Minnesota Case Mix Review Program

Provider Webinar July 16

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.

Assessment Notice change

In July, the Assessment Notice located in the Case Mix Review (CMR) Portal will display the Resource Utilization Group (RUG)-IV classification along with the Patient Driven Payment Model (PDPM) Nursing Component classification. The RUG-IV classification will be effective as listed and the PDPM Nursing Component will be effective on October 1, 2025.

Minimum Data Assessment (MDS) requirement for October 1

• Effective October 1, the Optional State Assessment (OSA) will no longer be required as a standalone assessment after all therapy or isolation is completed or with any Omnibus Budget Reconciliation Act (OBRA) assessment.
• If the most recent assessment completed prior to October 1 is a standalone OSA, an OBRA assessment will need to be completed, submitted and accepted into the Centers for Medicare and Medicaid Services (CMS) data base on or before September 30 to calculate a PDPM Nursing Component classification effective October 1.
• Effective October 1, a Significant Change in Status assessment will need to be completed on day 15, after isolation services have ended.

MDS supporting documentation

• Case Mix Review staff will be looking for Functional Abilities supporting documentation on all three shifts during the observation period.
• The resident’s self-care and mobility performance is based on direct observation, incorporating resident self-reports, reports from qualified clinicians, care staff/nursing assistants, and family documented in the medical record during the observation period.
• Documentation to complete the MDS must be obtained and documented in the medical record on or prior to the Assessment Reference Date (ARD). MDS coding must be consistent with the clinical assessments documented in the medical record.

Internet Quality Improvement and Evaluation System (iQIES)

• The iQIES User Interface Tool will no longer receive updates after October 1. Facilities who use the iQIES User Interface for manual completion and submission of their MDS’ will need to transition to vendor, third-party, or company software to complete MDS records. All assessments with a target date of October 1 and later must be submitted in XML format.

Training opportunities

The Case Mix Review (CMR) Program at the Minnesota Department of Health is offering training regarding changes to assessments effective October 1. The training will be presented by the State RAI Coordinator, Nadine Olness, RN RAC-CTA and Robin Lewis, RN Minnesota Case Mix Review Program Supervisor.

Contact information

For questions, please reach out to the Case Mix Review team at Health.MDS@state.mn.us.

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.

New data elements added to Quarterly Assessments

Effective 10/1/24, I0100 (Cancer), I3700 (Arthritis) and I6500 (Cataracts, Glaucoma and Macular Degeneration) are required on all quarterly assessments. These items do not appear on the Optional State Assessment (OSA) as they do not impact payment. Contact your software vendor if these items do not appear on your quarterly assessments.

Prevent delays in processing payments

• Staff must ensure that the Therapy and Isolation Start and End Dates are correctly entered on all Omnibus Budget Reconciliation Act (OBRA) comprehensive assessments, OBRA non-comprehensive assessments and OSA, when appropriate. When these dates are not on the assessment, this assessment will not be immediately processed, requiring a call from the Case Mix Review staff for further information.
• Staff must ensure the OBRA assessment and the corresponding OSA are submitted in the same batch.

When to complete an OSA

The OSA is required for most admissions to nursing facilities that are Medicare and Medicaid certified, regardless of who the payer is. The OSA is not required with Perspective Payment System (PPS) assessments, Discharge Assessments and Tracking Records. The OSA is required:

• Each time an OBRA comprehensive, quarterly or Significant Correction to prior Quarterly Assessment (SCQA) assessment is completed, and
• When all therapy and isolation services end, if the most recent OSA resulted in a rehabilitation RUG-IV classification in Z0200A or isolation was coded on the assessment.
• The OSA should not be used as a standalone assessment to capture a higher RUG classification. When completing a Significant Change in Status Assessment (SCSA) staff must ensure the criteria on pages 2-24 to 2-29 of the current RAI manual is met. A SCSA is not required when all therapy or isolation services end.
• The OSA for the end of therapy and the end of isolation cannot have the same ARD as an OBRA assessment. When a OSA has the same ARD as a Quarterly or Comprehensive assessment, the effective date of the OSA is the first of the month following the ARD. The standalone OSA completed when therapy or isolation ends is effective on the ARD of the OSA.

Contact information

If you have any questions, please contact Case Mix Review by email at health.fpc-cmr@state.mn.us or call 651-201-4200.