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The new Patient-Driven Payment Model: Draft 2020 Items Sets Posted: Providers Prepare

January 2020 PDPM
The new Patient-Driven Payment Model: Draft 2020 Items Sets Posted: Providers Prepare

Leah Klusch, RN, BSN, FACHCA, Founder and Director of The Alliance Training Center

At the end of December, the Centers for Medicare & Medicaid Services posted a new – and lengthy – draft version of the 2020 MDS that will take effect October 1. And the notice contains several changes that will impact providers’ data collection and documentation processes going forward, starting at admission. Here are the highlights of the affected sections.


Section A: Identification Information. This section has been expanded to six pages thanks to more data requirements around demographics, preadmission, and discharge. For instance, the new MDS has more options about ethnicity, where the elder is coming from, and the location they’re going to when they leave. There’s also a new section about any issues the elder has with transportation prior to admission or at discharge. With the new focus of Section A, facilities need to know what new data items they’ll need to collect at and around the time of admission, how they’re going to get the information and make it reproducible, and code it.

Section D: Mood. Another area of the form with notable changes is the mood interview. Mood interview scores have a direct impact on care planning and payment levels, and typically require a lot of time and interaction with the elder. But after October 1, 2020, if the elder doesn’t indicate that they have symptoms of a mood issue like little interest in activities, then the interview ends after the second question; it only continues if the individual reports symptoms. This change affects an organization’s tasks related to conducting the interviews so facilities need to look at their assignments.

Section G: Functional Status. Perhaps the most talked about change is that Section G has been removed on the comprehensive data set, yet functional limitation in range of motion and mobility devices have been moved to Section GG. Facilities will have to plan how they’re going to transition away from those tasks and take on some of the additional data collection required. Remember, though, there is still an optional state assessment for case mix states that contains an abbreviated Section G with those codes used to create the ADL score.

Section N: Medications. This section also underwent a significant amount of change, particularly the addition of a number of high-risk drug classes that the resident has been taking and is on at the time of discharge. Facilities will need to look at how CMS is defining terminology like high risk drug classes and how they need to code. In addition, the anti-psychotic medication review has been adapted slightly so this targeted area should be addressed as well.

Section O: Special Treatments. Another area with some changes is Section O, with the revised version of the form requiring a lot of detail for high-acuity treatments that the elder may be getting at admission, as a resident, and at discharge that will require new, very specific documentation to justify coding. While the specific directions for all of these additional items won’t be known until the final MDS is released, these are some of the areas that will be updated. Look for a large revision to the RAI manual to support all of the changes but, in the meantime, familiarize yourself now with the changes in the data content, what you’ll need to do to adapt your coding, and how to prepare your data processes to be able to get this information.

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