Assessment - MHA - An Association of Health Care Providers
Contents
1. Medications philosophy 2 3 Health maintenance 4 5 6 Daily care needs plantemoran com Plante Moran Clinical Group 2013 7 614 222 9020 The Balancing Act Different Regulations Time frames plantemoran com Comprehensive MDS CAAs Care Plan Admission 14 days Annual 366 days ARD to ARD Significant Change in Status SCSA 14 days oignificant Correction to Prior Comprehensive SCPA 14 d plantemoran com Plante Moran Clinical Group 2013 Situations Payment systems E i a d a Equal Importance BUT Grouper criterion Optimization strategie Non Comprehensive MDS Quarterly 92 days ARD to ARD oignificant Correction to Prior Quarterly SCQA 14 days Entry record entry 7 days Discharge return anticipated or return not anticipated 14 days Death in facility DOD 7 days 16 614 222 9020 MDS 3 0 Assessment Types plantemoran com Comprehensive Assessments Admission A0310A 01 m Day begins at 12 00 AM HI m Ends at 11 59 PM Day 1 of admission m ARD no later than 14 day of admission m MDS completion date Z0500B and CAAs completion date V0200B2 no later than 14 day m Care plan completion date VO200C2 CAAs completion date 7 days m Submission care plan completion date 14 days plantemoran com OPlante Moran Clinical Group 2013 9 614 222 9020 Comprehensive Assessments m Annua2. Coding Tips m Therapeutic diets are not defined by the content of what is provided or when it is served but WHY the diet is required m Anutritional supplement house supplement or packaged given as part of the treatment for a disease or clinical condition manifesting in altered nutrition status does not constitute a therapeutic diet but may be PART of a therapeutic diet Supplements only coded when administered as a part of a therapeutic diet to manage problematic health conditions plantemoran com KO700 Percent Intake by Artificial Route K0700 Percent Intake by Artificial Route Complete K0700 only if Column 1 and or Column 2 are checked for K0510A and or K0510B EnterCode A Proportion of total calories the resident received through parenteral or tube feeding 1 25 or less 2 26 50 3 5196 or more Enter Code B Average fluid intake per day by IV or tube feeding C 1 500 cc day or less 2 501 cc day or more m Only coded if column 1 and or column 2 are checked for K0510A and or K0510B a fs Ya plantemoran com OPlante Moran Clinical Group 2013 24 614 222 9020 K0700A Proportion of Total Calories Received through Parenteral or Tube Feedings in Last 7 DEVE m Review records to determine intake m f resident took no food or fluids by mouth or just sips of fluid stop here and code 3 51 or more m f oral intake more than this total oral intake calories and total tube intake calories Divide the
3. gt 0 AND M0300F1 lt 9 OR M0300G1 gt 0 AND M0300G1 lt 9 plantemoran com Plante Moran Clinical Group 2013 30 614 222 9020 Care Areas m riggered care areas form a clinical link between MDS and care planning decision CAA POC ZZ IP m CAAs cover the majority of problem areas known to be problematic for NH residents m Other areas may need assessment as well m Triggered CAA must be assessed may or may not warrant being addressed by care plan plantemoran com 20 CAAs in the MDS 3 0 Delirium Cognitive Loss Dementia Visual Function Communication ADL Function Rehabilitation Potential Urinary Incontinence and Indwelling Catheter Psychological Well being Mood State Behavioral Symptoms Activities plantemoran com M MEE Plante Moran Clinical Group 2013 31 614 222 9020 20 CAAs in the MDS 3 0 11 Falls 112 Nutritional Status I 113 Feeding Tube 114 Dehydration j Dental Care Pressure Ulcers Psychotropic Drugs Physical Restraints Pain Return to Community plantemoran com CAA Process m Evaluate triggered areas but CAAs do not provide exact detail on how to select pertinent interventions for care planning m Interventions must be individualized and based on effective problem solving and decision making approaches to all of the information available for each resident m Care Area Triggers CATs identify conditions that require evaluation because of po
4. 92 days for the quarterly A2300 Assessment Reference Date Timing for next assessment based on the ARD Observation end date Anything that happens after the PLU ARD will not be reflected on the Month Day Year MDS The facility is required to set the ARD on the MDS form itself or in the facility software within the appropriate timeframe of the assessment being completed plantemoran com OPlante Moran Clinical Group 2013 13 614 222 9020 Instructions for Coding 8 in ADLs t AOL Se Peor 2 ADL Support Provide Cede for residents performance ove all sits not including setup the ADL artvity Code fot most support provided ove al occured 30 mote timesa various levels of asistan code the most dependent excent for shit cede regardless of residents sl dpe eu fponte paces Code 8 ADL activity Codi i A amome itself did not occur area ies i pale during the entire period ki peson physics j e 2 Ln n ek giat if the activity did not occur of vorrweightbearng t TWO sini tile yoki mann Or family and or non egal cere s ieina facility staff provided care Avy occ ory ict pai 100 of the time for that 8 Activity did not ceur activity did not occur or famiy and or nonfat staff provided on activity over the entire 7 A imobilye Sanon ops tte day period postions body while in bd o alternate kep funiture B Transfer how resident moves between surface including to or ram bed cha whlch
