case mixing with PPS/OBRA combined assessments

[SMURPHYLPNRACCT]

When you combine a PPS/OBRA assessment at the beginning of a quarter, if the patient is then cut from skilled services after completion, is another OBRA assessment required in order for the patient to be included in the Medicaid case mix for that quarter? If you were to complete a 5day PPS/quarterly combined for a LTC resident the first week of January, the resident was cut from skilled service on their 14th day, will the 5d/Q combination included in the medicaid case mix score for first quarter or should another MDS be completed after skilled nursing ends????????

[SMURPHYLPNRACCT]

When you combine a PPS/OBRA assessment at the beginning of a quarter, if the patient is then cut from skilled services after completion, is another OBRA assessment required in order for the patient to be included in the Medicaid case mix for that quarter? If you were to complete a 5day PPS/quarterly combined for a LTC resident the first week of January, the resident was cut from skilled service on their 14th day, will the 5d/Q combination included in the medicaid case mix score for first quarter or should another MDS be completed after skilled nursing ends????????

[lifesaver252]

no another assessment is not needed. that assessment will go into the casemix.whatever the last assessment for a medicaid resident is during the assessment will go into the casemix even if its a part a or a combined partA and quarterly.

[SMURPHYLPNRACCT]

Really? I have always been told the opposite, so if I go back and review some combined PPS/OBRA assessments, these assessments should have been calculated in with that quarters case mix?! If indeed they were carried over to the Medicaid case mix, then my MDS nurses have been completing un-needed OBRA assessments for any LTC resident that was skilled and cut during the same quarter!!!!

[andy3k]

In my state, no new assessment is needed unless, of course, the resident meets the criteria for Significant Change. But different states might have different Medicaid requirements and your state might require that you to submit an early quarterly to address the change in skilled services. Contact your Medicaid office to find out if they have requirements beyond what MDS requires.

[SMURPHYLPNRACCT]

So the only way to find out, is to contact the State/dept. Jobs & Family Services? That is what I am trying to find out, if Ohio requires an additional MDS to be completed. We are a rather large 260 bed facility, with 5 MDS nurses, if the xtra MDS is not needed, we would sure like to know!!!

[andy3k]

Yes, or try contacting your state RAI or Technical Coordinator (Appendix B of the RAI Manual) to find out.

[SMURPHYLPNRACCT]

I have been all over the CMS and Ohio department of Jobs & Family websites, I can not find any answers to this question!! If anyone from Ohio knows a lot regarding case mix r/t OBRA and PPS combined assessments PLEASE HELP:confused:

[SMURPHYLPNRACCT]

Thank you, I will go there next!!!

[iceprincess492]

Ohio does require another assessment in order for it to count for casemix. It really is a pain but I know our corporation audits us quarterly to make sure we are completing an MDS for all LTC resident cut from skilled care :)

[lifesaver252]

well that does suck.. what if you do a seperate quarterly and a seperate medicare assessment but use the exact same info, with the exact same ARD dates..then you will not have to actually do two assessment on the resident but it will satisfy both requirments?

[SMURPHYLPNRACCT]

Thanks for the useful info. I am glad we have not been completing the extra assessments for no reason:)