Wondering what changes will happen to the MDS in October? A DRAFT version of the MDS 3.0 Item Sets has been posted. There are many item changes in this version, including a new section GG, as well as two new item subsets for PPS Medicare Part A End of Stay Assessments – one for nursing homes and the other for swing bed facilities. Below you find the top five changes to the MDS that will take effect October 1, 2016.
1.) New End Of Stay Assessment
There will be a new PPS Medicare Part A End of Medicare Stay Assessment. Currently, when a patient concludes a Medicare Part A covered stay and continues to reside in the SNF, no further PPS assessments are required although the OBRA schedule must continue to be followed. Under the new rules effective October 1, 2016, a new Nursing Home and Swing Bed PPS Medicare Part A discharge (End of stay) item set will be required to be completed in these situations. This item set will be opened for completion by coding the reason for assessment as a SNF PPS Medicare Part A Discharge in the new item in Section A310 H. The primary purpose of this End of Medicare assessment will be to collect data for quality reporting purposes.
2.) Delirium Section C 1600/1300 deleted and replaced with 1310
Section C1300, which related to the identification of the signs and symptoms of delirium (from the CAMS) and Section C1600 (acute change in mental status) have been deleted and replaced by Section C1310.
Section C1310 contains the items previously coded in section C1300, with the exception of item D psychomotor retardation which is no longer identified for coding. Section C1310 also contains the information previously coded in item C1600.
In addition, the Care Area Assessments for Delirium and Cognitive Status have also been updated as a result of this change.
3.) Functional Abilities and Goals Section GG is a new addition!
The new MDS items in Section GG “Functional Abilities and Goals” have been added to the item set. This section is divided into two parts:
- GG0130 (Self care)
- GG0170 (Mobility)
These items are coded initially on admission to Medicare Part A with an assessment period of 1-3 days after the start of Medicare dates as coded in Section A2400. This Section will be completed with the 5-day PPS assessment and the Discharge from Medicare Part A assessments only. It is not completed with any other assessment types.
Item GG0130 codes the functional status with respect to self care items, including eating, oral hygiene, and toileting hygiene.
Item GG0170 codes the resident’s functional status with respect to mobility, including an assessment of how the resident moves from sitting to lying and from lying to sitting on the side of the bed. It also includes an assessment of how the resident moves from sitting to standing and in chair, bed, and toileting transfers as well as assessment of various walking skills.
The assessor is instructed to code:
- the resident’s usual performance in each task area
- based on a six point scale with “01” being dependent and “06” being independent.
- In addition, the instructions further indicate that if the activity was not attempted, the reason should be identified using the following codes:
- “07”- resident refused,
- “08”- Not applicable, or
- “09”- not attempted due to medical condition or safety concerns.
4.) Pressure Ulcers Section M added on discharge and end of stay assessment
The items in Section M0300 used for coding the number of pressure ulcers present on admission/reentry will be added to the current Nursing Home Discharge and the new End of Medicare Part A End of Stay assessments.
Question 2: Number of these Stage [1–4] pressure ulcers that were present upon admission/entry or reentry. Enter how many were noted at the time of admission/entry or reentry.
Currently coded on the comprehensive, quarterly, and PPS item sets will be added to All Discharge and End of Medicare item sets.
5.) Medications Section N based on classification not intent
The instructions for item N0410 on the MDS form have been changed to clarify that the coding of the medications in this section is based on the classification not the intent of medication. The form will instruct the assessor to “indicate the number of DAYS the resident received the following medications by pharmacological classification, not how it is used, during the last 7 days”.
More to Come!
CMS is currently working on the final version of the item set and revisions to the RAI User’s Manual with coding instructions to clarify the new coding items. Given the complexity of the changes, including the addition of Section GG, and the fact that the instructions on the item set form for this section are somewhat ambiguous and unclear, the Manual instructions and guidance will be critical to ensure accuracy of the assessment. It is anticipated that the final version of the MDS and related RAI User’s Manual revision will be released in April 2016.
Harmony Healthcare International (HHI) is available to keep you abreast of the Manual revisions and updates as they are posted and provide training of the interdisciplinary related to the correct coding and supportive documentation for the MDS.
If you have questions about the upcoming MDS changes, please contact Harmony Healthcare International by clicking here or calling our office at (800) 530-4413. If you would like a free Five-Star Quality Analysis with 5 New Measures, click here.