5. B food favorites and dislikes m Dietary to explore with nursing need for restorative eating program m Nursing to provide hands on assistance when shows signs of fatigue or frustration plantemoran com Care Planning What the care plan needs to do m Indicates interventions in place to prevent avoidable declines in functioning or functional levels m Manage risk factors m Address resident strengths m Use current standards of practice in the care planning process m Evaluate treatment objectives and outcomes of care plantemoran com OPlante Moran Clinical Group 2013 48 614 222 9020 Care Planning m Respect the resident s right to refuse treatment m Allows resident to establish own goals m Offer alternative treatment m Use an interdisciplinary approach to care plan development to improve the resident s functional abilities m Involve the family and or other resident representatives if OK with the resident plantemoran com Care Planning m Assess and plan for care sufficient to meet the care needs of new admissions m Involve the direct care staff with the care planning process relating to the resident s expected outcomes m Address additional care planning areas that could be considered in the long term care setting plantemoran com OPlante Moran Clinical Group 2013 49 614 222 9020 Questions Submit questions by dialing 0 to unmute the phone line After asking question hit 6 to mute the phone
6. Column 1 m Check all nutritional approaches performed prior to admission entry or reentry to the facility and within the 7 day day look back period Leave Column 1 blank if the resident was admitted entered or reentered the facility more than 7 days ago plantemoran com KO510 Nutritional Approaches Coding m Coding Instructions for Column 2 m Check all nutritional approaches performed after admission entry or reentry to the facility and within the 7 day look back period m KO510A parenteral IV feedings m K05010B feeding tube nasogastric or abdominal PEG m K0501C mechanically altered diet requires change in texture of food or liquids e g pureed food thickened liquids m K05010D therapeutic diet e g low salt diabetic low cholesterol m K05010Z none of the above plantemoran com OPlante Moran Clinical Group 2013 21 614 222 9020 K0510A Parenteral IV Feeding m Code when supporting documentation reflects need for additional fluids addressing nutrition or hydration need m IV fluids or hyperalimentation including TPN administered continuously or intermittently m IV fluids running at Keep Vein Open KVO m IV fluids contained in IV piggybacks m Hypodermoclysis and subcutaneous ports in hydration therapy m IV fluids can be coded if needed to prevent dehydration if the additional fluid intake is specifically needed for nutrition and hydration and documented as such plantemoran com K0510A Parenteral
7. IV Feeding m Do NOT code the following in K0510A m V medications m IV fluids administered as a routine part of an operative or diagnostic procedure or recovery room stay IV fluids administered solely as flushes IV fluids administered in conjunction with chemotherapy or dialysis plantemoran com OPlante Moran Clinical Group 2013 22 614 222 9020 Definitions m K0510A Parenteral IV Feeding introduction of a nutritive substance into the body by means other than the intestinal tract e g subcutaneous intravenous m K0510B Feeding tube presence of any type of tube that can deliver food nutritional substances fluids medications directly into the gastrointestinal system Examples include but are not limited to nasogastric tubes gastrostomy tubes jejunostomy tubes percutaneous endoscopic gastrotomy PEG tubes plantemoran com Definitions m K0510C Mechanically altered a diet specifically prepared to alter the texture or consistency of food to facilitate oral intake Examples include soft solids pureed foods ground meat and thickened liquids m K0510D Therapeutic diet a diet intervention ordered by a health care practitioner as part of the treatment for a disease or clinical condition manifesting an altered nutritional status to eliminate decrease or increase certain substances in the diet e g sodium potassium ADA 2011 plantemoran com OPlante Moran Clinical Group 2013 23 614 222 9020
8. RAI Version 3 0 Manual Appendix C CAA Resources Emerging Solutions in Pain Tools Bip www emergingsolutioosine Institute for Geriatric c Nersiag Access to Important Geriatric Hartford Institute for Nursing Ev idence Based Geriatric Co CARE AREA GENERAL RESOURCES cont Impr ring Nursing Home ia ren CMS rue cut Study ererw healthcentricadvisors es documenteAnhe o men of Missouri s Geriatric vet Tool Kit Lo B e spei ement wan ei erve tpagen e US of Health and dard Services Agency for Healthcare Research and i http www guideline gov Quality s National Guideline Clearinghouse Conducting the Assessment Step 4 Draw conclusions based on the information collected m What is causing or contributing to the problem for this resident m What is this resident at risk for related to the problem m What other health professionals should be involved plantemoran com OPlante Moran Clinical Group 2013 38 614 222 9020 CAA Documentation m Nature of the issue or condition what is the problem for this resident m Causes and contributing factors m Complications affecting or caused by the care area for this resident m Risk factors that arise because of the presence of the condition m Factors that must be considered in developing individualized care plan interventions m Need for referrals to other health professionals plantemoran com CAA Documentation m Writ
