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]

I think the whole purpose is that the obra assessment has to be completed after skilled time has ended. To get them out of a skilled rate and into the medicaid mix for reimbursement, atleast that is my understanding.

[iceprincess492]

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?

It's my understanding that you can't use the same date because even though they are not combined it will recognize both assessments. Only the last OBRA assessment of the quarter counts in the case mix.

[Talino]

i'm not disputing the ohioans' interpretation. however, this is what the ohio regulation says--

b) for the purpose of assigning a rug iii classification determining medicaid payment rates for nfs, odjfs shall utilize the data from the mds 3.0 as specified by the state and approved by cms. each nf shall assess all residents of medicaid-certified beds using the appropriate mds 3.0 for assessment reference dates (ards) on or after october 1, 2010 as set forth in appendix a to this rule for a comprehensive assessment, or appendix d to this rule for a quarterly assessment, or appendix e to this rule for a pps assessment. when the omnibus budget reconciliation act of 1987 (obra 1987) assessment (admission assessment, annual assessment, quarterly assessment, or significant change in status or a significant correction to a prior assessment) and medicare assessment time frames coincide, one assessment shall be used to satisfy both assessments. admission assessments must be combined with either the medicare five day or medicare fourteen day assessment. for a resident who is not a new admission to the facility, the quarterly, the annual, and significant change in status assessments must be combined with any medicare assessment if the assessment reference date (ard) is within the assigned medicare observation period. when combining the obra and medicare assessments, the most stringent requirement for mds completion must be met. odjfs may not utilize the data in the other medicare required assessments (omras) for calculating case mix scores or determining medicaid payment rates.

http://codes.ohio.gov/oac/5101%3a3-3-43.1 section b (after a #26)

[rnman99]

Where I'm at, if it's an OBRA assessment, it goes into case mix, no matter if it's combined with a PPS assessment or not. If they're cut from MC on day 30, and stay in the facility, whatever medicaid RUG they had on their admission goes into the case mix. Once in a while, if we know a resident is going to stay long term, and they get cut from therapy early, we'll throw a quarterly in with the 60 day to establish a new RUG for case mix.