Effective October 1, 2021, MassHealth will require that nursing facilities complete the additional fields found in sections GG, I, and J of the MDS that are associated with Patient Driven Payment Model (PDPM) classification for all MassHealth members residing in a nursing facility. These PDPM fields must be reported for all OBRA assessments when such assessments are not combined with a five‐day skilled nursing facility prospective payment system (PPS) assessment. The collection of additional PDPM information for MassHealth residents is a critical step in moving towards a single acuity MDS-based payment system for Medicaid nursing facility reimbursement, a longstanding goal of the nursing facility provider community.
For the full details and requirements that become effective October 1, 2021, please refer to Nursing Facility Bulletin 168- Minimum Data Set Requirements for MassHealth Nursing Facility Residents.
If your facility does not have experience coding section GG of the MDS and you require assistance, or if you have questions generally about this bulletin, you may email your inquiry to: firstname.lastname@example.org. Please include the subject line “MDS Requirement for MH NF Residents” when submitting email inquiries.
For more detailed training please review the PDPM training available on the CMS website. The link to the training is: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Training.
Nursing facilities are encouraged to work with their software vendors to ensure the requisite MDS fields required for PDPM classification are available for entry and transmission on OBRA assessments.
Note that during the PDPM data collection phase, there is no change to the requirements to submit Management Minute Questionnaire (MMQ) data.