9. at two snapshots in time m Ata point closest to 30 days preceding the current weight m At a point closest to 180 days preceding the current weight m Physician Prescribed Weight Gain Regimen the weight gain was planned and pursuant to a physician s order plantemoran com Section K KO510 Gain of 5 or more in the last month or gain of 10 or more in last 6 months 0 Noorunknown 1 Yes on physician prescribed weight gain regimen 2 Yes not on physician prescribed weight gain regimen Performed while NOT a resident of this facility and within the last 7 days Only check column 1 resident entered admission or reentry IN THE LAST 7 DAYS If resident last entered E ago leave column 1 blank Both columns eoun for dir videora 2 While a Resident Performed atl EU eC Pe miursament feeding tube acsi PEG items C PE eee pen diet require change in texture of food or liquids e g pureed food DO thickened PE eee D D Therapeutic diet eg lov sa diabeti owchkste low salt diabetic low cholesterol Z None of the above Enteral feeding formulas NOT coded in C NNUS only if uctus managing problematic condition such as diabetes OPlante Moran Clinical Group 2013 20 614 222 9020 KO510 Nutritional Approaches Coding m Review the medical record to determine if any of the listed nutritional approaches were received performed during the 7 day look back period m Coding Instructions for
10. line again plantemoran com Ideas for the next series B Sign in Sheet than 1 week from today m Audio Order For Next July 19 from 1 00 to 2 30 PM EST The Federal Focus on Unnecessary Medications plantemoran com m Fvaluation ii Preferably TODAY but no later 614 222 9020 OPlante Moran Clinical Group 2013 50 plantemoran com M Thank you Jane Belt x Plante Moran Clinical Group jane belt plantemoran com 614 222 9020 plantemoran com Resources m RAI MDS Manual hitp www cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualitylnits MDS30RAlManual htmi m MDS Training Materials https www cms gov NursingHomeQualitylnits 45 N HQIMDS30TrainingMaterials asp TopOfPage m SNF PPS Website https www cms gov SNFPPS 03_RUGIVEdu12 asp TopOfPage plantemoran com OPlante Moran Clinical Group 2013 5 1 614 222 9020
11. plantemoran com Know the ADL Definitions of Self Performance 0 Independent 1 Supervision Tip 4 Total Dependence 7 Activity Occurred Only Once or Twice 8 Activity Did Not Occur plantemoran com OPlante Moran Clinical Group 2013 14 614 222 9020 Section K Swallowing Nutritional Status a Intent m Assess the many conditions that could affect resident s ability to maintain adequate nutrition and hydration m tems cover m Swallowing disorders m Height and weight m Weight change m Nutritional approaches plantemoran com KO100 Assessment m K0100 Swallowing Disorder m Ask resident about any difficulty swallowing during the look back period m Ask about each symptom m Observe resident to identify any symptoms m During meals m Attimes resident is eating drinking or swallowing m Interview staff members across all shifts m Review medical record nursing physician dietitian ST notes dental history or problems plantemoran com OPlante Moran Clinical Group 2013 15 614 222 9020 Section KO100 Swallowing K0100 Swallowing Disorder Code a symptom even if it Signs and symptoms of possible swallowing disorder only occurred once during Check all that apply the 7 day look back A Loss of liquids solids from mouth when eating or drinking B Holding food in mouth cheeks or residual food in mouth after meals C Coughing or choking during meals or when swallowing medications D Compla
12. practice guidelines and tools that may be used in completing the RAI CAA process NOTE This list of resources is neither prescriptive nor all inclusive References to non U_S Department of Health and Human Services HHS sources or sites on the Internet are provided EN d ki as a service and do not constitute or endorsement of these organizations or their progra N ot S ECI IC tO a h a rt C U lar by CMS or HHS CMS is not responsible for the content ef pages found at these sites URL ses were current as of the date this publication eei wmm Cale area a general listing n Agency for Health Cun ary and Quality oe al EM Ev Mine Ba pa ahr v clinic i ee of known clinical practice guidelines that may be used Health Care PDF Versi pin A WU erican 2 a practice atured r EE A 1 e ei al Directors Pr RE E E n 1 Practice Guidelines and t th RAI CAA pese Society http www www ampainsoc org pub cp guidelines htm pen M a ee ists Prac tic e Resources articles professi www a ional cal resources Association for Pr Stessi ionals in Infecti and Epi idemiology tice Resources D rocess Centers for e ase Control and Prevention Infection Control Ea Long Teren Care Facilities Guide e CMS Pub 100 pap NS e Appendix PP to Surveyors for Long Term Care Facilities federal regulations noted throughout r endnotes noes bara ors anre AN f mne rr CMS s
