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    v1.0.28
    OpenPayerPolicy UpdatesAdministrative/Operational PolicyMissouri DSS MDS Wait Time Policy Update | OpenPay…
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    CurrentMissouri Department of Social ServicesPolicy 49.19

    Nursing Facility MDS Reviews Excessive Wait Time Policy

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    Governs how nursing facilities provide medical records during MO HealthNet Division MDS Patient Driven Payment Model validation reviews, including response time limits, escalation procedures, and potential reimbursement or corrective consequences for excessive or undue delays.

    Policy Summary
    PayerMissouri Department of Social Services
    PolicyNursing Facility MDS Reviews Excessive Wait Time Policy
    Policy CodePolicy 49.19
    Change TypeAdded and revised
    Effective DateJuly 1, 2026
    Next Review DateNot specified
    Key ActionProvide at least two requested medical records within 30 minutes and all remaining records within 90 minutes after the entrance conference.
    SourceLink
    POLICY UPDATE CHANGES

    Incorrect or unsupported MDS submissions identified through review will be adjusted and used to recalculate the PDPM classification, case mix index, and facility per diem rate.

    The policy establishes required time limits and escalation steps for supplying requested medical records during an MDS Validation Review.

    5Minimum medical record requests per sample set
    30 minutesInitial record submission deadline
    90 minutes

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Remaining record submission deadline
    CMI and per diemPayment factors subject to recalculation

    MDS Validation Record Production Requirements

    MDS Validation Record Production Requirements

    During an MDS Validation Review, the facility must provide requested medical records within the established time limits. Extenuating circumstances will be evaluated on a case-by-case basis.

    MDS validation record production requirements

    • The RN reviewer(s) will make a minimum of 5 medical record requests until the sample size has been completed.
    • After the facility is presented with the list of requested medical records, at least 2 records must be provided within 30 minutes of completion of the entrance conference.>= 2 records within 30 minutes
    • The remaining requested medical records and/or electronic health records must be provided within 90 minutes total from completion of the entrance conference.All remaining records within 90 minutes total
    • A total of 90 minutes is allowed to supply the needed documentation for each set of 5 medical records requested.90 minutes per set of 5 records

    Consequences of delayed record production

    • If at least 2 medical records are not provided within 30 minutes of completion of the entrance conference, the facility liaison will be asked to provide the records or assist with providing the electronic health records to facilitate the review.
    • If the remaining medical records from the list are not provided within 90 minutes total of completion of the entrance conference, the Director of Nursing and/or facility Administrator will be notified of the excessive wait time, and the RN reviewer(s) will notify their manager.
    • The manager will determine how the RN reviewer(s) should proceed.
    • The Missouri Department of Social Services will be notified and will provide additional instruction.
    • Excessive and/or undue delays in providing medical records may result in additional review, unsupported assessments, and/or other corrective actions.

      Delay consequences may include additional review, unsupported assessments, and/or corrective actions.

    Record Submission Timeframes

    Minimum records requested per sample set
    Minimum sample-set requestAt least 5 medical records are requested until the sample size is complete.
    Response periodA total of 90 minutes is allowed for each set of 5 medical records requested.
    ExceptionsExtenuating circumstances are evaluated on a case-by-case basis.
    Initial record submission deadline
    Initial submissionAt least 2 medical records must be provided.
    DeadlineThe records must be provided within 30 minutes after completion of the entrance conference.
    If the deadline is missed

    Facility Responsibilities and Escalation

    Documentation Required

    Provide requested records during MDS validation

    During an MDS Validation Review, the facility must provide medical records requested by the RN reviewer within the established time limits.

    Documentation Required

    Meet record production time limits

    The RN reviewer will provide a minimum of 5 medical record requests until the sample size is complete. Provide at least two records within 30 minutes after completion of the entrance conference, and provide the remaining requested records and/or electronic health records within 90 minutes total.

