MDS 3.0 Assessment Process for Social Workers

1. MDS 3.0 Assessment Processfor Social Workers OKHASA 2011

2. First you need to Understand the Process • The new Assessment Process is very different and requires many new tasks and documentation. • Look at the data set format – yes I said data set format – no more MDS “forms” • Newly organized data formats, definitions and look back periods • New rules impact everyone

3. New data and new uses of the data • Definitions that will impact many members of the IDT • Many new assessment assignments – both for assessment and care planning tasks • Look at the need for training, resources and skills for the social service department. • What does it take to get the assessment tasks done?

4. TAKE A LOOK AT THE DATA SET PAY ATTENTION TO THE RED AND GREEN ITEMS – HIGH IMPACT DATA FOR PAYMENT AND CARE PLANNING. • DO NOT ASSUME – READ THE MANUAL – MANY NEW PROCESSES AND DEFINITIONS • BE CAREFUL BECAUSE SURVEYORS ARE LOOKING AT NEW DATA NOW

5. LOOK AT THE MANUAL FOR THE SECTIONS YOU ARE CODING • POLICIES AND PROCEEDURES • PAY ATTENTION TO THE STEPS FOR THE ASSESSMENT – IT IS IMPORTANT • DEFINITIONS ARE IMPORTANT AND WILL INFLUENCE THE DATA OUTCOMES • NUMERICAL DEFINITIONS – THIS IS NEW – VERY DANGEROUS – EVERYONE IS IDENTIFIED BY A NUMERICAL SCORE

6. Section B • Combination of assessment tasks from the 2.0 process. • B-700 – most important code as it could influence the interview activity. – code carefully. • Vision test and visual appliances – very important • Combine clinical and social service tasks

7. Section C • Technically not an interview – it is a test – very structured. • Brief Interview for Mental Status • One page assessment – 34 pages of directions in the manual • Read the Steps for Assessment – be certain that training is focused on RAI manual resources. • Appendix D and Appendix E

8. The BIMS test is not only very scripted it needs to be introduced consistently – See the Steps for the Assessment section C of the RAI Manual. • If the elder does not answer certain questions then a small amount of help can be given per the instructions in the RAI Manual and Appendix E . • Before you do the BIMS read Appendix D

9. Scoring the BIMS • Write the elder’s answers on the work sheet and then score after the test is completed. • No family or significant others are to be present • Be certain the elder is comfortable and can see and hear you. Use ampflication device if necessary • If elder can not speak use special test in Appendix E of the RAI Manual

10. BIMS Test is done on all assessments and scores each test with a number. • The IDT must consider the BIMS scores as they plan and conduct utilization review meetings. • Can be completed by any staff member with training and proper documentaiton • On admission doing the first BIMS close to the admission date assesses the elder’s ability as a base line.

11. VERY IMPORTANT – ALL BIMS TESTS SHOULD BE DONE THE SAME AND SCORED THE SAME SO THE SCORES ARE ACCURATE AND RELATIVE. THESE SCORES WILL BE USED BY MANY OUTSIDE SOURCES TO EVALUATE THE RESIDENT AND YOUR FACILITY POPULATION. REMEMBER EVERY RESIDENT GETS A NUMERICAL SCORE FOR EACH MDS ASSESSMENT.

12. Section D – Mood Interview • This must be done on the ARD or the day before the ARD • Read the Steps for the Assessment in the RAI Manual • Introductory statement is very important and the scoring of the intensity or frequency of the issues must be done carefully • Ask the questions in order

13. 14 day look back on all cases • Do not explain items –let elder answer what they think the items mean • Record the resident’s response – • Score the Mood Severity Score from the frequency of the indicators • Refer to scoring guides in Appendix E of the RAI Manual – very important • This interview is very converstaional • Use the VIVE DVD produced for CMS for training

14. Write the elder’s responses on the interview record and score after the interview is completed. • Use the scoring rules and examples in Appendix E • Record of the interview, date of the interview and the person doing the interview should be kept in the medical record as substaniation of compliance with the RAI process. • Score of the Mood interview of 10 or higher can impact payment levels for Nursing Categories and could be part of fiscal audit.

