CMS Posts MDS 3.0 RAI Manual Revisions
Author: Suzy Harvey
On February 5, 2015, the Centers for Medicare & Medicaid Services (CMS) posted an Errata Document of revisions to the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual on the Nursing Home Quality Initiative website. The document contains revisions to pages in Chapter 2 and Chapter 3 of Section A of the RAI Manual. The majority of revisions concern and clarify MDS Items A1600, A1700, A1800 and A1900.
The document includes formatting changes and deleted references to the Medicare Readmission/return assessment and corrected items to match verbiage on the MDS assessment form overlooked on the last RAI manual update in October 2014.
Revisions were made to pages 2-7 and 2-10 to clarify which situations require the completion of an admission assessment and match coding instructions for item A1700, Type of Entry, of the MDS. Both items (Admission Definition and Admission Assessment) were updated to no longer include the phrase “when the resident has been in this facility previously and was discharged prior to completion of the OBRA Admission assessment.”
Many of the revisions in this document are found in Chapter 3, Section A, including examples and coding tips for coding item A1900, Admission Date, and how the coding of Item A1900 relates to items A1600, Entry Date, A1700 and A1800, Entered From.
Due to lack of guidance in the RAI manual, A1900 coding has led to confusion and concern within the provider community since added to the MDS assessment October 1, 2014. A1900 should reflect the original admission date or the date the resident’s episode of care in the facility began. With the revision, providers will better understand how this item is tied to the concept of “stay” and “episode of care.” Under the fifth bullet on page A-26 of the revision, the following definitions were provided:
- “Stay” is defined as a set of contiguous days in the facility.
- “Episode of care” is defined as a series of one or more stays that may be separated by brief interruptions in the resident’s time in the facility. An episode continues across stays until one of three events occurs:
- The resident is discharged with no return anticipated
- The resident is discharged with return anticipated but does not return within 30 days
- The resident dies in the facility
The RAI manual now offers four new examples to illustrate the coding of items A1600, A1700, A1800 and A1900.
CMS has scheduled a SNF Open Door Forum for February 12, 2015; the Errata Document is on the agenda. SNF providers should review the MDS 3.0 RAI manual revisions carefully. If you have any questions or concerns, contact your BKD advisor.