Updates for MDS 3.0

1. Updates for MDS 3.0 Rose Helwig , RN BSN MCS II

2. What’s New • RAI Manual Updates: • Changes are: • Assessment Instruction • Special Treatments, Procedures, and Programs • Cognitive Pattern • Active Diagnosis • Swallowing and Nutritional Status • Skin Conditions • Medications

3. Changes Continued • Care Area Assessment Process and Care Planning • Medicare SNF Prospective Payment System • Glossary and Common Acronyms • CAA Resources • PHQ Scoring Rules and BIMS when administered in writing

4. PPS Policies • Change of Therapy (COT) Medicare Other Required Assessment • Changes are: • For Part A SNF Residents • Change of Therapy observation Period refers to a successive 7-day window beginning the day following the ARD (Assessment Reference Date) of the resident’s last PPS assessment used for payment • Effective for all assessments with an ARD date of Oct.1, 2011 • Revised MDS Assessment Schedule • Note: When Oct. 1st, 2011 is Day 19,34,64,or 94 of stay, assessments should be completed by Sept. 30th or the assessments will be considered late and payment penalties will apply.

5. End of Therapy Revised • If resident is classified into a RUG IV Rehabilitation plus Extensive services or Rehabilitation group, and has not received services 5 days a week, beginning FY 2012 all facilities will be considered 7-day a week. • Sample question: • A resident is skilled and has 3 consecutive days that are considered LOA days d/t the resident going home for a therapeutic leave, we don’t bill Medicare for those days. Those days are eliminated from the Medicare Calendar. Is the EOT still required b/c the resident missed 3 days of therapy although the days are considered LOA days? • Answer: • For any reason that the resident did NOT have therapy for 3 consecutive days there must be an EOT OMRA.

6. End of Therapy continued • Beginning FY 2012 SNF’s may choose to complete items O0450A and O0450B on the End of Therapy OMRA, which allows the resident to be reclassified back into Rehabilitation plus Extensive Services and resume the original therapy program.

7. Group Therapy Allocation • Group therapy is defined as therapy provided simultaneously to four patients (regardless of payer source) who are performing the same or similar activities. Must include no more or less than four participants. • Students are no longer required to be under line-of-sight supervision. Effective October 1,2011. The supervising therapist is expected to use his own judgment regarding the level of supervision a student may require. The student is considered an extension of the therapist.

8. Concurrent Therapy and Student SupervisionConcurrent Therapy/Student • Code as concurrent therapy when the therapist and student are treating one resident each, while not treating, or supervising any other resident/therapists. • Code as concurrent therapy if therapist is treating 2 residents while student is not treating any residents. • If the student is treating 2 residents while the therapist is not treating any residents this is also considered concurrent therapy.

9. Group Therapy/Student • The time for a group session may only be counted if the full group of four participants is being run by either the supervising therapist or the student, while the other may not be supervising any other therapists or treating residents.

10. Resources • DHH Internet – HSS Home Page • Effective 04/19/2011 • Update Internet Explorer Favorites http://new.dhh.louisiana.gov/index.cfm/page/248/n/24