Hot MDS Changes

1. Hot MDS Changes Managing Your MDS System After the April 2012 Changes

2. Mental Retardation Mental Retardation has been changed to intellectual disability

3. CMS MEMO �Use of dashes in Completing the MDS Assessment� Let�s look at your additional handout on the use of dashesLet�s look at your additional handout on the use of dashes

4. Section A A0500 replaces X0100 (new record) A0310 planned / unplanned Dc will trigger a sip pattern A1800 now includes the item for LTACH A2100 also includes LTACH

5. Chapter 2: Unplanned Discharge �Unplanned discharge� is defined as: Acute care transfer of the resident to a hospital or an emergency department in order to either stabilize a condition or determine is an acute care admission is required based on ER evaluation; or Resident unexpectedly leaving the facility against medical advice; or Resident unexpectedly deciding to go home or to another setting

6. Discharge Assessments Type of item set �form� to complete for DC assessments has been reduced Before April 1, 2012 there were 111 items to complete on a DC assessment Beginning April 1, 2012 unplanned DCs = 77 questions Beginning April 1, 2012 planned DCs = 89 questions

7. Section I Removed the wording �new normal� Removed the check boxes at I1800 � you will simply type in the ICD-9 Rarely / never understood is� Code 3, rarely or never understood: if, at best, the resident�s understanding is limited to staff interpretation of highly individual, resident-specific sounds or body language (e.g., indicated presence of pain or need to toilet). Rarely / never understood is� Code 3, rarely or never understood: if, at best, the resident�s understanding is limited to staff interpretation of highly individual, resident-specific sounds or body language (e.g., indicated presence of pain or need to toilet).

8. Section K Added weight gain back K0500 deleted K0510 added to address fluids while a resident/ while not a resident (this item is still used for the nursing rug-either column)

9. Section M M0700 � added �9� none of the above M1040H- added to address MASH M1040G � added to address skin tears

10. Chapter 3: Section G Definition of facility staff: Pertains to direct employees and facility contracted employees (e.g... Rehab staff, nursing agency staff). Does not include individuals hired, compensated or not, by individuals outside of the facility�s management and administration. Examples of �not staff� include family members, hospice staff, CNAs and nursing students. This supports the idea that the facility retains the primary responsibility for the care of the resident outside of the arranged services another agency may provide to facility residents.Examples of �not staff� include family members, hospice staff, CNAs and nursing students. This supports the idea that the facility retains the primary responsibility for the care of the resident outside of the arranged services another agency may provide to facility residents.

11. Section N N0410 added the # of days each specific medication was given

12. Section Q Additional questions added at: Q0400b Q0490 Q0550

13. Section X Deleted X0100 �add a new record The dash is being used because in these instances the wound bed can not be visualized and therefore cannot be assessedThe dash is being used because in these instances the wound bed can not be visualized and therefore cannot be assessed

14. Additional Changes 04-01-2012 Unscheduled OMRA assessments for COT, EOT, SOT: Interview items may be �carried over� to the OMRA if the signature date in section Z (indicating interview completion date) is not more than 14 days from completion date in Z for the OMRA *** can not use prior interviews if this assessment is combined with any other item set!

15. Interview continued Can not carry over staff interviews If staff notices a change in the resident, then it is expected a new set of interviews will be conducted

16. Assessment ARD Compliance Late Unscheduled Assessment Policy If the facility fails to set up the ARD for an unscheduled PPS assessment within the defined window for that assessment, and the resident being assessed is still on Part A, the ARD can not be set for any earlier than the day the omission was identified

17. Assessment ARD Compliance Continued� The total number of days the assessment is out of compliance including the late ARD must be billed at default beginning on the day that the assessment would have controlled payment

18. Assessment ARD Compliance Intervening Assessment: The SNF must only bill default until the point when another intervening assessment would control the payment (I.E.. COT, EOT, next scheduled assessment, etc�)

19. Assessment ARD Compliance Missed Unscheduled Assessment Policy: If the SNF fails to set the ARD for an unscheduled PPS assessment within the defined ARD window for that assessment, and the resident has been discharged from Part A the assessment cannot be completed

20. Assessment ARD Compliance All days which would have been paid by the missed assessment, had it been completed timely, are considered provider liable and may not be billed to Medicare

21. Assessment ARD Compliance Effective April 1, 2012, facilities are permitted to set the ARD on an unscheduled PPS assessment for a day within the allowable ARD window for the assessment no more than days after the window has passed I.E. COT This is called a �flexibility period�

22. Assessment ARD Compliance Regular scheduled PPS assessments: Must be set up in the computer software, or on paper (with paper copy saved) within the ARD acceptable window If it is not set up within the acceptable window the facility will follow the same guidelines to determine �late vs. missed� assessment

23. In-activations/ Modifications Provider discovers an error in the type of assessment (in section A0310) OR ARD: Follow inactivation guidelines in chapter 5 of the RAI (page 5-12) Inactivate and set up correct type of assessment BUT�..

24. In-activations/ Modifications The ARD must be the day the error in section A310, or ARD is discovered and will be completed as a new MDS assessment, including signatures

25. In-activations/ Modifications Example: MDS set up with an ARD of 02-04-2012, but should have been coded 02-01-2012, this key stroke error was discovered at end of month. The assessment has been transmitted and accepted. The MDS Coordinator will inactivate the mis-coded assessment, and set up a new one with the day the error was discovered (or current date).

26. In-activations/ Modifications CMS recommends: Follow RAI manual guidelines, double check the MDS before transmitting! Facility has 7 days from completion to review for errors before completing the assessment, and 7 more days before transmitting.

27. Chapter 5 : Reminder! Do not transmit MDS Assessments records except to meet OBRA and SNF PPS requirements. Assessments for private insurance, or Medicare Advantage Plans are not to be submitted

28. Chapter 5 Modifications Can no longer modify the reason for an assessment for: Type of provider Type of assessment Entry date (or entry tracking record) Discharge date (or death in facility record) ARD date In the case of errors in the above, we will have to complete an inactivation, transmit it, then go back in re-key the correct information, complete the assessment, and transmit it.In the case of errors in the above, we will have to complete an inactivation, transmit it, then go back in re-key the correct information, complete the assessment, and transmit it.

29. Questions?