    • Minimum request volume: 5 medical records
    • Initial submission: at least 2 records within 30 minutes
    • Complete submission: remaining records and/or electronic health records within 90 minutes

    Key Policy Terms

    MDS review
    DefinitionAn MDS review examines MDS elements and supporting documentation associated with the transmitted PDPM classification and case mix index.
    Resident listingThe review is performed on the final resident listing used to determine the facility’s per diem calculation.
    PurposeThe review validates the transmitted classification and associated CMI and confirms compliance with CMS procedures and documentation requirements.
    Hold harmless period
    DefinitionThe hold harmless period was the initial review period in which MDS reviews were used for provider training and education.
    Effective periodThe initial reviews conducted through June 30, 2026, were subject to the hold harmless period.
    Policy Summary
    PayerMissouri Department of Social Services
    PolicyNursing Facility MDS Reviews Excessive Wait Time Policy
    Policy CodePolicy 49.19
    Change TypeAdded and revised
    Effective DateJuly 1, 2026
    Next Review DateNot specified
    Key ActionProvide at least two requested medical records within 30 minutes and all remaining records within 90 minutes after the entrance conference.
    SourceLink
    On This Page
    MDS Validation Record Production RequirementsRecord Submission TimeframesFacility Responsibilities and EscalationKey Policy Terms
    The facility liaison will be asked to provide the records or assist with providing electronic health records.
    Complete record submission deadline
    Remaining recordsAll remaining requested medical records and/or electronic health records must be provided.
    DeadlineThe remaining records must be provided within 90 minutes total after completion of the entrance conference.
    If the deadline is missedThe Director of Nursing and/or facility Administrator will be notified, and the RN reviewer will notify the reviewer manager.
    Per-set documentation window
    Total response windowA total of 90 minutes is allowed to supply the needed documentation.
    Applicable setThe 90-minute window applies to each set of 5 medical records requested.
    Extenuating circumstancesExtenuating circumstances are evaluated on a case-by-case basis.
    Billing Rule

    Apply the five-record response window

    Allow 90 minutes to supply the needed documentation for each set of 5 medical records requested. Extenuating circumstances will be evaluated on a case-by-case basis.

    • Response window: 90 minutes for each set of 5 medical records
    • Extenuating circumstances are evaluated case by case
    Documentation Required

    Escalate the initial record delay

    If two medical records are not provided within 30 minutes after completion of the entrance conference, the facility liaison will be asked to provide the records or assist with providing the electronic health records to facilitate the review.

    Denial Risk

    Escalate excessive wait time

    If the remaining medical records from the list are not provided within 90 minutes total after completion of the entrance conference, the Director of Nursing and/or facility Administrator will be notified of the excessive wait time, and the RN reviewer will notify the reviewer’s manager.

    Denial Risk

    Follow management and department direction

    The reviewer manager will determine how the RN reviewer should proceed. The Missouri Department of Social Services will be notified of the situation and will provide additional instruction.

    Denial Risk

    Avoid review and reimbursement consequences

    Excessive and/or undue delays in providing medical records may result in additional review, unsupported assessments, and/or other corrective actions. Incorrect or unsupported MDS submissions will be adjusted and used to recalculate the PDPM, associated CMI, and the facility’s per diem rate.

    • Possible consequences of delayed records: additional review, unsupported assessments, and other corrective actions
    • Incorrect or unsupported MDS submissions may affect PDPM, CMI, and the facility’s per diem rate
    PurposeDuring this period, reviews did not negatively affect a nursing facility’s reimbursement rate.
    Excessive wait time or undue delay
    DefinitionExcessive wait time or undue delay means supplying requested medical records beyond the established response windows.
    Initial-record delayThis includes failing to provide the initial 2 records within 30 minutes after completion of the entrance conference.
    Remaining-record delayThis includes failing to provide the remaining requested records within 90 minutes after completion of the entrance conference.
    Potential resultExcessive or undue delays may result in additional review, unsupported assessments, and/or other corrective actions.