15. Section E • Behavior coding and outcomes • This is a redesigined section with many outcome codes included • Read the manual carefully and note the definitions and time lines carefully • Tracking of behaviors is very specific during the ARP = be sure to use definitions in the RAI manual • If you code behaviors you must answer outcome questions.

16. Be careful – What is the meaning of “Significant” to your team. Outcome answers will be very important to the surveyors. • Refusal of Care – New Item – 10 pages of instructions in the manual with examples. This includes all care – therapy, physician visits , treatments etc. • Wandering – Very dangerous code – What is your definition. Best definition – “ Locomotion with no rational discernable purpose” Do not over code !!!!!

17. Outcome coding for wandering behavior – code carefully and be sure clinical staff are aware of codes. • Surveyors will monitor these codes at all surveys – take action to be sure elders are safe. • Behaviors that occur in therapy or at activities are included here – need for excellent communication. Code from 24 - 7

18. Section Q • All new coding – • Manual instructions and Intent statements are very important • Coding examples are important to read to see what CMS is looking for • Mini interview on admission – identify the goal of the elder - needs to be documented • Return to the community – high impact – read instructions and follow the guidance in the manual.

19. Care Planning • Which areas of the planning are you responsible for? • First Step is to look at the red trigger items in your coding sections. • Look at triggers in the other sections. • Read the concepts and Care Planning Process guidelines in chapter 4 of the RAI Manual • Read the guidance and triggers for the CAA areas you are responsible for.

20. Care Area Assessments • Appendix C of the RAI Manual • You need hard copies of these documents to review • Now we have 20 CAAs – two new areas on Pain and Return to the Community • Look at what is triggered – Work the CAA – Document the result of the CAA with a proceed or not proceed to care planning statement.

21. Locate the documentation in the record in column 4 of Section V of the MDS • When your section of the care plan is completed then check column B of Section V. • Sequencing is very important • Documentation is very important • You must sign for the areas of the assessment you complete in Section Z on all assessments and complete CAA documentation on all comprehensive assessments. • Many parts of this process are new !!!!!

22. Chapter 4 Very important – spend the time to read it carefully – surveyors have been training on the CAA process and the documentation requirements. The entire IDT should read it and talk about the changes in the requirements. Make copies of the CAAs from Appendix C of all the areas you are care planning for – Many new items

23. Timelines for Assessments • Many have changed • The timelines for transmission have also changed and are going to impact your need to have the sections completed in a shorter time. • More assessments will need to be done – big problem start and stop of therapy and the discharge return anticipated and reentry forms. This is a big change to the process and impacts everyone.

24. You need to check with the MDS manager in your facility to discuss all the things that have changed with the MDS 3.0. • The BIMS and Mood Severity Scores will be part of the case review now. Monitor the scores throughout the stay. This includes the Utilization Review meeting.

25. Summary • Look at the total scope of the MDS 3.0 Change to your practice as a Social Worker • Read the RAI Manual for the sections you are responsible for and the care planning process that is involved. • The interviews need to be completed on the schedule in the RAI Manual and documented in the medical record. • Instructions are in the Steps for the Assessment section of the manual. • BIMS and Mood Interview create a numerical score for each resident and become part of the resident and faciltiy data base. Score carefully and communicate scores with appropriate meetings and departments.

26. AND Section Q is all new • Read instructions and CAAs content. – There is a lot of important new information. Surveyors will be evaluating the care planning and documentation process. • Discuss discharge planning and the resident’s awareness and goals with the IDT and the Utilization Review meeting. • The MDS 3.0 has more new than old information – you must be aware !!

27. QUESTIONS ?????