MDS Essentials MDS Scheduling Essentials: Introduction to OBRA Scheduling 4 Faculty Disclosures I have no financial relationships to disclose I have no conflicts of interests to disclose I will not promote any commercial products or services Content RAI User s Manual Chapter 2 OBRA Scheduling RAI User s Manual Chapter 5 Transmitting MDS Data All Planning Committee members, content reviewers, authors, and presenters have been evaluated for conflicts of interest and there are not any to disclose. 5 Educational Activity Completion and CE Disclosure Requirements for Successful Completion 1.25 contact hours will be awarded for this continuing nursing education activity. Criteria for successful completion includes attendance for at least 80% of the entire event. Partial credit may not be awarded. Approval of this continuing education activity does not imply endorsement by AANAC or ANCC (American Nurses Credential Center) of any commercial products or services. American Association of Post Acute Care Nursing (AAPACN)* is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. *AAPACN d/b/a American Association of Nurse Coordination (AANAC) 2.3 Responsibilities of Nursing Homes for Completing s Required for all residents in Medicare and/or Medicaid certified long term care facilities May also be additional requirements by state Contact State RAI Coordinator for state requirements The RAI process (MDS, CAA process, and Utilization Guidelines) must be completed for any resident residing in the facility for 14 or more days 6 1
The date a resident enters the facility and is admitted as a resident Days begins at 12:00 am and ends at 11:59 pm OBRA assessment must occur in any of the following admission situations: Resident has never been admitted to this facility before OR Resident has been in the facility previously and was discharged return not anticipated OR Resident has been in this facility previously and was discharged return anticipated and did not return within 30 days of discharge 7 Discharge The date a resident leaves the facility Also the date the resident s Medicare Part A stay ends but remains in the facility Three types of Discharge s 1. OBRA Discharge return anticipated 2. OBRA discharge return not anticipated 3. Part A PPS Discharge (Required for Medicare only) 10 Reference Date (ARD) The last day of the observation or look back period Must be set on the MDS Item Set or in the facility software within the required timeframe of the assessment type being completed Leave of Absence (LOA) Does not require completion of either a Discharge or an Entry tracking record Temporary home visit of at least one night; Therapeutic leave of at least one night Hospital observation stay less than 24 hours and the hospital does not admit 8 11 Death in Facility Refers to when a resident dies in the facility or dies while on a leave of absence (LOA) Requires Death in Facility tracking record No discharge assessment is required Entry Used for both admission and reentry Requires completion of an Entry tracking record Reentry Situation when all of the three occurred prior to this entry 1. Resident was previously in this facility 2. Was discharged return anticipated 3. Returned within 30 days of discharge 9 12 2
Entry Used for both admission and reentry Requires completion of an Entry tracking record Entry Situation when any of the following occurred prior to this entry 1. Resident has never been admitted to this facility before 2. Was previously a resident, but discharged return not anticipated 3. Was previously a resident, discharged return anticipated, but did not return within 30 days 0 1 OBRA Item Set (NC) Includes CAAs 13 16 OBRA Required s assessments Significant change in Status (SCSA) Significant correction to Prior (SCPA) Non comprehensive assessments Significant Correction to Prior (SCQA) Discharge Return not anticipated Discharge Return anticipated Tracking Records Entry Death in facility 14 Summary: RAI pg. 2 16 to 2 18 OBRA A03010A = 01 ARD may be no later than: 14 th calendar day of admission date + 13 calendar days Must be completed (MDS and CAAs) by the end of day 14 date + 13 calendar days Care plan must be completed within 7 days of CAA completion date 17 Standard OBRA Cycle Entry Record Significant Change 0 2 OBRA Item Set (NQ) Subset of items from comprehensive Does not include CAAs 18 3
OBRA (A03010A = 02) ARD may be no later than: 92 calendars from previous OBRA ARD Prior OBRA ARD + 92 calendar days Must be completed with in 14 days from ARD ARD + 14 calendar days 19 OBRA (A03010A = 03) assessment required annually ARD may be no later than: 366 calendars from previous comprehensive OBRA ARD Prior comprehensive OBRA ARD + 366 calendar days And Within 92 days from previous OBRA ARD Prior OBRA ARD + 92 calendar days Must be completed (MDS/CAAs) with in 14 days from ARD ARD + 14 calendar days Care plan must be completed within 7 days from CAA completion date 22 Standard OBRA Cycle OBRA Example 366 days 92 days 4/12 4/15 Day 366 from prior assessment = 4/15 Day 92 from prior OBRA assessment = 4/12 ARD must be set on or before 4/12 to meet criteria of within 366 days of prior comprehensive and within 92 days of prior OBRA 20 23 OBRA OBRA cycle 366 Days 0 3 92 days Item Set (NC) Includes CAAs 21 4
