On December 6, 2018, Deputy Administrator and Director for CMS issued a CMCS Informational Bulletin informing Case-Mix states of two changes that may impact their payments for Medicaid patients in the nursing home setting.

  1. Effective October 1, 2019, PDPM will replace the RUG version for case mix methodology to classify Part A skilled nursing facility residents;
  2. Effective October 1, 2020, CMS will no longer support the RUG-III and RUG-IV case-mix methodologies via the minimum data set MDS.

PDPM streamlines the assessment schedule by eliminating all current scheduled and unscheduled assessments except for the 5-day assessment. For states that rely on these assessments for calculating their case mix groups, CMS has created an optional assessment so that Medicaid payment is not adversely impacted when PDPM is implemented on October 1,2019. States will have some flexibility in crafting policies associated with this assessment. The optional assessment will be effective from October 1st, 2019 through September 30th, 2020.

CMS reports they will be removing several MDS data elements over the next few years “in an effort to reduce provider burden, improve quality of care, and standardize data elements across provider settings”. CMS said, “Many MDS data elements used for RUG-III and RUG-IV will no longer required for federal purposes and with the removal of the data elements, RUG-III and RUG-IV will no longer be functional.  

CMS will continue to communicate any updates regarding these changes and if providers have questions, an email address is provided in the bulletin to submit questions.

Gina Tomcsik
Director of Compliance and Regulatory Strategy