Minimum Data Set (MDS) 3.0 Blank Z0250

MDS 3.0 item Z0250 is required by the state of Texas per Provider Letter #10-19 - Provider Requirements for Minimum Data Set 3.0. However, a third of the providers in Texas are sending blank values in Z0250 for OBRA assessments where Z0250 should contain a valid RUG value. Others are submitting the wrong RUG in Z0250. You can read Provider Letter #10-19 at http://www.dads.state.tx.us/providers/communications/2010/letters/PL2010-19.pdf.

A provider can tell they are submitting blanks in Z0250 if recent final validation reports include multiple occurrences of warning -3616a, the incorrect value listed in the final validation report is ^, and Z0250 is recalculated. Providers might also receive warning -3616a when the Z0250 RUGs that their software calculates do not match the CMS recalculated Z0250 RUGs.

Either way, it takes only a few minutes for providers to fix the issue by properly setting the RUG configuration for Z0250 the MDS data entry software. Fixing this issue will benefit providers by decreasing the length of final validation reports and making it easier for providers to identify more critical validation issues that need immediate attention.

To fix this issue, providers should set their Z0250 RUG configuration to RUG-IV, 48 group, version 1.00, index maximizing, and case mix index set F01 - Research 48 Group Strive. If your MDS data entry software does contain the CMI set values for F01 then you will have to hand enter them using "RUGIV CMI doc [version].pdf" found in the "RUG IV Files" located on the CMS MDS 3.0 Technical Information page at http://www.cms.gov/NursingHomeQualityInits/30_NHQIMDS30TechnicalInformation.asp. Contact your software vendor if you need help setting your RUG configuration for item Z0250.

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Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule Published

On 7/29/11, the Centers for Medicare & Medicaid Services (CMS) posted the final SNF PPS rule for FY 2012 in the Federal Register at:
http://www.ofr.gov/OFRUpload/OFRData/2011-19544_PI.pdf

Along with recalibrating and updating the SNF PPS payment rates for FY 2012 - reducing Medicare payments in FY 2012 by $3.87 billion, or 11.1 percent lower than payments for FY 2011 - this final rule makes a number of additional revisions aimed at enhancing SNF PPS accuracy and integrity. The rule modifies the patient assessment windows and grace days to minimize duplication and overlap in observation periods between assessments. The final rule also:

• Clarifies circumstances when SNFs must report breaks of three or more days of therapy.
• Eliminates the distinction between facilities regularly furnishing therapy services on a 5- or 7-day basis for purposes of setting the date for the End of Therapy (EOT) Other Medicare Required Assessment (OMRA).
• Streamlines procedures for documenting situations involving a brief interruption in therapy, where therapy resumes without any change in the patient's RUG-IV classification level.
• Introduces a new Change of Therapy (COT) OMRA to capture those changes in a patient's therapy status that would be sufficient to affect the patient's RUG-IV classification and payment, even though they may not increase to the level of a significant change in clinical status.
• Provides for the allocation of a therapist's time for group therapy (defined in the rule as a single therapist leading four patients in a common activity) to ensure that Medicare payments better reflect resource utilization and cost for these services, and specifically that the therapist's time is being appropriately counted and reimbursed.
• Discusses the impact of certain provisions of the Affordable Care Act, and announces that proposed provisions regarding ownership disclosure requirements set forth in the Affordable Care Act will be finalized at a later date.

Your Texas state Resident Assessment Instrument (RAI) Minimum Data Set (MDS) staff strongly encourage you to read and become familiar with the new rules. At this time, state MDS staff have no additional information beyond what has been posted. However, the next CMS Skilled Nursing Facility (SNF)/Long-Term Care (LTC) Open Door Forum is available for questions and clarifications, as scheduled below.

Date: Thursday, August 11, 2011 Start Time: 1:00 PM Central Time (CT)/2:00 PM Eastern Time (ET);

Please dial in at least 15 minutes prior to call start time. Open Door Forum Participation Instructions: This call is Conference Call Only.

To participate by phone: Dial: 1-800-837-1935 & Reference Conference ID#: 68644999.

Persons participating by phone are not required to RSVP.

TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.