In an effort to connect Post-Acute Care (PAC) across the care continuum, the IMPACT Act of 2014 challenged CMS to standardize patient assessment and quality measures data including resource data use. This allows for the exchange of this vital data among PAC and other providers to facilitate coordinated care efforts between care settings and ultimately, improve patient outcomes.
Based on these directives, CMS has developed the Continuity Assessment Record and Evaluation (CARE) Item Set. The CARE Item Set measures the health and functional status of Medicare beneficiaries at the time of acute discharge, and measures changes in severity and other outcomes for Medicare PAC patients.
Effective October 1, 2016 the SNF settings are required to submit both functional and quality measure data in the form of patient assessments. This data will be collected from elements in the revised MDS 3.0 Sections A and a new Section GG. Along with these revisions, changes to the Minimum Data Set frequency - through the addition of a SNF Medicare Part A PPS discharge assessment when a Medicare Part A stay ends - will once again challenge SNF Administrative teams to broaden their understanding of the internal systems and processes that could make or break a facility's quality outcome data.
The 16 new items in Section GG (representing half of the items included in the CARE item set) will require the assessor to assess the following:
- Oral hygiene
- Toileting hygiene
- Sit to lying
- Lying to sitting on side of bed
- Chair/bed-to-chair transfer
- Toilet transfer
- Does the resident walk?
- Walk 50 feet with two turns
- Walk 150 feet
- Does the resident use a wheelchair/scooter?
- Wheel 50 feet with two turns
- The type of wheelchair/scooter used (Manual or Motorized if the resident uses a wheelchair/scooter) to Wheel 50 feet.
- Wheel 150 feet
- The type of wheelchair/scooter used (Manual or Motorized if the resident uses a wheelchair/scooter) to Wheel 150 feet.
Timing: Section GG Functional Abilities and Goals will be completed with each 5 day MDS PPS Assessment. The assessment period for this section of the MDS is days 1 through 3 of the SNF PPS Stay starting with the date recorded in section A2400B (Start date of most recent Medicare stay). This differs from the CARE tool that requires only a 2 day assessment period.
Section GG Functional Abilities and Goals will also be completed on the new SNF PPS Part A Discharge (End of Stay) Assessment when a Medicare Part A stay ends. The assessment period is the last 3 days of the SNF PPS Stay ending on the date recorded in item A2400C (End date of most recent Medicare Stay). Section GG will be completed when all of the following occurs:
- Planned discharges (if A0310G Type of Discharge is not coded as “unplanned”)
- The patient is not discharged to the acute care hospital (A2100 discharge status is not is not “acute hospital”)
- When the discharge occurs on or after the fourth day of their Medicare Stay (A2400C End date of most recent Medicare stay minus A2400B Start date of most recent Medicare stay is greater than two)
Completion of “Admission Performance” and “Discharge Goal” for each of the 16 new items will be required with each 5 Day PPS MDS. Only “Discharge Performance” for each of the 16 new items will be required for the SNF PPS Part A Discharge (End of Stay) MDS. The assessor is instructed to code “the resident's usual performance” for each activity using the 6-point scale consistent with the CARE Tool. If an activity was not attempted the assessor codes the reason why the activity was not attempted (Resident refused, Not applicable or Not attempted due to medical condition or safety concerns). The 6 point scale differs significantly from current MDS coding conventions for Section G ADLs. In addition, although the new terminology for coding appears similar to Therapy terminology, the definitions are in fact different. The 6 point scale includes:
- Independent: Resident completes the activity by him/herself with no assistance from a helper.
- Setup or clean-up assistance: Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity.
- Supervision or touching assistance: Helper provides verbal cues or Touching/Steadying assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently.
- Partial/moderate assistance: Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.
- Substantial/maximal assistance: Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.
- Dependent or Helper does ALL of the effort: Resident does none of the effort to complete the activity or the assistance of 2 or more helpers is required for the resident to complete the activity.
Further details regarding the new CARE item set can be found on the CMS CARE Item Set webpage accessed though the link below.
The specific instructions and requirements for completion will not be confirmed until the release of the Resident Assessment Instrument (RAI) User’s Manual update, Harmony Healthcare will announce and update when released. Update is expected during third quarter 2016.