Harmony Healthcare Blog

MDS 3.0 Updates Effective October 1, 2018: Question and Answer (Part IV of IV)

Posted by Sally Fecto on Tue, Oct 02, 2018


Edited by Kris Mastrangelo

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


Side view of young female surgeon using digital tablet in front of computer at desk in clinicOur MDS 3.0 Updates Q&A Series concludes with a few additional questions concerning Section GG, mobility goals and discharges.  Harmony Healthcare International (HHI) will continue to publish blog posts concerning these updates and how they may affect your facilities.  If you have immediate concerns regarding MDS 3.0 Updates, please feel free to contact our team of HealthCARE Specialists to discuss facility-specific in-services and our on-site/remote training options.

Interested in learning more? Join us at harmony18, our 7th annual interdisciplinary LTPAC symposium.  This year’s symposium features former NFL and Super Bowl player, Joe Andruzzi; Inspirational Charity Founder, Ellie Anbinder; AHCA Sr. VP, Dr. David Gifford; an entire panel on PDPM; and more!  10 continuing education hours for all disciplines.  November 1-2, 2018 at Mohegan Sun Resort and Casino.

Click Here to Register. Room block expires early October. 

Question and Answer with Sally Fecto Sr. VP Field Operations Harmony Healthcare International (HHI) 

  1. I have a long-term care resident who uses an actual noninvasive ventilator. It is not bipap or cpap. It is a mask that she uses any time she sleeps.  How would I code that?

    What you describe appears to be a non-invasive ventilator and coded as such.
  1. Will Section GG continue to pertain to Med A residents only?

    Section GG is completed for Traditional FFS Medicare Part A residents.  Managed Medicare or Medicare Advantage MDS for RUG/reimbursement is not submitted to CMS. 

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  1. Since the roll-out is October 1 then the MDS changes would apply to residents admitted on or after September 24th?

    The item set is effective October 1st.  If the ARD is October 1st or later, the new item set is utilized.  The SNF QRP begins collecting data on October 1st.
  2. Do you happen to know if the intention is for Section G to be removed and GG to take its place for all residents (all payors)?

    No, Section G will remain part of the MDS and important for OBRA, Case Mix and the CAA and care planning process.
  3. How many discharge goals are you required to complete vs. how many does HHI suggest?

    One goal is required. HHI suggest entering goals as established via the evaluation process and care plan development.  The intent of coding Section GG is to have an Admission and Discharge Functional Assessment and a Care Plan to address function.  Goals should be established as part of the resident’s care plan as appropriate.
  4. Are you penalized if you do not have any mobility goals?

    No, one goal is required.  It makes sense that there would be a goal of improvement, decline or stay the same in at least one mobility item.  
  5. Are you penalized if your resident doesn’t achieve the discharge goals even though they’ve made improvements towards the goals (i.e. resident who is discharged from the facility to home prematurely)?

    The SNF QRP QM is basing improvement in self-care and mobility by calculating the admission and discharge score that reflects change or improvement. 
  6. I read an excellent HHI blog on how the quality measure “improvement in function” is calculated. How is section GG calculated or how does it tie into the quality reporting program? Any suggestions for “choosing wisely?”

    The SNF QRP Data collection for the following measures begins October 1, 2018 and focuses on: 

    • Application of IRF Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients (NQF #2633)
    • Application of IRF Functional Outcome Measure: Change in Mobility Score for Medical Rehabilitation Patients (NQF #2634)
    • Application of IRF Functional Outcome Measure: Discharge Self-Care Score for Medical Rehabilitation Patients (NQF #2635)
    • Application of IRF Functional Outcome Measure: Discharge Mobility Score for Medical Rehabilitation Patients (NQF #2636)

      The (15) Mobility Assessment items used for admission Mobility score calculations are as follows: 

      1. GG0170A1. Roll left and right
      2. GG0170B1. Sit to lying
      3. GG0170C1. Lying to sitting on side of bed
      4. GG0170D1. Sit to stand
      5. GG0170E1. Chair/bed-to-chair transfer
      6. GG0170F1. Toilet transfer
      7. GG0170G1. Car transfer
      8. GG0170I1. Walk 10 feet
      9. GG0170J1. Walk 50 feet with two turns
      10. GG0170K1. Walk 150 feet
      11. GG0170L1. Walking 10 feet on uneven surfaces
      12. GG0170M1. 1 step (curb)
      13. GG0170N1 4 steps
      14. GG0170O1 12 steps.
      15. GG0170P1. Picking up object
      • If code is between 01 and 06, then use code as the score for each Mobility item.
      • If code is 07, 09, 10, or 88, then recode to 01 and use this code as the score for the Mobility Item.
      • If the mobility item is skipped (^), dashed (-), or missing, recode to 01 and use this code as the score.

       The (7) Self-Care Assessment items used for admission Self-Care score calculations are: 

      1. Eating
      2. Oral hygiene
      3. Toileting hygiene
      4. Shower/bathe self
      5. Upper body dressing
      6. Lower body dressing
      7. Putting on/taking off footwear

Sum the scores of the admission self-care items to create an admission self-care score for each stay-level record. 

• Scores can range from 7 to 42, with a higher score indicating greater independence. 

Calculate the discharge Self-Care score using the discharge Self-Care score items and valid codes, for the same self-care areas as the admission items.

A resident is excluded if any of the following are true:  

  1. Resident has an incomplete stay:
    • Length of stay is less than 3 days: Discharge Date – Admission Date is less than 3 days.
    • Resident discharged against medical advice (AMA).
    • Resident died while in facility.
    • Medical Emergency: Patient’s discharge destination: Short-term General Hospital, Long-Term Care Hospital (LTCH), Inpatient Psychiatric Facility, Critical Access Hospital
    • Patents discharged directly to another IRF: Another Inpatient Rehabilitation Facility.
    • The resident is independent with all self-care and/or mobility activities at the time of admission.
  2. The resident is independent with all self-care and/or mobility activities at the time of admission.

The Quality Measure is calculated by observing the change in self-care and mobility scores for each resident stay-level record.For each stay-level record included in the target period, subtract the admission self-care or mobility score from the discharge self-care or mobility score. If a patient’s self-care score decreased from admission to discharge, the difference will be a negative value.

Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have.  You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 


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