United States

Senior Living Health Care Connection: Minimum data set changes

SENIOR LIVING HEALTH CARE CONNECTION  | 

Based on the fiscal year (FY) 2019 skilled nursing facility (SNF) prospective payment system (PPS) proposed rule, the minimum data set (MDS) will have significant changes to various sections and providers should start preparing now for them. Section A will reflect the change to the newly formatted Medicare beneficiary indicator (MBI) in A0600B. Sections GG (functional abilities and goals), I (active diagnoses), J (health conditions), K (swallowing and nutritional status), M (skin conditions), O (special treatments, procedures and programs) and N (medications) are the sections that have the most significant changes. While there are approximately 106 changes to the MDS, most changes are simple grammar corrections and clarifications. Below are highlights of the changes:

Section M0300E – adds the word “devices” to non-removable dressing/devices and “injuries” to pressure ulcers/injuries.

Section GG (functional abilities and goals) – includes changes that will allow reporting on the SNF quality reporting requirements, quality reporting program (QRP) and the new QRP quality measures:

  • Section GG0130 – adds a new reason code “10” if the activity was “Not attempted due to environmental limitations (lack of equipment, weather constraints).” This was put in place to address the issue of “car transfer” that is added to Section GG also.
  • Section GG0100 – includes a new item “prior functioning.” This item refers to a resident’s usual ability with everyday activities prior to the current illness, exacerbation or injury:
    • A. Self-care
    • B. Indoor mobility
    • C. Stairs
    • D. Functional cognition
    • E. Shower/bathe self
    • F. Upper body dressing
    • G. Lower body dressing
    • H. Putting on/taking off footwear
  • Coding for GG0100 includes: (note the new scale of measurement)
    • 3. Independent
    • 2. Needed some help
    • 1. Dependent
    • 8. Unknown
    • 9. Not applicable
  • Section GG0110 – new item “prior device use”  
    • A. Manual wheelchair
    • B. Motorized wheelchair and/or scooter
    • C. Mechanical lift
    • D. Walker
    • E. Orthotics/prosthetics
    • Z. None of the above
  • Section GG0170 – mobility section includes eight new items:
    • A. Roll left and right
    • G. Car transfer
    • I. Walk 10 feet
    • L. Walking 10 feet on uneven surfaces
    • M. 1 step (curb)
    • N. 4 steps
    • O. 12 steps
    • P. Picking up object

Section I - I0020 and I0020A – includes new Items that indicate the patient’s primary medical condition, and the primary reason for admission.

Section J – J2000 – includes new item “prior surgery”: major surgery during 100 days prior to the SNF admission.

Section N – N2001 and N2005 drug regimen review

  • N2001 – change in the “drug regimen review” section includes: “Did a complete drug regimen review identify potential clinically significant medication issues?” No, Yes or NA.
  • N2003 – change in the “medication follow-up” section includes: “Did the facility contact a physician (or designee) by midnight of the next calendar day and complete prescribed/recommended actions in response to the identified potential significant medication issues?” No or Yes
  • N2005 – change in the “medication intervention” section includes: “Did the facility contact and complete physician (or designee) prescribed recommended actions by midnight of the next calendar day each time potential clinically significant medication issues were identified since admission?” No, Yes or NA.

These items will affect the quality measures in FY 2019 and beyond. Completing these items correctly and timely will affect reimbursement for years. The 2 percent sequestration and value-based purchasing will also affect the payments beginning with Oct. 1, 2018 service dates. 

Questions? Contact Joan McCarthy at +1 312 634 3479.

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