day pays for 9/27-9/30 (4 days)
· MDS 3.0 5-day pays for 10/1-10/10 (10 days)
· If resident remains skilled, MDS 3.0 14-day picks up on 10/11
14-day assessment payment block (days 15-30) overlaps September to October
· Use MDS 2.0 14-day assessment to cover the days through Sept. 30 with RUG-III
· Use MDS 3.0 14-day assessment to cover the remainder of the days with RUG-IV
· Use MDS 3.0 30-day assessment to cover applicable days (days 31-60) with RUG-IV if skilled coverage continues
Example
·Part A day 1 = 9/12/10
·14-day assessment covers 9/26-10/11
·MDS 2.0 14-day assessment covers 9/26 – 9/30 (5 days)
·MDS 3.0 14-day assessment covers 10/1 – 10/11 (11 days)
·If resident remains skilled, MDS 3.0 30-day assessment picks up on 10/12
Option 2 – MDS 3.0 for MDS 3.0
5-day assessment payment block (days 1-14) overlaps September to October
· Use MDS 2.0 5-day assessment to cover days through Sept. 30 with RUG-III
· Use MDS 3.0 14-day assessment to calculate RUG-IV group to cover
o Remaining days from 5-day payment block AND
o Payment block for 14-day assessment (as long as Part A coverage continues)
Example
·Part A day 1 = 9/27/10
·5-day assessment covers 9/27 to 10/10
·MDS 2.0 5-day pays for 9/27-9/30
·MDS 3.0 14-day assessment covers 10/1 – 10/26 (10 days from the 5-day payment block + the 16 days for the 14-day payment block) as long as Part A coverage continues
14-day assessment payment block (days 16-30) overlaps September to October
· Use MDS 2.0 14-day assessment to cover days through Sept. 30 with RUG-III
· Use MDS 3.0 30-day assessment to calculate RUG-IV group to cover
o Remaining days from 14-day payment block AND
o Payment block for 30-day assessment (as long as Part A coverage continues)
Example
·Part A day 1 = 9/12/10
·14-day assessment covers 9/26-10/11 (16 days)
·MDS 2.0 14-day assessment pays for 9/26-9/30 (5 days)
·MDS 3.0 30-day assessment pays for
o Remaining days in 14-day payment block,10/1 – 10/11 (11 days) AND
o Payment block for 30-day assessment (days 31-60, 30 days)
Option 3 – Substitute MDS 3.0 for MDS 2.0 (don’t do MDS 2.0 at all)
5-day assessment payment block (days 1-14) overlaps September to October
· Use MDS 3.0 5-day assessment to cover all 14 days
o Calculates RUG-III for days through September 30
o Calculates RUG-IV for days in October
· Use MDS 3.0 14-day assessment to calculate RUG-IV group to cover starting day 15 of Part A stay (as long as Part A coverage continues)
Example
· Part A day 1 = 9/27/2010
· MDS 3.0 5-day assessment covers all 14 days of the 5-day payment block (days 1-14)
o 9/27-9/30: RUG-III
o 10/1-10/10: RUG-IV
· MDS 3.0 14-day assessment covers regular 16-day payment block starting 10/11 (as long as Part A coverage continues)
14-day assessment payment block (days 15-30) overlaps September to October
· Use MDS 3.0 14-day assessment to cover all 16 days
o RUG-III for days through September 30
o RUG-IV for days in October
· Use MDS 3.0 30-day assessment to calculate RUG-IV group to cover starting day 31 of Part A stay (as long as Part A coverage continues)
Example
· Part A day 1 =9/12/10
· MDS 3.0 14-day assessment covers all 16 days of the 14-day assessment payment block (days 16 through 30)
o 9/26-9/30: RUG-III
o 10/1-10/11: RUG-IV
· MDS 3.0 30-day assessment covers regular payment block (days 31-60) as long as Part A coverage continues
Default Option (LOL - NOT an option)
· When the Part A stay ends 10/1/1- to 10/4/10, the facility may opt not to complete required PPS assessment and bill the default rate instead
· Discharge assessment still required under OBRA requirement (does not pertain to payment)
OBRA Schedule & Transition Planning
From one MDS 3.0 to the next 3.0 you will use the ARD.
For the Transitions from 2.0 to 3.0 you will use the following:
If the first assessment come Oct is a quarterly, schedule it so the ARD is not later than 92 days from the previous MDS 2.0 quarterly R2b date.
If the first assessment come Oct is a comprehensive (Annual), schedule is so the ARD is not later than 366 days from the Previous MDS 2.0 Comprehensive Vb2 date and not later than 92 days from the previous MDS 2.0 assessment R2b.
Once you complete your first MDS 3.0 you will schedule subsequent MDS 3.0 assessments from ARD to ARD.
For the Transitions from 2.0 to 3.0 you will use the following:
If the first assessment come Oct is a quarterly, schedule it so the ARD is not later than 92 days from the previous MDS 2.0 quarterly R2b date.
If the first assessment come Oct is a comprehensive (Annual), schedule is so the ARD is not later than 366 days from the Previous MDS 2.0 Comprehensive Vb2 date and not later than 92 days from the previous MDS 2.0 assessment R2b.
Once you complete your first MDS 3.0 you will schedule subsequent MDS 3.0 assessments from ARD to ARD.
Subscribe to:
Posts (Atom)