304

Part III Standards for Compliance

TABLE 21.1 Federally Mandated Assessments Type of Assessment

Admission (Initial) Assess- ment (Comprehensive)

Annual Reassessment (Com- prehensive)

Significant Change in Status Reassessment (Comprehen- sive)

Quarterly Assessment (state- mandated subset or MPAF)

Timing of Assessment

Must be completed (VB2) by the 14th day of the resident’s stay

Must be completed (VB2) within 366 days of the most recent compre- hensive assessment

Must be completed (VB2) by the end of the 14th calendar day follow- ing determination that a significant change has occurred

Set of MDS items, mandated by state (contains at least CMS- established subset of MDS items)

Must be completed every 92 days

Significant Correction of a Prior Full Assessment

Significant Correction of a Prior Quarterly Assessment

Completed (VB2) no later than 14 days following determination that a significant error in a prior full as- sessment has occurred

Completed (R2b) no later than 14 days following determination that a significant error in a prior quarterly assessment has occurred

42 CFr 483.20/F287

Regulatory Requirement CMS F-Tag 42 CFr 483.20(b)(4)(i)/F273

42 CFr 483.20(b)(4)(v)/F275 42 CFr 483.20(b)(4)(iv)/F274

42 CFr 483.20(b)(5)/F276

42 CFr 483.20/F287

Source: Centers for Medicare & Medicaid Services. MDS 3.0 RAI Manual v1.13. www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html. Accessed October 14, 2015.

diet, food intake, weights, and eating ability are coded accurately to ensure appropriate reimbursement. Section K of the MDS, “Swallowing/Nutritional Status,” is specific to nutrition services. However, there is information throughout the MDS that may be rele- vant for the RDN to aid in further analyzing the resi- dent’s condition. Table 21.2 (see pages 320–321) is the item-by-item MDS guide for the RDN that summarizes the different types of assessments that are federally mandated and explains the RAI assessment, care plan- ning, and transmission schedules.

Beginning in 1998, Medicare reimbursement under the Prospective Payment System (PPS) for extended care facilities moved from a reimbursement system based on self-reported costs to one that imposes fixed rates of reimbursement on the facility. Rates are set based on CMS’s Resource Utilization Groups (RUGs). The RUG-IV classification has eight major classification categories, including areas with

nutrition compromising components. This requires that the RDN stay informed about the most effective reimbursement for the resident. Scheduled Medicare PPS Assessments can be found in Table 21.3 with Unscheduled Medicare PPS Assessments located in Box 21.1 and Expected Orders of MDS Records in Table 21.4 (see page 322). All of these will be import- ant to the RDN’s understanding of this complex process.

Other forms and tables may be found in CMS’s

RAI Version 3.0 Manual, Chapter 2: “Assessments for the RAI” (www.cms.gov/Medicare/Quality-Initiatives- Patient-Assessment-Instruments/NursingHomeQuality Inits/MDS30RAIManual.html).

CARE AREA ASSESSMENT The CAA process is designed to assist in reviewing and interpreting the information from the MDS in order to develop an individualized care plan, if necessary (8).