13. review of triggered areas and Clarification of a resident s functional status and related causes of impairments Basis for additional assessment of potential issues including related risk factors Assessment of causes and contributing factors gives the IDT additional information to help develop a comprehensive plan of care m After completing CAA evaluation and analysis a clinical decision is made about whether the identified problem is in fact a problem or relevant issue plantemoran com Plante Moran Clinical Group 2013 28 614 222 9020 Care Area Assessment Triggers m The trigger CAT is an MDS response indicating clinical factors exist that may or may not represent a condition that should be care planned m When a resident s status on a particular MDS item matches one of the CATs the related A care area is triggered for further assessment plantemoran com Care Area Assessment Triggers m Triggers flag conditions that warrant further investigation a single response b combination of more than one response c comparison of resident s current status and prior assessment m The trigger is a hint a clue a flag just a small piece of information and only the beginning of the assessment process A plantemoran com Plante Moran Clinical Group 2013 29 614 222 9020 12 Nutritional Status m The Nutritional Status CAA process reflects the need for an in depth analysis of residents with impaired nutrition an
14. tube calories by the total calories X 100 of calories by tube feeding plantemoran com KO700B Average Fluid Intake per Day by IV or Tube Feeding in Last 7 Days m Review intake records from the last 7 days m Add up total amount of fluids received each day by IV and or tube feeding only m Divide this total fluid intake by 7 m Divide by 7 even if the resident did not receive IV fluids and or tube feeding on each of the 7 days plantemoran com Plante Moran Clinical Group 2013 25 614 222 9020 M1200 Reminders m Review the medical record speak with direct care staff m Observe the resident M1200 Skin and Ulcer Treatments A Pressure reducing device for chair B Pressure reducing device for bed C Turning repositioning program B n an individualiz D Nutrition or hydration intervention to manage skin problems ased on a dividualized nutritional assessment E Pressure ulcer care F Surgical wound care G Application of nonsurgical dressings with or without topical medications other than to feet H Applications of ointments medications other than to feet Application of dressings to feet with or without topical medications Z None of the above were provided BEE Bf fF fF Pe plantemoran com M1200D Mas m M1200D Nutrition or Hydration intervention to Manage Skin Problems m Dietary measures received by the resident for the purpose of preventing or treating specific skin conditions e g
15. use this number before completing the weight loss or weight gain calculations plantemoran com Section K Swallowing and Nutritional Status m Weight Loss K0300 From the medical record compare the resident s weight in the current observation period to his or her weight in the observation period 30 days ago p K 5 m From the medical record compare the resident s weight in the current observation period deleted 7 day look back to his or her weight in the observation period 30 days ago m f the current weight is less than the weight in the observation period 30 days ago calculate the percentage of weight loss plantemoran com OPlante Moran Clinical Group 2013 17 614 222 9020 Weight Loss KO300 continued m From the medical record compare the resident s weight in the current observation deletea 7 day look back period to his or her weight in the observation period 180 days ago m f the current weight is less than the weight in the observation period 180 days ago calculate the percentage of weight loss m Current observation period defined in K0100 Weight m Base weight on the most recent measure in the last 30 days If the last recorded weight was taken more than 30 plantemoran com Calculate Percentages of Weight Loss m Use mathematical rounding before calculation m Multiply previous weight by 0 95 to determine resident weight after 5 weight loss m Example 160 pounds X 0 95 152 pounds A
16. 2013 MDS S 00 Distance Learning Series Nutritional Status and Q the Associated CAAs Me SE e Handouts Prepared By wr Jane Belt MS RN RAC MT Plante Moran Clinical Group ey jane belt plantemoran com p 614 222 9020 E plantemoran com 2013 Partners L adingAge Thank You ngAge i KGadinaAge bean Arizona Cadi ngAg e Indiana KadingAge CadingAge Cad ngAgeR Kentucky l eadingAge qo ol f adingAge ur oon io CadingAge l AN ASSOCIATION OF fi Connecticut MH A MONTANA HEALTH CARE PROVIDERS l eadingAge money 22019 CadingAge Nebraska OPlante Moran Clinical Group 2013 1 614 222 9020 Objectives Review of the assessment types and when to use them Delineation of the items in Sections K Use of the Care Area Assessments for Dietary Questions and Answers plantemoran com The Resident Assessment Instrument Omnibus Reconciliation Act OBRA 87 the nursing home reform law provided an opportunity to ensure good clinical practice by creating a regulatory framework that recognized the importance of comprehensive assessments as the foundation for planning and care delivery to nursing home residents plantemoran com OPlante Moran Clinical Group 2013 2 614 222 9020 Certification Requirements F272 m The intent of the assessment is to provide the facility with ongoing assessment information to develop a care plan to provide appropriate care SC LA and
