Final Regulatory Updates for MDS 3.0 and ICD-10

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1 Final Regulatory Updates for MDS 3.0 and ICD-10 August 03, 2018 This document covers MDS 3.0 and ICD-10 regulatory updates for October 1, Updates are available in PointClickCare for skilled nursing facilities with the release in August, and in swing bed facilities with the release in September. CMS and State regulatory agencies may change their requirements at any time. For this and other reasons, PointClickCare may change the solutions outlined in this notification and can do so at any time, without notice. This is not a legal document and PointClickCare does not assume any liability for any errors or omissions which this document may contain.

2 Table of Contents Overview of MDS 3.0 Regulatory Updates... 3 Updated Section A Item... 3 New Section GG Items... 3 New Section I Item... 7 New Section J Item... 8 Deleted Section M Items... 8 New Section N Items... 8 New Section S Items... 9 Updated Pressure Ulcer CAA Triggers... 9 Additional Changes ICD-10 CMS Regulatory Update Page 2

3 Overview of MDS 3.0 Regulatory Updates CMS updated the MDS 3.0 base item sets and Data Submission Specifications, effective October 1, For more information, see the CMS documents. PointClickCare is addressing all Federal and State regulatory requirements and updates. Included in this document are changes for MDS 3.0 assessments with an ARD/Target Date on or after October 1, WARNING To prevent errors in assessments, do not open any MDS 3.0 assessments in PointClickCare with an ARD of October 1, 2018 or later, until after the release for skilled nursing facilities, and after the release for swing bed facilities. After CMS publishes the updated RAI manual, it will be accessible from the Toolkit in MDS assessments. Updated Section A Item Section A, item A0600B Social Security and Medicare Numbers is updated to include text changes for accommodation of the Medicare Beneficiary Identifier (MBI). New Section GG Items New items are added in section GG to include recording a resident's usual ability with everyday activities prior to the current illness. Page 3

4 Several items are added to the existing item GG0130 Self-Care to include: showering or bathing self. upper and lower body dressing. putting on and taking off footwear. Page 4

5 Several items are added to the existing item GG0170 Mobility to include rolling left and right, car transfers, walking 10 feet, and so on. Item GG0170H Does the resident walk? is removed. Page 5

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7 New Section I Item A new item is added in section I to include the resident's primary medical condition. Page 7

8 New Section J Item A new item is added in section J to record if the resident had major surgery during the 100 days prior to admission. Deleted Section M Items There are deleted items in section M. M0300B3 Date of oldest Stage 2 pressure ulcer. M0610 Dimensions of Unhealed Stage 3 or 4 Pressure Ulcers or Eschar. M0700 Most Severe Tissue Type for Any Pressure Ulcer. M0800 Worsening in Pressure Ulcer Status Since Prior Assessment (OBRA or Scheduled PPS) or Last Admission/ Entry or Reentry. M0900 Healed Pressure Ulcers. New Section N Items There are new items in section N, including Drug Regimen Review, Medication Follow-up, and Medication Intervention. Page 8

9 New Section S Items The following section S items are added for the state of New York. S0170A Advance Directive: Guardian S0170B Advance Directive: DPOA-HC S0170C Advance Directive: Living Will S0170D Advance Directive: Do Not Resuscitate S0170E Advance Directive: Do Not Hospitalize S0170F Advance Directive: Do Not Intubate S0170G Advance Directive: Feeding Restrictions S0170H Advance Directive: Other Treatment Restrictions S0170Z Advance Directive: None of the Above S0171A Does the Resident have a healthcare proxy? S0171B Has healthcare proxy been invoked? Updated Pressure Ulcer CAA Triggers There are updates to MDS items to trigger the Pressure Ulcer CAA (CAA 16). The following logic change is made to determine if the Pressure Ulcer CAA shows as triggered with MDS assessments where Section V is active. 1. ADL assistance for bed mobility was needed, or activity did not occur, or activity only occurred once or twice as indicated by: (G0110A1 >= 1 AND G0110A1 <= 4) OR (G0110A1 = 7 OR G0110A1 = 8) 2. Frequent urinary incontinence as indicated by: H0300 = 2 OR H0300 = 3 Page 9

10 3. Frequent bowel continence as indicated by: H0400 = 2 OR H0400 = 3 4. Weight loss in the absence of physician-prescribed regimen as indicated by: K0300 = 2 5. Resident at risk for developing pressure ulcers as indicated by: M0150 = 1 6. Resident has one or more unhealed pressure ulcer(s) at Stage 2 or higher, or one or more likely pressure ulcers that are unstageable at this time as indicated by: (M0300B1 > 0 AND M0300B1 <= 9) OR (M0300C1 > 0 AND M0300C1 <= 9) OR (M0300D1 > 0 AND M0300D1 <= 9) OR (M0300E1> 0 AND M0300E1<= 9) OR (M0300F1 > 0 AND M0300F1 <= 9) OR (M0300G1 > 0 AND M0300G1 <= 9)) 7. Resident has one or more unhealed pressure ulcer(s) at Stage 1 as indicated by: M0300A > 0 AND M0300A <= 9 8. THIS CONDITION WAS DELETED IN V BECAUSE THE M0800 ITEMS WERE DELETED FROM THE ITEM SET 9. Trunk restraint used in bed has value of 1 or 2 as indicated by: P0100B = 1 OR P0100B = Trunk restraint used in chair or out of bed has value of 1 or 2 as indicated by: P0100E = 1 OR P0100E = 2 Additional Changes Item set changes, submission edits for new items, and text changes for existing items are addressed with the MDS 3.0 regulatory update. ICD-10 CMS Regulatory Update CMS is updating the ICD-10 codes for FY 2019, effective October 1, For more information about these changes, see the CMS 2019 ICD-10-CM documents. PointClickCare is addressing all ICD-10 changes and will update the ICD-10 library with the release. No action is required to see these changes. NOTE After October 1, 2018, it is recommended to run the Diagnosis Report *NEW*, and select Inactive Codes Only, to identify residents with diagnoses deleted or modified by CMS effective October 1, You can then update the resident's chart, if required, and refresh any open MDS assessments to update the diagnoses in Section I. Page 10