New Section S and OSA Requirements in effect as of October 1, 2023

Minnesota Department of Health sent this bulletin at 10/10/2023 01:20 PM CDT
minnesota department of health

New Section S and OSA Requirements in effect as of October 1, 2023

Minnesota Case Mix Review Manual has been updated to include new data elements; recording of MDS 3.0 Updates and OSA Implementation webinar is now available.

This information is intended for Long Term Care Facility Administrators, Directors of Nursing, Minimum Data Set (MDS) Coordinators, and staff who work with the MDS.

On October 1, the new and revised elements for the Minimum Data Set (MDS) 3.0 Assessment went into effect. Providers should review the updates to the Resident Assessment Instrument (RAI) Manual version 1.18.11 to ensure they understand the changes. Detailed information is available on the CMS Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual website.

Minnesota nursing facilities are now required to complete the Optional State Assessment (OSA) each time a comprehensive (admission, annual, significant change in status, and significant correction of a prior comprehensive) and non-comprehensive (quarterly and significant correction of a prior quarterly) assessment is completed. Minnesota also has added two new Section S items to the MDS and the start and end dates of isolation will be required. Facilities will need to ensure that their software vendors are also aware of this change. More detail about these changes is provided below, and has been added to the Minnesota Case Mix Review Manual.

The recording of the webinar held by MDH Case Mix Review Program staff to review the changes to the MDS 3.0 and the OSA Implementation is now available for review on the MDS and RAI Information page of the MDH Case Mix Review website.

Section S

Section S is a new section containing three new data elements, S6060A, S6060B, and S6060C. These data elements identify whether strict isolation services were provided in the observation period. The isolation coding criteria has not changed; only strict isolation is coded on the MDS.

  • S6060A- Strict Isolation, Has the resident been in strict isolation since Admission, Reentry, or the prior OBRA/OSA assessment whichever is more recent? The response is simply, Yes or No.
  • S6060B- Start Date of Strict Isolation, If the response to S6060A is Yes, enter the start date of strict isolation in this data element and proceed to S6060C.
  • S6060C- End Date of Strict Isolation, Enter the last day of strict isolation since Admission, Reentry, or the prior OBRA/OSA assessment whichever is more recent? If strict isolation was ongoing after the ARD of the assessment, enter dashes.

Submission of the MDS 3.0 Optional State Assessment in Minnesota

The use of the Optional State Assessment (OSA) enables the Minnesota Departments of Health and Human Services to establish case mix classifications for reimbursement of nursing facility care, as of October 1. These requirements are in addition to the requirements set forth in the Resident Assessment Instrument (RAI) Manual.

Requirements

Nursing facilities are now required to submit an OSA for State Medicaid Billing.

The OSA is required:

  • Each time an OBRA Admission, Annual, Significant Change in Status (SCSA), Significant Correction to Prior Comprehensive (SCPA), Quarterly, and Significant Correction to Prior Quarterly (SCQA) assessment is completed.
  • The ARD of the OBRA assessment and OSA must match.
  • The assessments must be submitted in the same batch.
  • When all therapy services have ended,
  • When isolation services have ended.

Submit the OSA with these fields:

  • A0300A must = 1 indicating the assessment is for state payment purposes only.
  • A0300B must = 2 when all therapy services have ended, if the previous OBRA assessment resulted in a Rehabilitation classification. The ARD of the assessment must be set on day 8 after all therapy services have ended. This will generate a new classification notice.
  • A0300B must = 2 when all isolation services have ended if isolation was coded on the previous OBRA assessment. The ARD of the assessment must be on day 15 after isolation services have ended. This will generate a new classification notice.
  • A0300B must = 5 for an Admission, Annual, Significant Change in Status (SCSA), Significant Correction to Prior Comprehensive, Quarterly, and Significant Correction to Prior Quarterly.

Classification Effective Dates:

The classification effective dates are:

  • Admission date for an OSA with a corresponding Admission assessment,
  • Assessment Reference Date (ARD) for an OSA with a corresponding SCSA,
  • Assessment Reference Date for an OSA completed due to the End of Therapy (EOT) or End of Isolation (EOI), or
  • The first day of the month following the ARD for all other corresponding OBRA assessment types.

When a resident is Discharge Return Anticipated (DRA) and returns to the facility within 30 days of their discharge date the previous classification will resume unless a new assessment is completed.

Classification Notices

The OSA is submitted to CMS the same way all OBRA required assessments are submitted to CMS. Multiple classification notices may be generated during a billing period depending on the number of OSAs submitted. It is the facility's responsibility to provide the resident with the notice that contains the classification that will be used for payment purposes.