17. S assessment ALONE by setting the ARD of the scheduled PPS MDS for an allowable day that is on or prior to Day 7 of the rolling window the COT window is reset plantemoran com OPlante Moran Clinical Group 2013 11 614 222 9020 Change of Therapy COT Assessment Clarification page 2 51 m In cases where a resident is discharged from the SNF on or prior to Day 7 of the COT observation period then no COT OMRA is required m RAI Manual goes on to say If a facility chooses to complete the COT OMRA in this situation they may combine the COT OMRA with the discharge assessment THINK ABOUT THAT be carefull COT pays backwards plantemoran com A Quick Word of Caution CAUTION m Change of Therapy Assessments COT Check De dete LUI LJ n m Every 7 days checking for need to do COT Ji li COT Day 1 20999990 ra JaCKWaras plantemoran com 24 Plante Moran Clinical Group 2013 12 614 222 9020 Possible COT Signals m Considerations could trigger a COT Missed treatment sessions resident illness scheduling conflict family visit outing refusals withheld treatments holidays with missed sessions therapist illness Partial treatment sessions Changes in rehab intensity and or disciplines Discontinuation of or starting therapies Inconsistent delivery and poor communication plantemoran com Assessment Reference Date ARD m Timing the same 366 days for the annual and
18. S s RAI Version 3 0 Manual Appendix C CAA Resources 12 Nutritional Status ut from resident and or family representative regarding the care area Questions Comments Concems Preferences Suggestions 9 AL 5 5 j r Analysis of Findings N view and supporting E RUE care se plas sil wil ration c ions Document e Description of the problem e Causes and contributing factors and e Risk factors related to the care area zE Referral s to another discipline s is warranted to whom and why SSO no e CAA transferred to the CAA Summary Section V of the MDS D Yes Signature Title Date plantemoran com OPlante Moran Clinical Group 2013 42 614 222 9020 CAA Process m Documentation focus on key issues m Why or why not will you address the specific conditions in the care plan m What about the condition may affect the resident s daily functioning m Why did you decide the resident is at risk that improvement is possible or the decline can be minimized plantemoran com Remember m Regardless of tool or format documentation should walk through the evidence of and conclusions about the root causes contributing factors risk factors referrals to other health professionals plantemoran com OPlante Moran Clinical Group 2013 43 614 222 9020 V0200 CAAs and Care Planning m Documents m Which care areas triggered and require further assessment m Whether or not a care area Is addressed in the resi
19. d those who are at nutritional risk This CAA triggers when a resident has or is at risk for a nutrition issue condition Some residents who are triggered for follow up will already be significantly underweight and thus undernourished while other residents will be at risk of under nutrition This CAA may also trigger based on loss of appetite with little or no accompanying weight loss and despite the absence of obvious outward signs of impaired nutrition plantemoran com CAT Logic Tables CMS s RAI Version 3 0 Manual CH 4 CAA Process and Care Planning Nutritional Status CAT Logic Table re so pe NON MDS 3 0 trigger nym Nh int logic is complex BMI lt 18 5000 OR BMI gt 24 9000 E OASAN CAT logic tables 4 Any planned or unplanned weight gain as indicated by a valve of 1 or 2 as follows K0310 1 OR K0310 2 5 RI ROTE located within each K0510A1 1 OR K0510A2 1 6 eR P E EE CAA description K0510C1 1 OR K0510C2 1 7 Therapeutic diet while NOT a resident or while a resident is used as nutritional approach RAI M ss ice by anual pages K0510D1 1 OR K0510D2 1 8 Resident has one or more unhealed pressure ulcer s at Stage 2 or higher or one or more 4 1 6 likely pressure ulcers that are unstageable at this time as indicated by tO 4 41 M0300B1 gt 0 AND M0300B1 lt 9 OR M0300C1 gt 0 AND M0300C1 lt 9 OR M0300D1 gt 0 AND M0300D1 lt 9 OR M0300E1 gt 0 AND M0300E1 lt 9 OR M0300F1
20. days for an annual significant change in status or a significant correction to a prior full assessment m V0200B2 CAA Completion is the date of completion for comprehensive assessments and cannot be earlier than ZO500A plantemoran com OPlante Moran Clinical Group 2013 46 614 222 9020 OBRA MDS 3 0 Timing m VO200C1 signature of person facilitating care planning decision making Person signing does not have to be an RN m V0200C2 date on which staff person completed care plan decision column m Care plan must be completed within 7 days of the completion date V0200B2 of assessment MDS and CAAs V0200B2 7 days V0200C2 m Date at V0200C2 times transmission for comprehensive assessments must be sent within 14 days of V0200C2 VO200C2 14 days plantemoran com Care Planning m Good assessment forms the solid basis m CAAs are the link between the MDS and care plan m Plan of care is driven by resident problems strengths needs preferences and choices m Care plan by IDT m Answer the so what now question m No required format or structure plantemoran com OPlante Moran Clinical Group 2013 47 614 222 9020 Care Planning m Must have measurable goals and time tables m Goals should have a subject verb modifier and time frame m Mr B will eat 75 of 2 meals daily within the next 3 months m Approaches should identity what staff are to do and when they are to do it m Dietary to discuss with Mr
