Attention Providers of Section 67 Nursing Facilities (NF): Optional State Assessment (OSA) and Federal Minimum Data Set (MDS) Assessments Required

Oct 06, 2023

Effective October 1, 2023, Federal MDS assessments no longer support Resource Utilization Group (RUG) III/IV grouper calculations. MaineCare reimburses NFs using a modified RUG III grouper calculation. NFs perform MDS assessments on NF residents which determines both resident level of care and NF reimbursement. This federal change will impact how NFs submit information to the Centers for Medicare & Medicaid Services (CMS) and MaineCare.   

CMS recently informed states that it will discontinue supporting the OSA and RUG calculations in Internet Quality Improvement and Evaluation System (iQIES) as of September 30, 2025. MaineCare is reviewing what steps will need to be taken in response to this future federal change.     

MaineCare will continue to use a modified RUG III grouper calculation while it works on reimbursement reform for NFs. Because MaineCare will still require RUG data for payment purposes and/or analysis, Starting October 1, 2023, NFs will need to complete the OSA and submit the OSA with their MDS assessments through the iQIES. MaineCare has communicated this change to facilities through a number of calls and trainings.    

For questions, please email Suzanne Pinette or call her at 207-287-3933.