OBRA Significant Change in Status Significant Change in Status 0 4 Significant change differs from a significant error because it reflects an actual significant change in the resident s health status and NOT incorrect coding of the MDS. Item Set (NC) Includes CAAs A significant change may require referral for a Preadmission Screening and Resident Review (PASRR) evaluation if a mental illness, intellectual disability (ID), or related condition is present or is suspected to be present. 25 28 Significant Change in Status Significant Change is Status (A0310A = 4) assessment Must be completed when IDT has determined that a resident meets the significant change guidelines Improvement or decline Can be completed anytime after the completion of an assessment Significant Change in Status The nursing home may take up to 14 days to determine whether the criteria are met After determination has been made that a resident meets the guidelines Document the initial identification in the clinical record Significant change must be completed (MDS/CAAs) within 14 days of determination 26 29 Significant Change in Status A significant change is a decline or improvement in a resident s status that: 1. Will not normally resolve itself without intervention by staff or by implementing standard disease related clinical interventions, is not self limiting (for declines only); 2. Impacts more than one area of the resident s health status; and 3. Requires interdisciplinary review and/or revision of the care plan. Significant Change in Status A SCSA is appropriate when Determination that a significant change in a resident s condition from his/her baseline has occurred by comparison of resident s current status to the most recent OBRA assessment Condition is not expected to return to baseline within two weeks Resident enrolls in a hospice program Resident receiving hospice services and decides to discontinues services (revokes hospice) Resident changes hospice providers 27 30 5
SCSA Impact on Cycle Completion of a Significant Change in Status will reset the OBRA Cycle Next OBRA assessment due will be a within 92 days of SCSA ARD Next comprehensive OBRA assessment due will be an within 366 days of SCSA ARD OBRA Cycle 366 Days 92 days SCSA 31 OBRA Cycle 366 Days OBRA Significant Correction to Prior SCSA 92 days 0 5 Item Set (NC) Includes CAAs 35 OBRA Cycle 366 Days SCSA 92 days Significant Correction to Prior Significant Correction to Prior (SCPA) (A0310A= 05) Completed when IDT determines that a resident s prior comprehensive assessment contains a significant error Can be performed any time after the completion of an 36 6
Significant Correction to Prior Significant Correction to Prior ARD must be within 14 days after the determination that a significant error in prior comprehensive assessment occurred Determination date + 14 calendar days Completion date (MDS/CAAs) must be no later than 14 days after the ARD AND 14 days after the determination that a significant error occurred Care plan must be completed with 7 days of CAA completion 37 ARD must be set within 14 days after determination MDS must be completed no later than 14 days after the ARD And 14 days from the determination date 40 OBRA Significant Correction to Prior SCPA Impact on Cycle Significant correction to prior comprehensive 0 6 SCPA Item Set (NQ) Subset of the comprehensive items Does not include CAAs 38 92 days: ARD of SCPA to ARD of next quarterly 366 days: ARD of SCPA to ARD of next annual 41 Significant Correction to Prior Must be completed when the IDT determines that a resident s prior assessment contains a significant error Can be performed at any time after the completion of a assessment SCPQ Impact on Cycle Significant correction to prior SCPQ 92 days: ARD of SCPQ to ARD of next quarterly 366 days: ARD of annual to ARD of next annual 39 42 7
0 1 Entry Tracking Record Tracking Item Set (NT) Small subset of items Not an assessment Death in Facility Tracking record Death in Facility Tracking Record (A0310F = 12) Must be completed when the resident dies in the facility or when on LOA Must be completed within 7 days after the resident s death Is always a stand alone tracking record Cannot be combined with other assessments 43 46 Entry Tracking record Entry Tracking Record (A0310F = 01) The first item set completed for all residents Must be completed every time a resident is admitted (admission) or readmitted (reentry) Must be completed within 7 days after the admission/reentry Is always a stand alone tracking record May not be combined with an assessment OBRA Discharge Return Not Anticipated 1 0 OBRA Discharge Item Set (ND) Subset of items from comprehensive Does not include CAAs 44 47 Death in Facility Tracking Record 1 2 Tracking Item Set (NT) Small subset of items Not an assessment OBRA Discharge s OBRA Discharge Return Not Anticipated (A0310F = 10) Must be completed when the resident is not expected to return to the facility within 30 days Must be completed within 14 days after discharge dated Discharge date (A2000) + 14 calendar days If resident returns, will start with a new 45 48 8
