iQIES

Medicaid HIPPS Code Calculation Issue: MDS ASMT Extracts Action Required

In October, we were made aware of an issue with the grouper that was using the response codes for the applicable data elements in GG0130 & GG0170 column 1 (Admission Performance) instead of column 5 (OBRA/Interim Performance) on one or more assessments for providers in your state. Because of this, the grouper did not correctly calculate the Medicaid HIPPS code on some standalone OBRA assessments with a Target Date and Submission Date on or after October 1, 2023.   

The grouper issue that caused the invalid HIPPS code to be calculated has been corrected and the affected assessments have been assigned a correct system-calculated value in item Z0100A; however, new MDS 3.0 ASMT Extract Files with the correct value are not being reissued. Instead, CMS has made available a file labeled XX_MDS3_ASMT_EXTRACT_Addendum_for_HIPPS_code_correction.csv in your State Extract folder in CMS MFT which contains the correct system-calculated HIPPS code for each affected assessment. The file name includes the two-character state code in place of XX. The CSV file contains the following information to allow you to identify the affected assessments on the original ASMT Extract File, as well as provides you with the correct system-calculated HIPPS code: 

• CCN  

• Submission ID  

• Submission Timestamp  

• Assessment ID  

• Resident ID  

• Invalid iQIES calculated Z0100A HIPPS Code  

• Corrected iQIES calculated Z0100A HIPPS Code  

CMS is directing you to check the folder referenced above for the CSV file and utilize the corrected HIPPS code on any associated Medicaid claims, where applicable. CMS strongly recommends you review the file thoroughly to account for the original invalid RECALCULATED_Z0100A field on affected assessments. 

If you have questions or require assistance, please contact the QIES/iQIES Service Center by phone at (800) 339-9313 or send an email.