21. dent care plan m Location and date of CAA information m Reflects the IDT and resident s decisions on which triggered conditions will be addressed in the care plan plantemoran com V0O200A Column A Care Area Triggered m Facility uses the RAI triggering mechanism to determine which problem care areas require review and additional assessment m Triggered care areas are checked in Column A plantemoran com Plante Moran Clinical Group 2013 44 614 222 9020 VOZOOA Column B Care Plan Coding m Check Column B to indicate a decision to develop a new care plan revise a care plan or continue a current care plan to address the problem s identified Must be completed within 7 days of completing the RAI plantemoran com vV0200 Location and Date of CAA Information m Indicates date and location of the CAA documentation plantemoran com Plante Moran Clinical Group 2013 45 614 222 9020 LLL identifier Section V Care Area Assessment CAA Summa f i He li i i i W l o 2000 TRAP Tl VIT 0 lr i l Ee B M i EN oran C J MDS 3 0 Nursing Home Comprehensive NC Version 1 10 4 Effective 04 01 2012 OBRA MDS 3 0 Timing m V0200B1 Signature of RN coordinating the CAA process m V0200B2 Date that RN certifies that CAAs have been completed The CAAs must be reviewed and completed no later than the 14 day of admission admission date 13 calendar days and ARD 14
22. eview of Indicators 1 For any triggered care area s conduct a thorough assessment using care area specific resources Checkthe box in the left column if the item is present for resident Some of this information will be on the MDS some will not In the right column next to each checked item provide supporting documentation regarding the basis or reason for checking the item including the location and date of that information symptoms possible causal and contributing factor s for that item plantemoran com Care Area Review of Indicators 4 Obtain and consider input from resident and or family resident s representative regarding the care area Analyze findings in the context of their relationship to the care area Include a review of indicators and supporting documentation including symptoms and causal and contributing factors related to the care area Draw conclusions about the causal contributing factors and effect s on the resident s functional ability and document this information in Analysis of Findings section plantemoran com OPlante Moran Clinical Group 2013 41 614 222 9020 Care Area Review of Indicators Decide whether referral to other health professionals Is warranted and document decision In Care Plan Considerations section document if care plan will be developed and reason s why or why not Transfer information regarding the CAA to the CAA summary Section V of the MDS plantemoran com CM
23. ints of difficulty or pain with swallowing Z None of the above m Do NOT code a swallowing problem if interventions have been successful in treating the problem the Intervention is successful plantemoran com 31 Section KO200A Height m Base height on the most recent height since the most recent admission entry or reentry Measure and record height in inches m Measure height consistently over time in accordance with the facility policy and procedure which should reflect current standards of practice shoes off etc m For future assessments check medical record If the last height recorded was 1 year ago measure and record the resident s height again m Record height to the nearest whole inch amp Use mathematical rounding plantemoran com OPlante Moran Clinical Group 2013 16 614 222 9020 Section KO200B Weight Base weight on the most recent measure in the last 30 days Measure weight consistently over time using facility policy and procedure reflecting current standards of practice shoes off etc For future assessments check the medical record and enter the weight taken within 30 days of the ARD of this assessment If last recorded weight was taken than 30 days prior to the ARD of this assessment or previous weight is not available weigh the resident again If the resident s weight was taken more than once during the preceding month record the most recent weight Use mathematical rounding and
24. l A0310A 03 e ARD no later than ARD of previous comprehensive 366 days AND ARD of previous quarterly 92 days e MDS completion date Z0500B and CAAs completion date VO200B2 ARD 14 days e Care plan completion date V0200C2 CAAs completion 7 days e Submission care plan completion date 14 days plantemoran com Comprehensive Assessments m Significant change in status SCSA A0310A 04 e ARD no later than 14 day after determination e MDS completion date Z0500B and CAAs completion date V0200B2 no later than 14 day after determination ARD 14 days Care plan completion date CAAs completion date t 7 days Submission care plan completion 14 days plantemoran com OPlante Moran Clinical Group 2013 10 614 222 9020 Scheduled PPS Schedule I al the ARD must be set 5 day 14 day 30 day 60 day 90 day 02 03 04 05 13 14 Za OS 94 SE 87 89 I Ve 30 33 60 63 90 93 1 thru 14 15 thru 30 31 thru 60 61 thru 90 91 thru 100 plantemoran com Change of Therapy COT Assessment OPTION page 2 51 m COT has a rolling seven 7 day observation once a therapy RUG has been established and is required when the RUG category for rehab or rehab with extensive services will change for billing purposes EXCEPT m lf day seven 7 of the COT observation period falls within the ARD window of a scheduled PPS assessment the SNF may choose to complete the PP
