Long-term Providers Get Look at New Assessment Tool

MacKenzie Kimball, for HealthLeaders Media , December 10, 2009

The Center for Medicare & Medicaid Services (CMS) recently released chapters 1, 3, and 5 and appendices A through H of the new Resident Assessment Instrument (RAI) User's Manual for the Minimum Data Set (MDS) 3.0, giving long-term care providers insight into how to code the new assessment tool.

There are many changes included in the already released chapters of the new RAI User's Manual, such as modified language, different item labeling, and changes to coding instructions for the MDS 3.0, which will be implemented in October 2010.

"There are some hidden nuggets in these chapters that, on first reading, may go over people's heads," says Rena R. Shephard, MHA, RN, RAC-MT, C-NE, founding chair and executive editor of the American Association of Nurse Assessment Coordinators and president of RRS Healthcare Consulting Services in San Diego. "For example, you can use preadmission information when coding ADLs [activities of daily living] on the MDS 2.0, but this will not be true with the MDS 3.0. There are only a few sections on the new assessment in which you can look back into the preadmission period and there is not a big red flag that says ‘Notice this' but it does say this on p. 3-3 of the new manual."

ADL coding is an area of high interest in long-term care and although the methodology won't really change under the MDS 3.0, the manual contains some significant changes to some of the details of ADL coding. "For example, facilities will only be able to use the information collected by staff, not family or visitors," Shephard says. "There is an ADL coding flow diagram on p. G-6, and it will be very important for people to use this because it will help them code ADLs more accurately on the MDS 3.0."

Another notable change included in the new RAI User's Manual is that, under the MDS 3.0, facilities will only have 14 days to transmit the assessment, rather than the 31 days allowed under the MDS 2.0.

Chapters 2, 4, and 6, and Appendix C of the new RAI User's Manual are scheduled to be released this month.

"I think it is good that CMS released the manual in sections because it gives people time to digest the item-by-item coding of each section before trying to wrap their heads around the changes included in other chapters," Shephard says. "There will be enough changes to Chapters 2, 4, and 6, in terms of timing and scheduling of assessments, Care Area Assessments, and Resource Utilization Group–Version IV, and releasing chapters at different dates helps to not overwhelm everyone with all the changes at once."

MacKenzie Kimball is an associate editor in the long-term care market at HCPro. She writes PPS Alert for Long-term Care and manages MDSCentral.

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