CMS Will Continue to Report RUG-III and RUG-IV HIPPS Codes, as Requested by the State, Until September 30, 2020

As of October 1, 2019, all scheduled PPS assessments (except the 5-day) and all unscheduled PPS assessments were retired. If you’re in a Medicaid case-mix state you may be wondering, “How will we calculate RUG-III or RUG-IV HIPPS codes for Medicaid stays?” Fortunately, the Center for Medicare and Medicaid Services (CMS) “will continue to report RUG-III and RUG-IV HIPPS codes, as requested by the state, until September 30, 2020 [emphasis added] on the 5-day PPS, OBRA comprehensive and OBRA quarterly assessment types. If a State requires the calculation of RUG-III or RUG-IV more frequently, the State may require its providers to submit the Optional State Assessment (OSA) at time points determined by the State.

Beginning October 1, 2020, states must use the OSA [emphasis added] as the basis for calculating RUG-III and RUG-IV HIPPS codes” (PDPM: FAQ 14.13). The OSA is available indefinitely and will be retired at such time it is deemed no longer needed by CMS in consultation with the states, who may consider transitioning to a form of PDPM. Any questions regarding the OSA should be directed to the relevant state agency governing your state’s Medicaid policy issues.

Have questions? Contact us to learn how we can help with your PDPM transition.

PDPM Skilled Nursing Charting Guidelines

This resource provides PDPM Skilled Nursing Charting Guidelines for condition/service specific NTA items and by Clinical Category with actual skilled documentation examples. Click here to learn more about this product in our shop.

Webinar: PDPM Skilled Nursing Supportive Documentation for Skilled Level of Care

This 1.25 hour webinar will focus on skilled nursing documentation requirements and best practices as it relates to PDPM. Click here to learn more about this product in our shop.

Get more resources in our shop!

Patients rely on you. You can rely on us. Find toolkits, webinars, on-demand trainings, templates, and much more to meet the needs of your facility. Click here to visit our shop.

Blog by Eleisha Wilkes, RN, RAC-CT, Clinical Consultant, Proactive Medical Review

Click here to learn more about Eleisha and the rest of the Proactive team.