The Minimum Data Set is the uniform assessment tool for nursing homes to develop a plan of care and reimbursement. Recently, the Trump Administration arbitrarily decided to remove Section G of the MDS.  Section G assesses a resident’s Functional Abilities and Limitations.  Seems kind of important, right?

The decision set for October 1, 2020 is being met with apprehension and confusion in the industry — as it could potentially result in unintended financial and administrative consequences for providers who rely on G to receive proper reimbursements.

  • How will nursing homes be reimbursed for their Medicaid residents without G in the MDS?
  • Will there be more guidance before the October 1 deadline?
  • Will this shift result in decreased Medicaid reimbursements?
  • Will there be additional administrative burdens?

Many states use the old Medicare reimbursement system — the Resource Utilization Group (RUG) model — to determine Medicaid rates, but the RUG system was phased out last October in favor of the new Patient-Driven Payment Model (PDPM). Under PDPM, operators do not assess as often. But the removal of Section G could have nursing homes feeling like they’re taking a step forward and then a step back.

Jodi Eyigor, director of nursing home quality and policy at trade group LeadingAge, confirmed there are still many questions about CMS’s announcement to take out Section G.

“It didn’t seem very clear. When you look at the actual draft, it does seem to indicate that GG will be used for all residents, regardless of payer type and regardless of their stay, but we’ve reached out to CMS to confirm that, and we haven’t received confirmation yet,” Eyigor said.

Some of the same concerns coming out now also arose when PDPM was implemented last year, she added, pointing to the questions about how the states’ reimbursement for Medicaid will be affected.

“So there were questions that came out earlier in the fall that still were not answered,” she added.


Leave a Reply

Your email address will not be published. Required fields are marked *

Post Navigation