Discharge Return Not Anticipated Impact on Cycle Resident discharges return not anticipated: STOP The assessment cycle ends for this resident 49 OBRA Discharge s OBRA Discharge Return Anticipated (A0310F = 11) Must be completed when the resident is discharged from the facility and the resident is expected to return within 30 days Must be completed within 14 days after discharge dated Discharge date (A2000) + 14 calendar days If resident returns, the IDT must determine if criteria are met for a SCSA If criteria are met, complete a SCSA If criteria are not met, continue with the OBRA schedule as established prior to the resident s discharge 52 Discharge Return Not Anticipated Impact on Cycle DC RNA Resident discharges return not anticipated and admits again at later date DC STOP RNA Discharge Return Anticipated Impact on Cycle Resident discharges return anticipated and returns within 30 days DC RA SCSA? No Restart with admission type entry record, followed by a new Evaluate for a SCSA on return If No, continue current OBRA Cycle 50 53 OBRA Discharge Return Anticipated 1 1 Discharge Return Anticipated Impact on Cycle Resident discharges return anticipated and returns within 30 days DC RA SCSA? Yes OBRA Discharge Item Set (ND) Subset of items from comprehensive Does not include CAAs SCSA Evaluate for a SCSA on return If Yes, the SCSA will reset the cycle 51 54 9
OBRA Discharge s Tips for OBRA Discharge s Must be completed when: The resident is discharged from the facility The resident is admitted to an acute care hospital The resident has a hospital observation stay greater than 24 hours Completion and Transmission Transmission requirements are based off of completion dates assessments Transmission date must be no later than Care plan completion date + 14 calendar days Non s Transmission date must be no later than MDS completion date + 14 calendar days Tracking Records Transmission date must be no later than event date + 14 calendar days 55 58 Algorithm RAI Page 2 40 56 Completion and Transmission Chapter 5 Transmitting MDS Data All Medicare and/or Medicaid certified nursing homes and swing beds, must transmit MDS data records to CMS Quality Improvement and Evaluation System (QIES) Submission and Processing (ASAP) system s that are completed for purposes other than OBRA and SNF PPS reasons are not to be submitted Private insurance (such as Medicare Advantage Plans) 59 OBRA cycle 366 Days Completion and Transmission Chapter 5 Item A0410 indicates the certification or licensure of the unit on which the resident resides Item indicated submission authority for a record 92 days 60 10
Completion and Transmission Chapter 5 When the transmission file is received by the QIES ASAP system, the system performs a series of validation edits to determine if the data submitted meets the required standards A Final Validation Report provides the results of this evaluation by error and warning messages OBRA Impact Five Star Publically reported to take information directly to the consumers Assists consumers in selecting a facility Nursing Home Compare website www.medicare.gov/nursinghomecompare/se arch.html 61 64 Completion and Transmission Final Validation Report Understanding errors and warning messages Fatal Record Errors Results in rejection of assessment has NOT been accepted into the QIES ASAP system must be corrected and resubmitted Non Fatal Errors (warnings) MDS has been accepted into the QIES ASAP system May include warnings of missing data, item consistency errors, timing errors Each warning must be reviewed for corrective actions if needed OBRA Impact Survey outcomes Surveyors also use similar list of QMs as part of the survey process Surveyors can site facilities for MDS related issues For example: F273 14 days after F274 after significant change F275 at least every 12 months F278 Accuracy/Coordination/Certified F287 Encoding/Transmitting Resident F279 Develop Care Plans 62 65 OBRA Impact Quality Measures Intended to reflect quality of care in a facility CMS pulls data specific to particular conditions and problems from the national data base Examples Rate of UTIs in a facility comes from I2300 Decline in ADLs is computed from comparing G0110 data on successive assessments Quality Measures info and User s Manual: https://www.cms.gov/medicare/quality Initiatives Patient instruments/nursinghomequalityinits/nhqiqualitymeasures.html OBRA Impact Case mix reimbursement Some states reimburse Medicaid based on a casemix system Contact your State RAI Coordinator for state specific reimbursement information Appendix B of the RAI Manual provides this information http://www.cms.gov/medicare/quality Initiatives Patient Instruments/NursingHomeQualityInits/MDS30RAIManu al.html 63 66 11
MDS Essentials Questions Please submit questions to: The New to MDS Community 67 70 Please continue with PPS Scheduling Essentials 68 MDS Essentials RAC CT Education Advancement Education Advancement Professional Development Expert within your Organization Successfully Completed RAC CT Completed QCP CT Completion of Medicare University RAC MT, QCP MT 69 12