25. ndards of practice such as evidence based or expert endorsed research clinical practice guidelines and resources When applying these evidence based resources to practice the use of sound clinical problem solving and decision making critical thinking skills is imperative plantemoran com Conducting the Assessment Step 1 Identify the trigger m Usually a sign symptom or other indicator of possible problem need or strength Example Weight loss loss of 5 or more in the last month or loss of 10 or more in last 6 months plantemoran com OPlante Moran Clinical Group 2013 34 614 222 9020 Conducting the Assessment Step 2 Identify the triggered Care Area Example 1 or 2 YES on physician prescribed weight loss regimen or YES not on physician prescribed weight loss regimen K0300 1 or 2 triggers Nutritional Status care area plantemoran com Conducting the Assessment Step 3 Conduct thorough assessment of the entire Care Area m Include factors that could cause or contribute to the symptom m Include factors for which the symptom places the resident at risk Some factors will be on the MDS many will not plantemoran com Plante Moran Clinical Group 2013 35 614 222 9020 Conducting the Assessment Tools Requirement m Must be current evidence based or expert endorsed research and clinical practice guidelines resources m The facility should be able to identity the resources
26. resident whose weight drops from 160 to 152 pounds or less has experienced 5 or more weight loss m Multiply previous weight by 0 90 to determine resident weight after 10 weight loss m Example 160 pounds X 0 90 144 pounds A resident whose weight drops from 160 to 144 pounds or less has experienced 10 or more weight loss plantemoran com OPlante Moran Clinical Group 2013 18 614 222 9020 Definitions m Physician Prescribed Weight Loss Regimen a weight reduction plan ordered by the resident s physician with the care plan goal of weight reduction May employ a calorie restricted diet or other weight loss diets and exercise Also includes planned diuresis It is important that weight loss is intentional m Body Mass Index BMI a number calculated from a person s weight and height used as a screening tool to identify possible weight problems for adults plantemoran com Code weight loss based on whether it was planned managed or unplanned unmanaged K0300 Weight Loss Loss of 5 or more in the last month or loss of 10 or more in last 6 months 0 No or unknown 1 Yes on physician prescribed weight loss regimen 2 Yes not on physician prescribed weight loss regimen Enter Code plantemoran com OPlante Moran Clinical Group 2013 19 614 222 9020 Section K Swallowing and Nutritional Status m KO310 Weight Gain m Item compares the resident s weight in the current observation period with his or her weight
27. services for each resident and to modify the care plan and care services COT OW based on the resident s status plantemoran com Right Forms and Manual m All Item Sets must indicate the correct version 1 10 4 and date 04 01 2012 MDS 3 0 Nursing Home Comprehensive NC Version 1 10 4 Effective 04 01 2012 m Long Term Care Facility Resident Assessment Instrument User s Manual May 2013 v1 10 https www cms gov NursingHomeQualitylnits445 NHQIM DS30TrainingMaterials asp TopOiPage m More updates expected in late summer for 10 01 13 plantemoran com OPlante Moran Clinical Group 2013 3 614 222 9020 RAI Process Purpose A m To promote the highest practicable level of functioning for a resident through an assessment of triggered care areas m To understand the causes and contributing factors of identified problems m Development of resident specific care plan based on identified problems needs strengths plantemoran com The Overall RAI Framework Minimum Data Set MDS Care Area Assessments CAAs Utilization Guidelines Care plan Comprehensive Assessment plantemoran com Plante Moran Clinical Group 2013 4 614 222 9020 RAI Philosophy Problem Solving Decision making Assessment MDS other Problem identification CAAs other Care Plan l Implementation Care Plan i Development Evaluation plantemoran com RAI Process Components Minim
28. ssible impact on specific issues and or conditions or the risk of issues and or conditions plantemoran com Plante Moran Clinical Group 2013 32 614 222 9020 CAA Process m Triggered items may or may not represent a condition that should or will be addressed in the care plan m Significance and causes of any given trigger may vary for different residents or in different situations for the same resident m Different CATs may have common causes or various items associated with several CATs may be connected plantemoran com CAA Process m Indicate care area needs to be assessed more completely prior to making care planning decisions m Triggered care area assessment may identify causes risk factors and complications associated with the care area condition m Plan of care addresses these factors with the goal of promoting the resident s highest practicable level of functioning 1 improvement where possible or 2 maintenance and prevention of avoidable declines m A risk factor increases the chances of having a negative outcome or complication plantemoran com OPlante Moran Clinical Group 2013 33 614 222 9020 Care Area Assessment m No specific tool mandated for completing the further assessment of the triggered areas m No specific guidance on how to understand or interpret the triggered areas m Instead facilities are instructed to identify and use tools that are current and grounded in current clinical sta
