See http://www.tmhp.com/txtlstvw.aspx?LstID=31c4e36a-19f7-4f54-a074-3b19aee58533 for more information related to this release.
An on-time MDS assessment is one that has been submitted within the 92 days covered by the assessment (R2b + 91 days).
A modification to an MDS assessment can be in the form of either:
- An MDS submitted to the State MDS database using the federal Centers for Medicare and Medicaid Services (CMS) Correction Request Form or
- A correction to the Long Term Care Medical Information (LTCMI) on the MDS assessment in the LTC Online Portal
The LTC Online Portal enhancement also initiated an extensive research effort by Department of Aging and Disability Services (DADS) staff to identify any MDS Document Locator Numbers (DLNs) within the systems that may have resulted in a forced Purpose Code E prior to this change in policy and the release of this enhancement.
The research effort consisted of system and business analysis of all MDS assessments submitted on time where a subsequent MDS modification or LTCMI correction was submitted. Example DLNs provided to DADS were also used as validation of DADS research.
At this time DADS has identified several situations where there is a discrepancy between the LTC Online Portal message which indicates that a DLN processed with a default RUG (PCE) and the actual value of the Resource User Group (RUG) in Medicaid Eligibility Service Authorization Verification (MESAV) for that DLN. The MESAV indicates that the calculated RUG is in place and ready for payment on the modification or correction time period. If payment had already occurred for the time frame, a system generated retroactive adjustment to the payment to the calculated rate would have processed the weekend following the date the calculated RUG was updated.
If it appears that a provider has DLNs that have resulted in a forced Purpose Code E, the provider should review the MESAV for the RUG value associated with the time period covering that assessment. If the MESAV indicates a RUG value of PCE rather than the calculated RUG, please send an email to DADS using the Secure Webmail account https://hhsportal.hhs.state.tx.us/wps/portal. Click enter to submit an inquiry and a Form will be displayed. Please complete the required fields and submit. For identification purposes please start the description with “Modification PCE Request”.
The description must include the following information:
· The original DLN # submitted
· The reason for assessment code (1,2,4,5 or 10)
· The R2b date
· The original LTCMI completion date (Original Form submission date on portal)
· The modification date
· The Modification LTCMI completion date
· The Missed assessment Begin and End date
Please understand that the PC E’s being requested were not submitted to fill a Gap in the Level of Service records. These modifications occurred on an original form submitted timely which required a modification to correct data for the same time period the original form represented.
These requests will be researched and evaluated to determine if a calculated RUG should be paid for the time period requested. However, the research that is performed could result in payment adjustments both positively and negatively.