Texas MDS for back payment

andy3k · May 10, 2011

I will share the answer to your question, after which I will share some valuable MDS resources that Texas provides (great for new and experienced MDS coordinators alike).

Purpose Code E, Off Cycle MDS, and Resident Discharge

An MDS must be submitted so that a Purpose Code E can be attached to it. The only purpose for the MDS is to attach the Purpose Code E, so it cannot be used as part of the Medicaid schedule for maintaining RUG rates (thus the name "off-cycle MDS"). In other words, if you submitted an MDS in January for quarterly payment, and submit an off-cycle MDS in February, you must still submit a quarterly MDS on time in April (in relation to the January assessment) to attach a regular LTCMI for quarterly Medicaid payment.

The MDS must follow all the rules established in the MDS RAI Manual. An off-cycle MDS (usually a quarterly MDS) is completed with current clinical information. If it is May 10, 2010 when you realize that you need to complete an off-cycle MDS, then the ARD of the off-cycle MDS will be on or near May 10, 2010. In MDS 3.0 RAI Manual terms, you are completing an early quarterly.

If the resident dies or is discharged prior to the end of the observation period for your off-cycle quarterly, the ARD must be adjusted to equal the discharge date. So the quarterly MDS you use to attach the Purpose Code E cannot have an ARD later than the date of discharge. The quarterly assessment must be completed no later than 14 days after the ARD. That is, Z0500B can be no more than 14 days from the ARD (ARD + 14 days). So you have 14 days after ARD (date of discharge) to complete an MDS for a Purpose Code E. The MDS must be accurate, so if you are signing the Z0500 on a specific date then the ARD must be no more than 14 days prior - you can't backdate the ARD. This means that if it is now over 14 days since resident discharge, you can no longer complete an off-cycle quarterly.

The only other way to submit a Purpose Code E is to attach it to a previously completed MDS that does not, and will not in the future, have an LTCMI attached to it for regularly scheduled quarterly Medicaid payment.

MDS Resources

The DADS MDS website has a lot of information for helping you with MDS-related topics, quality and process improvement, and links to other very helpful MDS resources. The MDS Mentor newsletter is particularly useful, including clinical and technical articles related to MDS. The website is: www.dads.state.tx.us/providers/MDS/

If you are not personally signed up to receive DADS MDS e-mail updates then I recommend you get signed up. The state MDS coordinators use the list to occasionally send out educational material and important alerts related MDS. This is a good way to stay up-to-date with new information, updates, and CMS alerts related to Texas MDS. Go to www.dads.state.tx.us (the DADS homepage), click on the tab "E-mail updates" and subscribe. You may select any of the email update lists that you like but I recommend you sign up for the "DADS Texas Minimum Data Set (MDS) Resources" list. Don't forget to click the "Save" button at the bottom.

The CMS MDS 3.0 Training Materials website has good information regarding MDS 3.0, training videos on the various MDS sections, as well as the most current MDS 3.0 RAI Manual. If the date at the bottom of your RAI Manual Chapter 2 pages is earlier than September 2010 then you need a newer version of the MDS RAI Manual. The link for the CMS MDS 3.0 Training Materials is: http://www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp#TopOfPage

The www.QTSO.com website has an MDS 3.0 link that takes you to the MDS 3.0 Provider User's Guide. The Guide explains how to submit your MDS data and pull your reports. Chapter 5 is the most important part of the Guide and explains the various errors and warnings you may get on your MDS validation report and what you can do about them.

If you have questions, the "Contact Program Staff" link on the DADS MDS website lists the people you can call for MDS-related issues.