29. ten documentation of the CAA findings and decision making process may appear anywhere in resident s record m No particular location or format is required m Section V indicates Location and Date of CAA documentation related to decision making plantemoran com OPlante Moran Clinical Group 2013 39 614 222 9020 CAA Documentation m Helps explain basis for care plan by showing how the IDT determined that the underlying causes contributing factors and risk factors were related to the care area condition for a specific resident m Indicate basis for decisions why the findings require an intervention and the rationale for selecting specific interventions lt plantemoran com CAA Documentation Popular Format m Checklist with summary analysis CMS s RAI Version 3 0 Manual pene C CAA Resour Nutritional Status 12 NUTRITIONAL STATUS Supporting Wu Rap EL Current cating pattern resident lea Basis r for checking the rpe ificant proportion of meals snacks md including the location date soled source e if sup able Poole ffered or available is not consisten atin tauandion tent with the resident s food choices needs pref Resident has allergies or food intolerance for example needs lactose free Food not congruent with religious or cultural needs Resident t complains about food quality o plantemoran com OPlante Moran Clinical Group 2013 40 614 222 9020 Care Area R
30. they use upon request m Requirement is consistent with F492 services must meet professional standard of quality plantemoran com Appendix C Resources m Staff should follow their facility s chosen protocol or policy for performing the CAA m Resources provided in Appendix C are not mandated m CMS does not endorse the use of any particular resource s including those in Appendix C m Resources selected may be used outside of RAI process also plantemoran com OPlante Moran Clinical Group 2013 36 614 222 9020 Conducting the Assessment Tools Option 1 m Review of Indicators for each care area provided in Appendix C m Each provides a checklist of indicators that guides the assessment for the particular care area m Also provides location and guidelines for documentation plantemoran com Conducting the Assessment Tools Option 2 m Appendix C also offers a list of resources that may be used for this purpose m May be accessed online or through professional associations or other organizations m Not an exhaustive list providers are free to use others that meet regulatory requirement plantemoran com 614 222 9020 OPlante Moran Clinical Group 2013 37 Other Care Area General Resources CMS s RAI Version 3 0 Manual Appendix C CAA R CARE AREA GENERAL RESOURCES eneral resources contained on this s page are not speci ific to any icular care area Instead they prov vide a rm quy listing of known clinical
31. um Data Set MDS Core set of standardized screening clinical physical functional and psychosocial status items that form the foundation of the comprehensive functional status assessment plantemoran com Plante Moran Clinical Group 2013 5 614 222 9020 RAI Process Components Care Area Triggers CATs m MDS answer options that provide clues to possible problems needs strengths in any of the 20 specific care areas i e delirium nutrition mood pain plantemoran com RAI Process Components Care Area Assessments CAAs MDS is not a complete assessment it Is a screening tool m Further assessment of entire triggered care area is required using sound clinical problem solving and decision making skills to be able to draw conclusions about problems needs and strengths plantemoran com OPlante Moran Clinical Group 2013 6 614 222 9020 RAI Process Components Utilization Guidelines m Provide instructions for when and how to use RAI m Include instructions for completion of RAI as well as structure frameworks for synthesizing MDS and other clinical information m https www cms gov manuals downloads som107ap pp guidelines ltcf pdf CMS gov Centers for Medicare amp Medicaid Services plantemoran com RAI Process Components oix General Care Planning Areas 1 Functional status Rehabilitation restorative nursing Recipe ae Discharge potential The how to for mE achieving the OBRA
32. wheat free diet to prevent allergic dermatitis high calorie diet with added supplementation to prevent skin breakdown high protein supplementation for wound healing plantemoran com OPlante Moran Clinical Group 2013 26 614 222 9020 More M1200D m M1200D Nutrition or Hydration Interventions to Manage Skin Problems m Provides additional instruction and enhanced examples Goal to illustrate that the use of vitamins and mineral supplements are utilized only if nutritional deficiencies have been confirmed or suspected through thorough assessment not automatically implemented m Additional supplementation is not automatically required for pressure ulcer management Any interventions should be specifically tailored to the resident s needs condition and prognosis plantemoran com RAI Process Components CAA Summary Section V m Provides location for documentation of triggered care areas and decisions whether to proceed to care planning or not plantemoran com Plante Moran Clinical Group 2013 27 614 222 9020 V0200A CAA Results Location and Date of CAA documentation Use Location and Date of CAA documentation column to note where CAA information and decision making documentation can be found in the medical record In the column Care Planning Decision mark whether the triggered care area is addressed in the care plan plantemoran com What are the CAAs m CAA process framework Guides the
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